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The case for stacking them rests on a single observation: the four receptor systems involved GLP-1, GIP, glucagon, and amylin are all non-overlapping

Hypoglycemia risk increases when Zepbound is used concomitantly with insulin or insulin secretagogues such as sulfonylureas

A patient might misread a concentration (confusing mcg with mg), draw from the wrong vial, or inject a full reconstituted vial instead of a fractional dose