Managing Weight with Mounjaro and Levothyroxine: What You Need to Know

Introduction

Living with a thyroid condition, particularly hypothyroidism, often means navigating a complex health landscape. While levothyroxine effectively manages thyroid hormone levels, many individuals find that weight management remains a persistent challenge, often feeling like an uphill battle. The journey to achieving and maintaining a healthy weight can feel compounded when you are already committed to daily medication. It’s a common and completely understandable concern: how can you pursue effective weight loss strategies, especially with innovative medications like Mounjaro, while continuing your essential thyroid hormone replacement?

This question, “can you take Mounjaro while on levothyroxine?”, is at the heart of our discussion. It’s a crucial query for many who are seeking a balanced approach to their health. At TrimRx, our journey began with a shared vision to help individuals embrace healthier lifestyles by merging cutting-edge telehealth innovations with effective weight loss solutions. We understand these complexities, and we believe that sustainable weight loss should be achieved through science, empathy, and a transparent approach. Our platform is a user-friendly and supportive space where individuals receive personalized, medically supervised care, all designed to make sustainable weight loss attainable and tailored to the individual.

This post will delve into the intricacies of taking Mounjaro alongside levothyroxine. We’ll explore how these medications work, discuss their potential interactions (or lack thereof), and provide practical guidance on optimal timing, monitoring, and managing any related symptoms. We aim to equip you with the knowledge needed to have an informed conversation with your healthcare provider, understand how these treatments can complement your health journey, and explore how a personalized approach to weight loss can support your overall well-being. By the end, you’ll have a clearer understanding of how to safely and effectively manage your weight while maintaining stable thyroid health.

Understanding Hypothyroidism and Levothyroxine

Hypothyroidism, or an underactive thyroid, occurs when the thyroid gland doesn’t produce enough thyroid hormones. These hormones, primarily thyroxine (T4) and triiodothyronine (T3), are vital for regulating the body’s metabolism, energy levels, heart rate, and body temperature. When these hormones are insufficient, various bodily functions can slow down, leading to a range of symptoms.

The Role of Thyroid Hormones in Metabolism

Thyroid hormones act like the body’s internal thermostat, controlling the basal metabolic rate (BMR)—the energy your body uses at rest. This directly influences how many calories you burn daily, even without physical activity. A sluggish metabolism, often associated with low thyroid hormone levels, can unfortunately lead to weight gain, making it challenging to shed pounds despite efforts in diet and exercise.

Beyond calorie burning, thyroid hormones are deeply involved in:

• Glucose Metabolism: They help ensure stable blood sugar levels by influencing how the body processes carbohydrates.
• Lipid Metabolism: They are crucial for breaking down fats for energy and regulating cholesterol levels. Efficient fat oxidation, or the burning of fat as fuel, is also influenced by these hormones.
• Thermogenesis: They contribute to the process by which your body generates heat, helping to maintain a comfortable body temperature.

A state where the thyroid gland is functioning normally and producing the correct amount of T3 and T4 is called “euthyroid.” This balance is paramount for overall health. When thyroid hormones are out of balance, the body can experience either hyperthyroidism (too much hormone, leading to a hypermetabolic state) or hypothyroidism (too little hormone, leading to a slower metabolism). For those with hypothyroidism, the aim of treatment is to restore this euthyroid state.

Levothyroxine: How It Works and Its Importance

Levothyroxine is a synthetic version of thyroxine (T4), the main hormone produced by your thyroid gland. It is the most commonly prescribed medication for hypothyroidism. Once absorbed, levothyroxine is converted to the active form T3 in your tissues, thereby helping to regulate metabolism, heart rate, and body temperature. This medication effectively replaces the missing hormone, alleviating symptoms like fatigue, weight gain, dry skin, and low mood.

Dosing and Absorption Considerations for Levothyroxine

Levothyroxine requires careful dosing, with adjustments based on regular thyroid function tests, typically every 6-8 weeks until stable. Its absorption occurs primarily in the small intestine, but only about 60-80% of the tablet dose is absorbed under optimal conditions. This incomplete and variable absorption makes precise timing and administration critical for its effectiveness.

Several factors can impact levothyroxine absorption, including:

• Food: Consuming food, especially high-fiber meals, can significantly reduce absorption by up to 40%.
• Coffee: Taking levothyroxine with coffee can reduce its absorption by 25-35%.
• Other Medications and Supplements: Calcium and iron supplements should be separated from levothyroxine by at least four hours. Antacids and proton pump inhibitors (PPIs) can also reduce absorption by altering gastric pH.
• Gastrointestinal Conditions: Conditions like celiac disease or inflammatory bowel disease (IBD) can also affect absorption.

Given these factors, levothyroxine is typically recommended to be taken on an empty stomach, usually 30-60 minutes before breakfast or several hours after dinner at bedtime. Consistency in timing is key to maintaining stable blood levels of the hormone, which is essential for consistent thyroid function.

Introducing Mounjaro: A Modern Approach to Weight Management

For individuals with hypothyroidism, managing weight can often feel particularly challenging due to a potentially slower metabolic rate. Modern medical advancements offer new avenues for support, and Mounjaro (tirzepatide) represents one such significant development in weight management. This weekly injectable medication has garnered attention for its effectiveness in promoting substantial weight loss.

What is Mounjaro and How Does It Work?

Mounjaro is the brand name for tirzepatide, a dual-action medication that mimics two naturally occurring hormones in the body: glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). These hormones play crucial roles in appetite regulation and blood sugar control.

Specifically, Mounjaro works through several mechanisms:

• Appetite Regulation: It communicates with the brain’s appetite control center, the hypothalamus, to reduce hunger and curb food cravings. This helps individuals feel full sooner and stay satisfied longer, making it easier to consume fewer calories and achieve a calorie deficit.
• Blood Sugar Control: Mounjaro boosts insulin release when blood sugar levels are high and reduces the amount of glucose produced by the liver.
• Slowed Gastric Emptying: It slows down the rate at which food leaves the stomach. This prolongation of gastric emptying contributes to prolonged feelings of fullness, helping to curb sudden overeating.

Our commitment at TrimRx is to offer compassionate care that respects every individual’s unique journey by combining advanced medical science with modern technology. We recognize the profound impact that innovative medications like Mounjaro can have on an individual’s path to healthier living.

Mounjaro and Weight Loss Potential

Clinical trials have demonstrated Mounjaro’s significant efficacy in weight loss. For instance, studies have shown participants losing a substantial percentage of their body weight over several weeks. This capacity for significant weight reduction offers a new layer of hope and effectiveness for many who have struggled with conventional weight loss methods. Our programs, including those featuring Mounjaro®, are designed to harness these advancements within a structured, supportive framework.

If you’re curious about whether a personalized plan involving medications like Mounjaro could be right for you, we encourage you to take our free assessment quiz to explore your eligibility and receive a tailored treatment plan.

Mounjaro Dosing Schedule

Treatment with Mounjaro typically begins with a low dose, gradually increasing over several weeks. This titration helps the body adjust to the medication and minimizes potential side effects, which are most common during the initial adjustment phase. This careful approach to dosing aligns with our commitment to safe and effective weight loss. At TrimRx, we ensure a comprehensive service that includes doctor consultations, medication, lab work, unlimited support, and shipping, with no hidden fees, regardless of dosage changes. Our medications, including Mounjaro®, Ozempic®, and Zepbound®, are provided through FDA-registered, inspected, and approved pharmacies, ensuring the highest standards of safety and quality.

Can You Take Mounjaro While on Levothyroxine? Addressing the Interaction

The central question for many individuals is whether it’s safe to combine Mounjaro with levothyroxine. The good news is that current research and clinical practice indicate that these medications can generally be taken together. However, understanding the nuances of their co-administration is crucial for optimizing the effectiveness of both treatments and ensuring patient safety.

No Direct Drug-Drug Interactions

According to reputable pharmacological resources, there are no direct drug-drug interactions between tirzepatide (Mounjaro) and levothyroxine. This means that the medications do not interfere with each other’s metabolic pathways or mechanisms of action within the body in a way that would cause harmful chemical reactions. This lack of direct interaction is a significant factor in their safe co-administration.

Indirect Considerations: Gastric Emptying and Absorption

While direct interactions are not a concern, Mounjaro’s effects on the gastrointestinal system introduce an indirect consideration for levothyroxine absorption. Mounjaro is known to slow gastric emptying, meaning food and other oral medications take longer to pass through the stomach into the small intestine where absorption primarily occurs.

Levothyroxine is an oral medication with specific absorption requirements:

• It requires an acidic pH for optimal dissolution.
• It is best absorbed in a fasting state.
• Peak absorption typically occurs 2-3 hours post-dose.

The slowing of gastric emptying by Mounjaro could theoretically alter the timing and extent of levothyroxine absorption. Although this hasn’t been formally studied in depth for this specific combination, the potential for altered absorption underscores the importance of strategic timing when taking both medications. This is especially critical because levothyroxine is considered a narrow therapeutic index (NTI) drug, meaning small changes in its absorption or blood levels can have significant clinical effects.

Thyroid-Stimulating Hormone (TSH) Levels

Some observational studies have suggested that GLP-1 medications, which are similar to one of Mounjaro’s mechanisms, may slightly lower TSH levels in some patients. The clinical significance of this finding is still being investigated and is not considered a barrier to combined use, provided there is appropriate monitoring. Weight loss itself can also influence thyroid hormone requirements, sometimes leading to a need for levothyroxine dose adjustments.

TrimRx is dedicated to patient safety and transparent service. Our approach remains consistent regardless of dosage changes, emphasizing continuous monitoring and support. We partner exclusively with FDA-registered and inspected pharmacies for the shipping of weight loss medications to ensure quality and compliance. While TrimRx provides access to doctor consultations and personalized plans, it’s important to understand that actual medical supervision, including medication adjustments, is provided by the licensed healthcare providers within our network.

Optimal Timing and Monitoring for Both Medications

Successfully managing Mounjaro and levothyroxine together involves a strategic approach to timing and consistent, thorough monitoring. This dual focus ensures that both medications work effectively while minimizing potential challenges.

Strategic Timing for Levothyroxine and Mounjaro

Given that Mounjaro can affect gastric emptying and levothyroxine has strict absorption requirements, spacing the administration of these medications is a recommended best practice.

Levothyroxine Timing:

• Morning Routine: The traditional and often preferred method is to take levothyroxine first thing in the morning, with a glass of water, at least 30-60 minutes before any food, coffee, or other medications. This allows for optimal absorption in a fasted state.
  • Example: Take levothyroxine at 6:00 AM, engage in morning activities, then have breakfast and other medications at 7:00 AM.
• Evening Alternative: Taking levothyroxine at bedtime, at least 3-4 hours after your last meal, is another effective option that has shown comparable or even superior absorption in some studies. This can be particularly beneficial for individuals who find morning medication routines difficult or whose morning nausea from Mounjaro affects adherence.
  • Example: Finish dinner by 6:00 PM, then take levothyroxine at 10:00 PM.

Mounjaro Timing:

• Mounjaro is a weekly injection and can be administered at any time of day, with or without food.
• Choose a consistent day and time each week that best suits your routine. Many people prefer mornings for consistency, but the specific timing is flexible.
• If you experience initial nausea with Mounjaro, you might choose to take it at a time that avoids impacting your levothyroxine routine.

Practical Tips for Co-Administration:

• Space Medications: If you’re taking any oral medication (including levothyroxine) that relies on threshold concentrations for efficacy or has a narrow therapeutic index, it’s generally recommended to separate its administration from Mounjaro by at least 30 minutes, or as advised by your healthcare provider. This ensures levothyroxine has its best chance at absorption without interference from Mounjaro’s effects on gastric emptying.
• Consistency is Key: Whether you choose morning or evening dosing for levothyroxine, maintain a consistent schedule every day.
• Set Reminders: Use phone alarms or medication logs to help maintain consistency, especially during travel or shift work.

Essential Monitoring Requirements

Taking both Mounjaro and levothyroxine necessitates coordinated and consistent monitoring by your healthcare team. This helps ensure both treatments are working as intended and allows for timely adjustments if needed.

Blood Test Schedule:

• Before Starting Mounjaro: Baseline TSH and Free T4 levels should be checked to confirm stable thyroid status for at least 3 months prior to initiating weight loss treatment.
• 6 Weeks After Starting Mounjaro: Recheck TSH levels to identify any immediate changes that might require levothyroxine dose adjustment.
• Every 3 Months for the First Year: Regular TSH and weight reviews are crucial to assess the combined impact of both medications.
• Annually: A full thyroid panel, including TSH and Free T4, should be conducted for an annual review, with ongoing monitoring planned based on stability.

What Your Healthcare Provider Will Monitor:

• Thyroid Function: Your provider will closely track TSH (aiming for a target range, typically 0.4-4.5 mU/L) and Free T4 levels, especially if symptoms persist despite normal TSH.
• Weight Loss Progress: They will assess your rate of weight loss (e.g., expected 1-2kg/week initially) and its potential impact on your levothyroxine requirements. Significant weight loss can sometimes lead to a need for dose reduction in levothyroxine.
• Side Effect Management: Monitoring for and addressing any side effects from either medication is important to ensure comfort and adherence.
• General Health Markers: Blood pressure, heart rate, and nutritional status will also be considered, as these can be influenced by weight loss and thyroid function.

TrimRx emphasizes the importance of these monitoring schedules. Our personalized weight loss programs, which include prescription medications like Compounded Semaglutide, Oral Semaglutide, Ozempic®, Compounded Tirzepatide, Oral Tirzepatide, Mounjaro®, Zepbound®, and Wegovy®, require a free assessment quiz to determine eligibility and ensure medically supervised care. We believe in empowering individuals with the tools and support they need, maintaining transparency in our service, and focusing on safety by partnering with FDA-registered and inspected pharmacies.

Managing Side Effects and Potential Concerns

When combining Mounjaro and levothyroxine, it’s important to be aware of potential side effects and how to differentiate their origins. While both medications are generally well-tolerated, some individuals may experience symptoms that require careful attention.

Overlapping Side Effects and How to Distinguish Them

Both Mounjaro and levothyroxine can sometimes cause similar symptoms, which can make it challenging to pinpoint the source. However, understanding typical presentation patterns can help.

Common Side Effects and Management:

Symptom	Likely from Levothyroxine	Likely from Mounjaro	Management
Nausea	If dose is too high (hyperthyroid state)	Common, especially in initial weeks	Smaller, frequent meals, bland foods, ginger tea.
Heart Palpitations	Sign of over-replacement	Rare, but possible with rapid weight loss	Urgent TSH check if persistent or severe. Consult your healthcare provider immediately.
Fatigue	Sign of under-replacement	If not eating enough, or dehydration	Review both medication dosages and ensure adequate nutrition and hydration.
Hair Loss	Thyroid imbalance, rapid weight loss	Rapid weight loss	Check thyroid levels and nutritional status. Ensure adequate protein and nutrient intake.
Constipation	Hypothyroidism (slowed digestion)	Common side effect	Increase fiber intake from cooked vegetables, whole grains, and milled seeds (chia, flax). Ensure adequate fluid intake.

Distinguishing Between Medication Effects:

• Levothyroxine-related symptoms typically develop gradually over weeks, tend to be consistent throughout the day, and improve with appropriate dose adjustments guided by TSH levels.
• Mounjaro-related symptoms often appear or worsen 1-3 days post-injection, may improve towards the end of the week before the next dose, and are most common during the first month of treatment, often being food-related (e.g., nausea triggered by certain foods).

Our brand is empathetic and supportive, and we understand that navigating these experiences can be concerning. That’s why we offer unlimited support to our members, ensuring you have a resource to discuss any concerns with your healthcare provider.

When to Contact Your Healthcare Provider

It’s crucial to know when to seek medical advice regarding your symptoms:

Urgent Consultation (Same Day):

• Severe palpitations, chest pain, or rapid heart rate.
• Signs of thyroid storm (a rare but severe complication of hyperthyroidism): fever, agitation, confusion, extreme rapid heart rate.
• Severe abdominal pain.
• Persistent vomiting that prevents you from keeping down food or medication.

Soon Consultation (Within a Few Days):

• New or worsening symptoms of hyperthyroidism (e.g., anxiety, insomnia, heat intolerance) or hypothyroidism (e.g., extreme fatigue, severe cold intolerance, depression).
• Inability to take levothyroxine consistently due to Mounjaro-induced nausea.
• Significant hair loss or other persistent side effects impacting your quality of life.
• Any neck swelling, lumps, or voice changes.

Important Contraindications and Precautions for Mounjaro

While Mounjaro can be a powerful tool for weight management, there are specific situations where it is not appropriate. It is contraindicated if you have a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). These conditions involve a higher risk of a specific type of thyroid cancer, and Mounjaro’s mechanism of action could potentially exacerbate this risk. Therefore, a thorough discussion of your medical and family history with your healthcare provider is essential before starting Mounjaro.

At TrimRx, patient safety is paramount. We provide medically supervised care, ensuring that all aspects of your health journey are considered. Our detailed assessment quiz helps us determine your eligibility for prescription medications, including Compounded Semaglutide, Oral Semaglutide, Ozempic®, Compounded Tirzepatide, Oral Tirzepatide, Mounjaro®, Zepbound®, and Wegovy®, and create a personalized treatment plan that prioritizes your well-being. Take our free assessment quiz today to begin your journey.

Holistic Support for Your Weight Loss Journey

While prescription medications like Mounjaro can be transformative, a holistic approach that includes lifestyle adjustments and supportive supplements can further enhance your weight loss journey, especially when managing conditions like hypothyroidism. At TrimRx, we believe in providing comprehensive support designed to complement your personalized treatment plan.

The Role of Lifestyle and Dietary Changes

No medication works in isolation. Integrating healthy lifestyle habits is fundamental for sustainable weight management, particularly for individuals who can take Mounjaro while on levothyroxine.

• Balanced Nutrition: Focus on a diet rich in whole foods, lean proteins, fruits, vegetables, and healthy fats. This approach supports overall health, manages blood sugar, and provides essential nutrients that can be crucial, especially if you’re experiencing changes in appetite or digestion due to Mounjaro. Adequate fiber intake is also vital to manage potential constipation, a common side effect of GLP-1 agonists.
• Regular Physical Activity: Incorporate consistent exercise into your routine. This not only aids in calorie expenditure but also improves metabolism, muscle mass, and mood. Consult your healthcare provider to determine a safe and effective exercise plan tailored to your capabilities.
• Hydration: Staying well-hydrated is essential for all bodily functions, including metabolism and managing medication side effects like constipation.
• Stress Management and Sleep: Chronic stress and poor sleep can negatively impact weight loss by affecting hormone regulation and increasing cravings. Prioritizing stress-reducing activities and ensuring adequate, restorative sleep are integral to a successful weight management journey.

Quick-Access Supplements for Enhanced Wellness

Beyond prescription solutions, TrimRx offers quick-access supplements designed to support your overall wellness during the weight loss journey. These products do not require a quiz and are available for immediate purchase, providing additional support for your health goals.

GLP-1 Daily Support

Our GLP-1 Daily Support supplement is formulated to complement the actions of GLP-1, aiming to assist with appetite management and digestive health. It provides a natural pathway to maintain a feeling of fullness and support metabolic balance, offering a valuable addition to your routine whether you’re on a prescription GLP-1 or not. This can be especially beneficial for those looking for continuous, gentle support for their metabolic and digestive systems.

Weight Loss Boost

For individuals seeking an additional edge in their weight loss efforts, our Weight Loss Boost supplement is designed to provide targeted support. This supplement helps optimize your body’s natural fat-burning processes and energy levels. It’s a proactive step towards enhancing your body’s efficiency, contributing to more effective and sustained weight loss outcomes.

These quick-access supplements are a testament to our commitment to providing diverse, effective tools for healthier living. We believe in empowering you with choices that align with your individual needs and preferences, reinforcing our empathetic and results-oriented brand personality.

The TrimRx Difference: Personalized, Supportive, and Transparent Care

At TrimRx, our core values revolve around providing personalized, medically supervised care with a deep sense of empathy and trustworthiness. We understand that every individual’s journey is unique, especially when balancing multiple health conditions and medications like Mounjaro and levothyroxine.

• Personalized Plans: Our approach begins with a comprehensive assessment to understand your specific health profile, including any existing conditions and medications. This allows our affiliated healthcare providers to craft a treatment plan that is precisely tailored to you.
• Expert Medical Supervision: We connect you with licensed healthcare professionals who provide expert guidance, ensuring your treatment plan is safe, effective, and compliant with FDA guidelines. This includes careful consideration of how Mounjaro interacts with other medications you may be taking, such as levothyroxine.
• Continuous Support: Our programs offer unlimited support, allowing you to have ongoing conversations about your progress, concerns, and any adjustments needed. We are committed to being a supportive partner throughout your weight loss journey.
• Transparency: We believe in a transparent approach to healthcare. Our services include everything from doctor consultations and medication to lab work and shipping, with no hidden fees, so you always know what to expect.

Our innovative use of telehealth allows us to deliver this high-quality, personalized care conveniently and accessibly. We are dedicated to helping you achieve sustainable weight loss safely and effectively, empowering you to embrace a healthier lifestyle with confidence.

Conclusion

Navigating the journey of weight management while managing a thyroid condition like hypothyroidism, particularly when considering new medications like Mounjaro, requires careful thought and a personalized approach. The good news is that for many individuals, taking Mounjaro while on levothyroxine is a viable and safe path, provided there’s a clear understanding of potential indirect interactions, optimal timing, and consistent medical monitoring.

We’ve explored that while there are no direct drug interactions between Mounjaro (tirzepatide) and levothyroxine, Mounjaro’s effect on gastric emptying necessitates strategic timing for levothyroxine administration to ensure its proper absorption. We’ve also highlighted the critical importance of regular blood tests—specifically TSH and Free T4 levels—to monitor thyroid function, as weight loss itself can influence your thyroid hormone requirements. Managing potential overlapping side effects through informed observation and prompt communication with your healthcare provider is key to a smooth and effective treatment journey.

At TrimRx, we are founded on the vision of merging cutting-edge telehealth with effective, personalized weight loss solutions. We understand the complexities of individual health needs and are committed to offering compassionate, innovative, and trustworthy care. Our platform is designed to be a supportive space where individuals receive medically supervised plans, tailored to their unique circumstances. Whether you’re considering prescription medications like Mounjaro®, Ozempic®, or Zepbound®, or seeking additional support through our quick-access supplements like GLP-1 Daily Support or Weight Loss Boost, we are here to support you.

We firmly believe that sustainable weight loss is achieved through a blend of science, empathy, and transparent guidance. Our comprehensive service ensures you have access to doctor consultations, necessary lab work, medication from FDA-registered and inspected pharmacies, and unlimited support, all without hidden fees.

If you’re ready to explore how a personalized, medically supervised weight loss program can align with your thyroid management and help you achieve your health goals, we encourage you to take our free assessment quiz today. Discover if you qualify for a tailored plan designed to help you embrace a healthier, more vibrant lifestyle. Your journey towards effective and safe weight loss, hand-in-hand with stable thyroid health, is within reach.

Frequently Asked Questions

What are the key considerations when taking Mounjaro and levothyroxine together?

The primary consideration is the potential for Mounjaro to slow gastric emptying, which could indirectly affect the absorption of levothyroxine. There are no direct drug interactions. It’s crucial to optimize the timing of levothyroxine administration, usually on an empty stomach and separated from other medications or food, and to undergo consistent monitoring of thyroid function tests.

How should I time my levothyroxine and Mounjaro doses?

It’s generally recommended to take levothyroxine on an empty stomach, 30-60 minutes before breakfast or 3-4 hours after your last meal at bedtime. Mounjaro can be taken any time of day, once a week. To minimize any potential absorption interference, ensure at least a 30-minute gap between your levothyroxine dose and any other oral medications, and always follow your healthcare provider’s specific guidance.

Will taking Mounjaro affect my levothyroxine dosage?

Mounjaro itself doesn’t directly alter levothyroxine’s effectiveness, but significant weight loss achieved with Mounjaro can sometimes lead to changes in your body’s thyroid hormone requirements. This may necessitate a downward adjustment of your levothyroxine dose. Regular monitoring of your TSH levels by your healthcare provider is essential to determine if any adjustments are needed. Never change your levothyroxine dosage without medical supervision.

Are there any specific warning signs I should look out for when on both medications?

Yes, it’s important to monitor for symptoms of both overactive thyroid (hyperthyroidism), such as heart palpitations, anxiety, insomnia, or excessive sweating, and underactive thyroid (hypothyroidism), such as extreme fatigue, severe cold intolerance, or depression. Also watch for severe gastrointestinal side effects from Mounjaro, like persistent vomiting or severe abdominal pain. Contact your healthcare provider immediately if you experience any severe or persistent symptoms.