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This mimics adenylate cyclase and hence we get more cAMP

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Pattern 3: The Intolerant Switcher (approximately 25% of switchers) Develops moderate to severe nausea, vomiting, or diarrhea during tirzepatide titration Side effects persist beyond the typical 2-week adaptation window May tolerate 2.5 to 5 mg but cannot escalate to therapeutic doses (10+ mg) This pattern is more common in patients who had persistent but manageable GI side effects on semaglutide

Kuo B, Barnes CN, Nguyen DD, et al