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Conservative combination protocol (if attempting) Rationale for conservative approach: No safety data available Both peptides slow gastric emptying significantly Risk of severe GI complications Start low, go slow principle Tirzepatide component: Follow standard FDA-approved titration Weeks 1-4: 2.5mg weekly Weeks 5-8: 5mg weekly Weeks 9-12: 7.5mg weekly Weeks 13-16: 10mg weekly Week 17+: 12.5mg weekly (or stay at 10mg) Some reach 15mg weekly (maximum) Cagrilintide component (reduced from standard): Start AFTER tirzepatide stabilized at therapeutic dose (week 13+) Week 13-16: 0.6mg weekly (lower than standard) Week 17-20: 1.2mg weekly Week 21-24: 1.8mg weekly (may be maximum tolerable) Consider 2.4mg only if tolerating perfectly Conservative dosing comparison: Why sequential is safer: Tirzepatide establishes baseline first Can attribute new side effects to cagrilintide Easier to manage one variable at a time Option to stop cagrilintide if intolerable Less overwhelming than both simultaneously Expected benefits: 18-25% total weight loss (conservative estimate) Potentially superior to tirzepatide alone (15-22%) But incremental benefit may be modest (3-5% additional) Use SeekPeptides to plan sequential peptide additions safely

GHK-Cu is studied for stimulating collagen and elastin production, supporting the formation of new blood vessels and skin cells, and acting as an antioxidant and anti-inflammatory in tissue

Miscellaneous Extraintestinal Manifestations and Complications of Inflammatory Bowel Disease Renal Nephrolithiasis (oxalate, urate) Glomerulonephritis (rare) Right ureteral obstruction Urinary system fistulas (eg, enterovesical, colovesical, rectourethral) Tubulointerstitial nephritis (5-aminosalicylates) Secondary amyloidosis Hematologic Anemia Iron deficiency Vitamin B12 deficiency Folic acid deficiency Anemia of chronic disease Autoimmune hemolytic anemia Neoplastic Myelodysplastic syndrome (rare) Promyelocytic leukemia (rare) Cardiopulmonary Pericarditis (extraintestinal manifestation or drug-induced) Myocarditis Conduction abnormalities Pneumonitis Eosinophilic pneumonia Cryptogenic organizing pneumonia Bronchiectasis, bronchiolitis, bronchitis, and subglottic stenosis Pancreatic Acute pancreatitis Drug-induced (purine analogues,5-aminosalicylates) Duodenal Crohn disease Granulomatous involvement of pancreas (rare) Chronic pancreatitis Autoimmune pancreatitis Thrombophilia Multifactorial Nephrolithiasis is a recognized problem for patients with CD, particularly ileal CD

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