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It is a patient-specific formulation choice made by the prescribing provider, not a universal addition, and its use depends on an individual clinical evaluation
Topiramate is an anticonvulsant licensed in the UK for epilepsy and migraine prevention, and although weight loss can occur as a side effect, it is not licensed for weight management and carries significant neurological, metabolic, and pregnancy-related risks
Tirzepatides glucagon-receptor occupancy stays under 0.3% even at 15 mg. So its liver-fat reduction, its lipid improvements, and its heart-rate rise do not run through a glucagon arm the way retatrutides do
