For Medspa Owners / Clinical Protocols

How to deliver care.

Intake screening, contraindication workup, dosing protocols, monitoring cadence, and liability-aware documentation for NP-led and MD-led GLP-1 programs.

Key Facts

4 weeks

Minimum titration interval between dose escalations.

1–2%/wk

Target weight-loss rate after first month. >2%/wk warrants dose hold.

3–6 mo

Standard lab recheck cadence for maintenance patients.

Intake & contraindication screening

Absolute contraindications to GLP-1 therapy: personal or family history of medullary thyroid carcinoma, Multiple Endocrine Neoplasia syndrome type 2, known hypersensitivity. Relative contraindications requiring careful evaluation: history of pancreatitis, severe gastroparesis, active gallbladder disease, pregnancy/breastfeeding, and type 1 diabetes. Diabetic retinopathy warrants ophthalmology clearance before rapid-onset weight loss.

Dosing protocols by medication

Wegovy (semaglutide 2.4mg): 0.25 → 0.5 → 1 → 1.7 → 2.4mg, 4 weeks each. Ozempic (T2D dose): 0.25 → 0.5 → 1 → 2mg. Zepbound (tirzepatide): 2.5 → 5 → 7.5 → 10 → 12.5 → 15mg, 4 weeks each. Titrate more slowly if tolerability issues; hold dose rather than de-escalate unless severely adverse.

Monitoring cadence

Follow-up every 4 weeks during titration; every 8–12 weeks in maintenance. Each visit capture: weight, BP, heart rate, side effect review, protein intake estimate, resistance training adherence. Lab recheck at 3–6 months: HbA1c, CMP, lipid panel. Escalation triggers: persistent nausea >2 weeks, abdominal pain unrelieved by titration hold, signs of pancreatitis, rapid weight loss >2%/week after first month.

Liability-aware documentation

Document: informed consent specific to the medication (FDA-approved indication vs off-label, compounded vs brand), contraindication screening, each dose escalation rationale, every side-effect conversation, and discharge/discontinuation reasoning. Maintain medication source documentation (pharmacy name, compounding vs brand, lot number if bulk-dispensed). Record patient acknowledgment of stopping protocol and expected weight regain.

Frequently asked

What should be on a GLP-1 intake form?+
Core fields: complete medical history (pancreatitis, gastroparesis, severe GI disease, gallbladder disease, thyroid cancer, MEN 2), personal and family MTC history, current medications and allergies, pregnancy/breastfeeding status, baseline weight/BMI/waist, recent labs (CMP, HbA1c, TSH, lipid panel), prior weight-loss medication history, behavioral health screening, and informed consent for off-label use if applicable.
What labs should I draw at baseline?+
Standard baseline panel: CMP, HbA1c, TSH, lipid panel. Many clinics add lipase and amylase as a baseline for future pancreatitis workup. Thyroid ultrasound is not routinely indicated but should be considered if any MTC risk factors are identified on history.
How often should I follow up with patients?+
Standard protocol: every 4 weeks during titration (weeks 0–20), then every 8–12 weeks during maintenance. Each visit: weight, BP, heart rate, side effect review, protein intake review, resistance training adherence, and medication supply review.
When should I hold or decrease a dose?+
Hold the current dose (do not decrease) if the patient is experiencing moderate GI side effects, dehydration, or rapid weight loss (>2% body weight per week after first month). Decrease the dose only if side effects are severe and unmanageable at the current level.

Related

Pillar

Regulations

State rules & compounding.

Pillar

Operations

Stack, vendors, staffing.

Consumer

Patient Protocol

Patient-facing treatment guide.