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29 Additionally, alcohol can trigger mast cell activation directly

The most frequently reported adverse effects are gastrointestinal and typically occur during treatment initiation or dose escalation: Nausea (very common): Usually mild to moderate and diminishing over time Diarrhoea (very common): Potentially contributing to dehydration Vomiting (common): Particularly during early treatment phases Constipation (common): Due to delayed gastric emptying Abdominal pain and dyspepsia (common): May affect eating and drinking patterns Decreased appetite (very common): A therapeutic effect that may inadvertently reduce fluid intake Other notable side effects include: Injection site reactions (erythema, pruritus, swelling) Fatigue and dizziness, which may be exacerbated by dehydration Hypoglycaemia, particularly when used with insulin or sulfonylureas (doses of these medications may need to be reduced when starting tirzepatide) Increased heart rate (modest elevation of 2-4 beats per minute) Gallbladder problems including gallstones and inflammation Potential worsening of diabetic retinopathy in patients with pre-existing disease According to NICE guidance , patients should be counselled about these expected side effects before initiating treatment

Ent2 complex was crystallized with a 2:1 (protein:precipitant) ratio in a 0.2 M lithium sulphate, 0.1 M Bis-Tris pH 5.5, 25%(w/v) PEG 3350 solution at 19C

The symptoms may be partly due to overactivity in the autonomic nervous system, which controls the motility and secretions of the gut and is very reactive to stress, including the stress of benzodiazepine withdrawal

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