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Baseline (Before Starting Ipamorelin) 12-lead ECG with QTc measurement Fasting IGF-1 level Fasting glucose and HbA1c (ipamorelin can raise fasting glucose transiently) Complete metabolic panel Document current SSRI, dose, and duration At 6-8 Weeks Repeat IGF-1 to confirm GH axis response Fasting glucose Symptom check: joint pain, water retention, paresthesias (GH-related), and any new or worsened anxiety, insomnia, or GI symptoms At 3 Months and Every 6 Months Thereafter Repeat ECG IGF-1 trending HbA1c if diabetic or prediabetic Reassess need for both agents The Endocrine Society's 2011 Clinical Practice Guideline on GH use in adults recommends IGF-1 monitoring every 6-12 months for patients on GH-axis therapy, with dose titration targeting IGF-1 in the age-adjusted upper-normal range [14]
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