Mounjaro in India: An Expert Breaks Down the Good, the Bad, and the Controversial

After months of mounting anticipation, Tirzepatide (Mounjaro) was finally launched in India in March by the US-based pharmaceutical giant Eli Lilly. The launch marks a significant milestone in a country where excitement around similar weight-loss drugs has been both intense and long-standing.It is arguably one of the most talked-about medications after the COVID-19 vaccine in recent years. Approved by the FDA in the US in May 2022 for type 2 diabetes and later in November 2023 for chronic weight management, Tirzepatide represents a major breakthrough in managing diabetes and obesity.The global impact of the molecule has been nothing short of remarkable. In 2024 alone, Tirzepatide generated around $10–12 billion globally. In fact, one key reason for its delayed arrival in India was an overwhelming international demand, which led manufacturers to prioritise established markets.Ozempic For Weight Loss: Why Is There a Shortage Of This Diabetes Drug?Tirzepatide's dual action makes it unique. The drug targets GLP-1 and GIP receptors and offers additional advantages over liraglutide and semaglutide, the other two internationally approved weight-loss drugs (Wegovy and Ozempic), which act only on GLP-1 receptors. The dual mechanism leads to weight loss of up to 22 percent , which is close to what bariatric surgery can achieve (typically 25–30 percent).To put things in perspective, older weight loss drugs usually offer around 5–8 percent reduction, although injectable semaglutide (Wegovy) comes close with 15 percent weight loss.Naturally, such dramatic results have stirred up debates.While some purists argue that lifestyle changes should be the only way to lose weight, others remain concerned about potential side effects. But the truth is, many people struggle with weight despite sincere efforts at diet and exercise. For them, this drug offers hope, and its arrival in India has been welcomed by many.It is also important to bust a common myth: India, a country still battling malnutrition in some regions, doesn’t need anti-obesity drugs. The data says otherwise. According to the National Family Health Survey-5 (2022), 23 percent of Indian women and 22.1 percent of men are overweight based on BMI, and up to 40 percent of women have abdominal obesity.This hidden epidemic increases the risk of diabetes, high blood pressure, heart disease, sleep apnea, and joint problems, often going unnoticed until it's too late.Until now, treatment options for obesity in India were limited to lifestyle changes and older drugs like Orlistat, which typically resulted in only modest benefits. While healthy habits remain the foundation, sustained weight loss through lifestyle alone is hard to maintain. The arrival of Tirzepatide and the upcoming launch of injectable semaglutide (Wegovy) could dramatically change how obesity is treated in India. Video | All Things Diabetes: An Expert Answers Your QueriesThe country’s anti-obesity market is projected to touch $2.6 billion, with these two drugs expected to dominate.And there is good reason for the buzz surrounding these drugs. These newer agents don’t just help with weight; they are also potent medicines to treat diabetes.In addition, they may offer protective benefits for the heart and liver. Tirzepatide has even been recently approved in the US for treating obstructive sleep apnea.That said, there are hurdles.Despite being about 80 percent cheaper than in the US, the drug may be out of reach for most Indians.Tirzepatide is priced at Rs 3,500 per 2.5 mg vial and Rs 4,375 per 5 mg vial, translating to Rs 14,000–Rs 17,500/month for standard weekly doses.Clinical trials show that the mean weight loss with the drug after 72 weeks was 15 percent with 5 mg, 19.5 percent with 10 mg, and 20.9 percent with 15 mg weekly doses.In contrast, the participants in the placebo arm of the trial, who received dietary and exercise-related counseling, lost just 3.1 percent.The higher doses of the drug are yet to be launched in India (as of April 2025), and currently, it is available only in vial form rather than a prefilled syringe, making it inconvenient to administer.Gastrointestinal side effects are quite common with Tirzepatide.In clinical trials, nausea was reported by 31 percent of participants, while constipation and diarrhoea affected up to 17 percent and 23 percent, respectively.Although most symptoms tend to be mild and settle over time, about 4–7 percent of individuals end up discontinuing the medication due to intolerance.What’s Your Poison? Decoding the Use of Snake Venom as a Recreational DrugTo minimise these issues, doctors usually start with a lower dose and gradually increase it, a strategy that helps the body adjust and minimise gastrointestinal side effects.A study published in 2024 tried to analyse the possibility of weight regain after discontinuing the medication.Participants regained around 14 percent of the weight they had lost within a year after stopping. However, those who continued the drug lost an additional 5.5 percent over the following year.So, the question of how long one needs to stay on treatment remains unanswered.The drug carries a boxed FDA warning for medullary thyroid cancer observed in animal studies, making it unsuitable for people with a personal or family history of this condition. While large multicenter trials did not consistently show a link with pancreatitis, it remains a potential risk. Rapid weight loss may also increase the likelihood of gallbladder issues, including gallstones and cholecystitis, which has been reported in about 0.6 percent of clinical trial participants.Ultimately, two golden rules in medicine continue to apply: we must always weigh the risks against the benefits and keep observing and learning as new data emerges.The currently available evidence favors the use of the newer anti-obesity medicines as an adjunct if diet and physical activity do not achieve or sustain sufficient weight loss. However, as with all new therapies, continued vigilance and open-minded studies are essential to ensure we help without harm.(Dr Saptarshi Bhattacharya is the Secretary of the Endocrine Society of Delhi, and a Senior Consultant in the Department of Endocrinology at Indraprastha Apollo Hospitals, New Delhi.)(The author would like to thank Dr Ambrish Mithal, Chairman and Head, Endocrinology and Diabetes, Max Healthcare for additional inputs on the article.)Food Trends: Surviving the Keto Diet – Or Not

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Mounjaro Is Here. Will It Change How India Treats Obesity?

Mounjaro can leads to weight loss of up to 22 percent, which is close to what bariatric surgery can achieve.

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