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Moreover, glutamine-induced activation of mTORC1 results in the phosphorylation of the enzyme complex called carbamoyl phosphate synthetase 2, aspartate transcarbamylase, and dihydroorotase (CAD), which catalyzes the condensation reaction converting glutamine-derived nitrogen into the pyrimidine precursor orotate 34,35

Post-marketing surveillance through the FDA Adverse Event Reporting System (FAERS) and clinical experience suggest that some patients do report sleep changes after starting tirzepatide