Your Path to Swift Recovery after Semaglutide/GLP1RA Treatment!
Are you one of the brave individuals who have undergone Semaglutide treatment to manage your health condition? Congratulations on taking that important step towards a healthier future! We understand that recovering from such a transformative experience can sometimes be challenging. That's why we've developed the “Tide IV”, designed specifically to support your recovery journey after Semaglutide. Our dedicated team of healthcare experts have meticulously crafted the Tide IV to optimize your well-being and help you bounce back to the top of the tide after feeling as if you were pummeled to the bottom by the common side effects of GLP1RA/Semaglutide therapy.
Tailored Nutritional Boost: Semaglutide treatment can have a profound impact on your body's nutritional balance. The Tide IV is packed with a customized blend of essential vitamins, minerals, and nutrients specifically formulated to replenish your system, restore vitality, and accelerate recovery. We also have pharmaceutical options to control nausea and vomiting, the same ones you’d receive in the ER, for a fraction of the cost.
When vomiting and diarrhea occur, the body loses fluids and important electrolytes, which are essential for proper bodily functions. Electrolytes are minerals that carry an electric charge when dissolved in bodily fluids like blood and other bodily fluids. They play a crucial role in maintaining the balance of fluids inside and outside cells, regulating muscle contractions, transmitting nerve impulses, and supporting various biochemical processes.
Hydration Reinforcement: Staying hydrated is vital for a smooth recovery process. If you've been experiencing any nausea, vomiting, diarrhea or constipation, you will likely benefit from intravenous hydration.
Electrolyte Replacement: The electrolytes most commonly affected by vomiting and diarrhea in which are treated in the “Tide IV” include:
Sodium (Na+): Sodium helps maintain fluid balance and is important for nerve and muscle function. Vomiting and diarrhea can lead to excessive loss of sodium, resulting in a condition called hyponatremia, characterized by low sodium levels in the blood. Symptoms may include fatigue, weakness, headache, muscle cramps, and in severe cases, confusion and seizures.
Potassium (K+): Potassium is essential for maintaining proper heart and muscle function, nerve transmission, and fluid balance. Vomiting and diarrhea can cause potassium depletion, leading to a condition known as hypokalemia. Symptoms may include muscle weakness, fatigue, irregular heart rhythms, and, in severe cases, paralysis.
Chloride (Cl-): Chloride works together with sodium to maintain fluid balance and helps in the production of stomach acid. Vomiting and diarrhea can result in chloride loss, contributing to electrolyte imbalances.
Magnesium (Mg2+): Magnesium is involved in numerous biochemical reactions in the body, including muscle and nerve function, protein synthesis, and energy production. Vomiting and diarrhea can lead to magnesium deficiency, causing symptoms such as muscle cramps, tremors, weakness, and cardiac arrhythmias.
It is important to note that the severity of electrolyte imbalances can vary depending on the frequency and duration of vomiting and diarrhea, as well as the underlying cause. Dehydration resulting from these conditions can exacerbate electrolyte disturbances, potentially leading to more severe symptoms and complications.
Digestive Health: Whether it be diarrhea or constipation, we have you covered. Customizable ingredients ranging from specific vitamins/minerals/electrolytes to support GI health to the same pharmaceuticals you would receive in the ER!
Enhanced Digestive Enzyme Production: production of digestive enzymes, including amylase, lipase, and protease. These enzymes aid in breaking down carbohydrates, fats, and proteins in the food we consume, facilitating efficient digestion and absorption. When digestion is improved, it can help prevent or alleviate constipation.
Improved Bowel Movements: assists in maintaining the integrity of the gut lining and promoting proper muscle contractions in the intestines. This can help to regulate bowel movements, preventing constipation or easing its symptoms.
Stress Relief: Excessive stress or anxiety can disrupt normal digestive function and contribute to constipation by producing more cortisol, the stress hormone. By helping to regulate stress levels,it may indirectly support a healthy digestive system and alleviate constipation caused by stress.
Antiemetics: To improve/resolve any nausea related to GLP1-RA therapy
Energy Restoration: Fatigue can be a common side effect of Semaglutide treatment. Our IV infusion is specially formulated to provide a natural energy boost, rejuvenating your body and mind, and helping you regain your vitality with 5,000 mcg of B12!
Don't let the recovery process hinder your journey to wellness after Semaglutide. Take advantage of the “Tide Recovery IV” and expedite your recovery so you can be on the path of living “your best life”
Studies / Evidence:
Vitamins: B complex, Dexpanthenol (B5), Pyridoxine (B6)
Electrolytes/Minerals: Magnesium, Calcium, Potassium
Pharmaceuticals: Diphenhydramine, Metoclopramide, Promethazine, Prochlorperazine, Ondansetron, Dexamethasone
(Ingredients are flexible, per provider discretion pertaining to each patient/customizable)
Vitamins: B complex, B5, B6
Dexpanthenol (B5):
B5, also known as vitamin B5 or pantothenic acid, plays an important role in supporting various bodily functions, including digestive health. While B5 itself does not directly alleviate constipation, it can indirectly contribute to relieving constipation by promoting optimal digestive system function. Here's how B5 may help with constipation:
Enhanced Digestive Enzyme Production: Vitamin B5 is involved in the production of digestive enzymes, including amylase, lipase, and protease. These enzymes aid in breaking down carbohydrates, fats, and proteins in the food we consume, facilitating efficient digestion and absorption. When digestion is improved, it can help prevent or alleviate constipation.
Improved Bowel Movements: B5 is known to support the overall health of the gastrointestinal tract. It assists in maintaining the integrity of the gut lining and promoting proper muscle contractions in the intestines. This can help to regulate bowel movements, preventing constipation or easing its symptoms.
Stress Relief: Pantothenic acid is also involved in the production of stress hormones, such as cortisol. Excessive stress or anxiety can disrupt normal digestive function and contribute to constipation. By helping to regulate stress levels, B5 may indirectly support a healthy digestive system and alleviate constipation caused by stress.
It's worth noting that while B5 can play a role in promoting digestive health, it's typically not used as a standalone treatment for constipation. A well-rounded approach to relieving constipation may include a combination of dietary modifications, increased fiber intake, hydration, regular exercise, and possibly the use of pharmaceuticals.
Treatment of constipation with vitamin B5 or dexpanthenol
Dexpanthenol (Ro 01-4709) in the treatment of constipation
The potential role of B5: A stitch in time and switch in cytokine
Pantothenic acid (vitamin B5) efficiency on wound healing
A pilot study of the effect of pantothenic acid in the treatment of post-operative ileus: results from an orthopedic surgical department. 2012;163(3):e121-6.
G Giraldi 1, E De Luca d'Alessandro, A Mannocci, V Vecchione, L Martinoli Affiliations expandPMID: 22964703
Abstract
Objectives: Post-operative ileus can also occur in other types of surgery not strictly related to abdomen. The objective of this study was to investigate the efficacy of pantothenic acid administration to stimulate intestinal peristalsis in case of post-operative ileus and estimate the most effective dose. This vitamin can be used for the treatment of chronic atonic intestine or for chronic constipation, but therapeutic indications are not precise in these conditions.
Patients and methods: This pilot study has used patients divided in groups treated in post-operative period with physiological solution for patients in control group (Placebo) and Dexpantenolo, which is a derivative in alcohol of pantothenic acid, for all the actively treated patients. The treatments were administered intravenously during the second and third post-operative day, according to the treatment schedule.
Results: 60 patients were recruited and they were allocated to five treatment groups or one control group. For males, the median time of the first bowel evacuation was 90 hours while for females the median time was 84 hours (p=0.891). For patients who received a spinal anesthetic, the median time was 72 hours, while for those who received a peridural anesthetic the median time was 96 hours (p=0.571). Between six treatment groups, instead, there is a significant difference between the median times from the operation to the first bowel evacuation (p<0.001). Linear regression model obtained using as outcome evacuation hours after surgery show that only variable which significantly affects time between operation and the first bowel evacuation is treatment dose (Beta = -0.868, p<0.001).
Discussion: This study would seem to indicate that pantothenic acid is effective for treatment of post-operative intestinal ileus; there is a dose response relationship between pantothenic acid and the decreasing time from surgical operation to first bowel evacuation. However, this study is preliminary; further studies are necessary, preferably randomized and with a larger number of patients.
Electrolytes: Magnesium/ Potassium/ Calcium
Basic knowledge of electrolyte balance /stability is very well established; if actual evidence is desired, please feel free to inquire and we will assist you in finding materials.
Nausea and vomiting
Commonly used antiemetics and categories include:
5HT receptor antagonists (eg, ondansetron)
Dexamethasone
Scopolamine transdermal
Neurokinin receptor antagonists (eg, aprepitant)
Antihistamines (eg, dimenhydrinate or diphenhydramine)
Antidopaminergics (eg, haloperidol)
When more than 1 antiemetic is administered, drugs from different classes should be chosen as the beneficial effects of antiemetics that act on different receptors are additive.
Nausea and Vomiting Treatment Recommendations (IV/IM only; Detailed Version)
Gastroparesis:
Prokinetics — Pharmacologic therapy is necessary for patients who continue to have symptoms of gastroparesis despite dietary modification. Prokinetics increase the rate of gastric emptying and should be administered 10 to 15 minutes before meals with an additional dose before bedtime in patients with persistent symptoms. As compared with tablets, liquid formulations allow for easier dose titration and are less likely to accumulate in the stomach and cause erratic absorption
Metoclopramide PO (also available in liquid form)/IV/IM/SQ: Titrate to lowest effective dose
PO: 5-10 mg TID or QID PRN nausea/vomiting (5 minutes before meals and at bedtime)
IV/IM/SQ:5-10 mg TID PRN nausea/vomiting (5 minutes before meals and at bedtime)
Metoclopramide is first-line therapy for gastroparesis ;Metoclopramide, a dopamine 2 receptor antagonist, a 5-HT4 agonist, and a weak 5-HT3 receptor antagonist, improves gastric emptying by enhancing gastric antral contractions and decreasing postprandial fundus relaxation. Metoclopramide is approved by the US Food and Drug Administration (FDA) for treatment of gastroparesis for no longer than 12 weeks unless patients have a therapeutic benefit that outweighs the risks.
The side effects associated with metoclopramide include central side effects of anxiety, restlessness, and depression, hyperprolactinemia, and QT interval prolongation.
Extrapyramidal side effects, including dystonia in 0.2 percent of patients and tardive dyskinesia in 1 percent of patients, have led to a black box warning. In one observational study that included 479 reports of extrapyramidal side effects associated with metoclopramide, while acute dystonias were more likely in children and young adults and in females, parkinsonian reactions were more likely in older adults.
It is important to inform patients of the side effects and to obtain written informed consent before treating patients with metoclopramide. We initiate treatment with a low-dose liquid formulation (eg, 5 mg, 15 minutes before meals and at bedtime), titrating up to identify the lowest effective dose. Many patients can tolerate treatment with up to 40 mg of oral metoclopramide per day, in divided doses, without significant adverse effects. "Drug holidays" or dose reductions (eg, 5 mg, before two main meals of the day) should be implemented whenever clinically possible.
It is recommended to review these patients every three months to assess medication efficacy and adverse events, before repeat prescription. A drug holiday of two weeks between prescriptions helps to ensure that the patient is really benefiting from the medication, as evidenced by recurrence of gastroparesis symptoms, or inability to tolerate solid or calorie-rich foods. If patients remain asymptomatic while off metoclopramide, the length of the drug holiday is then prolonged.
If continued symptoms:
Domperidone 10 mg PO TID before meals
Domperidone is an alternative to metoclopramide in patients with gastroparesis. However, domperidone, a dopamine 2 antagonist, is not readily available in the United States but is available in Canada and in other countries.
If continued symptoms: PROCEED TO MACROLIDES OR ANTIEMETICS
Macrolide antibiotics
Erythromycin base; oral /liquid formulation, 40 to 250 mg three times daily before meals
Erythromycin, a motilin agonist, induces high-amplitude gastric propulsive contractions that increase gastric emptying.Erythromycin also stimulates fundic contractility, or at least inhibits the accommodation response of the proximal stomach after food ingestion.Patients who fail to respond to a trial of metoclopramide should be treated with oral erythromycin.
Oral erythromycin should be administered for no longer than four weeks at a time, as the effect of erythromycin decreases due to tachyphylaxis. Use of higher doses (eg, 250 mg, compared with 40 mg) may be more likely to cause abdominal pain or induce tachyphylaxis. Chronic administration of oral erythromycin should be restricted to patients who have failed to respond to other prokinetics and who continue to demonstrate an improvement in symptoms over baseline and tolerance of oral feeding. Intravenous erythromycin should be reserved for acute exacerbations of gastroparesis in which oral intake is not tolerated.
Tachyphylaxis to erythromycin and potential side effects limit its use in the management of gastroparesis. Side effects of erythromycin include gastrointestinal toxicity, ototoxicity, the induction of resistant bacterial strains, QT prolongation, and sudden death, particularly when used in patients taking medications that inhibit CYP3A4
Antiemetics — We treat patients with persistent nausea and vomiting despite prokinetics with
-Antihistamines
Diphenhydramine 12.5 mg PO/IV/IM Q 6-8 hrs PRN n+v
If continued symptoms:
5HT3 antagonists
Ondansetron 4 - 8 mg ODT TID PRN n+v
Antiemetics have not been studied in the management of patients with gastroparesis, and their use in gastroparesis is based on their efficacy in controlling nonspecific nausea and vomiting and in chemotherapy-induced emesis.
First generation 5-HT3 antagonists (eg, ondansetron, granisetron, and dolasetron) are associated with electrocardiographic (ECG) changes. While most changes are small and insignificant, fatal arrhythmias have been reported in association with prolonged QT intervals. ECG monitoring is recommended in patients on 5HT3 antagonists with hypokalemia, hypomagnesemia, heart failure, bradyarrhythmias, or patients taking concomitant medications that prolong the QT interval.
In contrast to phenothiazines, 5HT3 antagonists have not been associated with cognitive, psychomotor, or affective disturbances.
If continued symptoms:
Prolongation of the QT interval and central side effects have limited the use of phenothiazines
Prochlorperazine 5 to 10 mg PO TID PRN N+V three times daily
Prochlorperazine5 to 25 mg BID per rectum PRN N+V
***While antihistamines, phenothiazines, and 5T3 antagonists can all be administered orally and parenterally, only antihistamines and phenothiazines can be administered rectally.
Nausea and Vomiting: Gastroparesis Algorithm (Simplified Version)
Gastroparesis:
Metoclopramide PO (also available in liquid form)/IV/IM/SQ: Titrate to lowest effective dose
PO: 5-10 mg TID or QID PRN nausea/vomiting (5 minutes before meals and at bedtime)
IV/IM/SQ:5-10 mg TID PRN nausea/vomiting (5 minutes before meals and at bedtime)
If continued symptoms: PROCEED TO MACROLIDES OR ANTIEMETICS
Macrolide antibiotics
Erythromycin base; oral /liquid formulation, 40 to 250 mg three times daily before meals
Antiemetics — If n+v despite prokinetics-> tx with antihistamines or 5HT3 Antagonist
-Antihistamines
Diphenhydramine 12.5 mg PO/IV/IM Q 6-8 hrs PRN n+v
If continued symptoms:
5HT3 antagonists
Ondansetron 4 - 8 mg ODT TID PRN n+v
If continued symptoms:
Prochlorperazine 5 to 10 mg PO TID PRN N+V three times daily
Prochlorperazine5 to 25 mg BID per rectum PRN N+V
***While antihistamines, phenothiazines, and 5T3 antagonists can all be administered orally and parenterally, only antihistamines and phenothiazines can be administered rectally.