Doctors' Questions and Answers

Since you have completed the initial 4 weeks at 2.5 mg and are tolerating Mounjaro well, the usual next step is to increase to 5 mg once weekly.

I would recommend booking a follow-up consultation rather than requesting a prescription review alone. This allows the doctor to assess your response, weight evolution, appetite control, medical history and any potential contraindications before prescribing the next dose.

The 2.5 mg dose is considered the starting dose; according to the European product information, after 4 weeks the dose is normally increased to 5 mg once weekly. Further increases, if necessary, should only be made after at least 4 weeks at the current dose.

The fact that you have had good appetite suppression without nausea or other significant side effects is reassuring, but the appropriate maintenance dose is individual and should not simply be increased as quickly as possible.

A follow-up consultation is therefore the safest and most appropriate option.

Yes new consultation is needed to determine next best step

Yes, you should request a follow-up appointment with me, not just a prescription review. We need to assess:

Weight and height (to calculate BMI and track progress).

Blood tests (glucose, HbA1c, lipid profile, liver and kidney function, complete blood count, etc.).

Tolerance and side effects (in your case, good tolerance with no nausea or discomfort, only appetite loss, which is expected).

Clinical response (weight loss, appetite control, satiety).

With that information we'll decide whether to stay at 2.5 mg or increase to 5 mg (the usual next dose in Mounjaro). The dose should not be changed without a medical evaluation that includes weight, height, and blood tests.

he Dizziness and Near-Fainting (Presyncope)
In a 67-year-old with your history, dizziness with a sensation of impending fainting is never "just dizziness." It indicates that your brain is not receiving enough blood flow or oxygen. Given that you have thyroid surgery in your history, we must consider that your calcium levels (regulated by the parathyroid glands, which are often affected during thyroid surgery) could be dangerously low (hypocalcemia), which causes dizziness, tingling, and even fainting. Furthermore, the dizziness could be cardiac in origin (arrhythmia) or neurological.

Dear Dolores, based on the symptoms you describe, I recommend that you have an in-person medical assessment today, preferably at an Emergency Department. If needed we can guide you trough a online appoitment, but will not be able to solve it here.

Dizziness or feeling that you are about to faint can have many causes, including low blood pressure or blood sugar, dehydration, medication side effects, heart rhythm abnormalities, or thyroid-related problems. However, in your case there are several reasons for caution: recurrent episodes, low blood pressure and heart rate, an oxygen saturation of 92%, and a new one-sided headache that has been present for two days.

It is not possible to determine the cause safely through an online consultation. At the hospital, your blood pressure, heart rate and oxygen saturation should be rechecked, along with a blood glucose measurement, ECG and neurological examination. Depending on the findings, additional tests may be necessary.

If you currently have severe or worsening dizziness, difficulty breathing, chest pain, fainting, confusion, weakness or numbness on one side of the body, difficulty speaking, visual disturbances, or a sudden/severe headache, call 112 and do not drive yourself to hospital.

Until you are assessed, remain sitting or lying down to reduce the risk of falling, and ideally have someone stay with you. Take your complete medication list and any recent test results with you.

Based on what you describe — dizziness with a feeling you might faint, oxygen saturation at 92%, low blood pressure, low heart rate, and pain on the left side of your head for two days — this episode needs an in‑person medical evaluation. These symptoms can come from several causes, including blood pressure instability, heart rhythm changes, breathing issues related to asthma, glucose fluctuations, thyroid‑related changes even after surgery, or neurological conditions. Although dizziness can occur with fibromyalgia or osteoarthritis, the combination of low oxygen, low blood pressure, low heart rate, and persistent one‑sided head pain makes it important to be seen today. The safest next step is to go to urgent care or a hospital so they can repeat your vital signs, check your oxygen, perform an ECG, run basic blood tests, examine your neurological status, review your medications, and check for interactions of the medications you are currently on.

Hello! I really understand your situation - being in a new country without an assigned family doctor and at the same time getting sick is really unpleasant and worrying. Let me try to help you figure it out.

A sore throat combined with a fever is one of the most common reasons for visiting a therapist. In most cases, we are talking about ARVI, pharyngitis or tonsillitis, which are perfectly treatable and do not require emergency help. The emergency department (urgência) in Portugal is a resource for truly critical situations: a high temperature above 39–40°C that does not break down, severe shortness of breath, chest pain, severe weakness or confusion. If you have a moderate temperature and your general condition is tolerable, an ambulance in this case is redundant, and you risk spending several hours in line.

An online consultation with a doctor is exactly what you need right now. An experienced therapist will assess your symptoms remotely, prescribe treatment if necessary, recommend over-the-counter medications that can be bought in a Portuguese pharmacy, and tell you whether you still need to see them in person. It's convenient, fast and allows you to get professional help without leaving home, which is especially important when you're not feeling well.

Do not delay in seeing a doctor - even mild ARVI is better treated in a timely manner to avoid complications. I wish you a speedy recovery and a speedy settlement in Portugal!

A sore throat and fever can often be assessed by an online doctor, especially if symptoms started recently and you are otherwise well. However, if you have difficulty breathing, severe difficulty swallowing, dehydration, chest pain, confusion, or are feeling seriously unwell, you should seek urgent in-person medical care. An online consultation can help determine whether you need testing, medication, or referral for further evaluation.

Hello! A sore throat should always be evaluated and at Oladoctor we can advise you without problems. happy afternoon

Good morning. In many cases, sore throat and fever can initially be assessed with an online consultation. On our platform you can consult any available doctor, even if they are in another country. If necessary, the doctor will be able to prescribe a therapy and issue a prescription also valid in Portugal. Online consultation allows you to start treatment as soon as possible and understand whether further investigations or an in-person visit are necessary. However, if breathing difficulties, significant difficulty swallowing or other serious symptoms appear, it is advisable to contact an emergency service promptly. I wish her a speedy recovery!

A sore throat with fever is most often caused by a viral infection, but it can also be due to a bacterial infection such as tonsillitis. Both situations can be safely evaluated through an online consultation, where a doctor can assess your symptoms, determine the most likely cause, and prescribe appropriate treatment valid in Portugal. You should only go to urgência if you develop trouble breathing, major difficulty swallowing, very high fever that does not improve with medication, chest pain, confusion, dehydration, or if your overall condition clearly worsens. If you do not have these warning signs, an online consultation is the correct first step and ensures timely care without an unnecessary emergency visit.

Mixing sildenafil (Viagra) with alcohol is unsafe. Both substances lower blood pressure, and their combined action can lead to serious unwanted effects.

Main risks:

1. Severe hypotension. Sildenafil is a PDE-5 inhibitor, it dilates blood vessels and lowers blood pressure. Alcohol has a similar effect. When used together, a sharp drop in pressure, dizziness, fainting, and in severe cases - collapse are possible.

2. Increased side effects of Viagra. Headache, hot flashes, tachycardia and visual disturbances (including “blue tint”) may be exacerbated by alcohol.

3. Reduced effectiveness of the drug. Alcohol disrupts the normal mechanism of erection - it depresses nerve conduction and reduces testosterone levels, which can negate the effect of sildenafil.

4. Increased load on the heart. In patients with cardiovascular disease or hypertension, the combination of Viagra and alcohol significantly increases the risk of cardiac complications.

What is acceptable according to clinical studies:
A small amount of alcohol (up to 1 standard dose - approximately 150 ml of wine or 350 ml of beer) does not significantly affect the pharmacokinetics of sildenafil. However, even moderate use in combination with the drug is individual and requires caution.

Recommendation: refrain from alcohol while taking Viagra, especially if you have cardiovascular disease, hypertension, or are taking nitrates (the combined use of sildenafil and nitrates is absolutely contraindicated and life-threatening).

Yes—a small amount of alcohol is usually okay with Viagra, but drinking a lot can make you dizzy or faint and can also make the Viagra work worse, so it’s best to keep it to 1–2 drinks and avoid binge drinking.
Don’t use Viagra if you take nitrates (e.g., GTN spray/patch) because that combination can cause dangerous low blood pressure
If you get chest pain, severe dizziness, or fainting after mixing them, seek urgent care.

Both alcohol and sildenafil, that is, Viagra, can dilate blood vessels and lower blood pressure, so when mixing them some people experience dizziness, headache, feeling faint or palpitations. It's not usual.

Additionally, alcohol in high amounts can make erection more difficult on its own. This means that, logically, even if you have taken Viagra, a significant intake of alcohol can reduce sexual response and make the medication seem less effective.

It would not be contraindicated but it is advisable to avoid excessive consumption and take special caution if there is a history of hypotension, cardiovascular diseases or if other medications that affect blood pressure are taken.

If you have any intense or persistent symptoms, you can consult with our professionals for further development of your questions and/or necessary prescriptions.

Spanish
It is not recommended. Mixing Viagra (sildenafil) with alcohol increases the risk of side effects such as low blood pressure, dizziness, headache and tachycardia, since both dilate blood vessels. Alcohol can also reduce the effectiveness of the medication and affect your ability to get or maintain an erection. If you drink, do it very moderately (one drink maximum) and separately from the drink, but it is safest to avoid alcohol while you are under treatment. Always consult your doctor before combining any drug with alcohol.

English
It is not advisable. Mixing Viagra (sildenafil) with alcohol increases the risk of side effects like low blood pressure, dizziness, headaches, and rapid heartbeat, since both dilate blood vessels. Alcohol can also reduce the drug's effectiveness and affect your ability to get or maintain an erection. If you do drink, do so very moderately (at most one drink) and separate from the dose, but the safest option is to avoid alcohol altogether while on this medication. Always check with your doctor before combining any drug with alcohol.

When combining Viagra (sildenafil) and alcohol, both safety and effectiveness must be considered. A glass of wine or a beer, in most cases, is not a problem. The real limit is excess alcohol: in addition to increasing the risk of side effects (such as dizziness, drop in blood pressure and headaches), it can compromise erections and give the impression that sildenafil is not working. If you want to get the maximum benefit from the drug, it is advisable to limit alcohol consumption and avoid excesses.

It’s usually fine to have a small amount of alcohol when taking Viagra, but drinking too much can make side effects like dizziness, flushing, or feeling faint more noticeable. Alcohol already lowers blood pressure, and Viagra can lower it a bit more, so combining the two—especially in larger amounts—can make you feel unsteady or light‑headed.
The risk increases if you’re also taking other medications that relax blood vessels, such as drugs for high blood pressure or prostate symptoms. When these are combined with Viagra and alcohol, the drop in blood pressure can be stronger, making fainting or feeling weak more likely. Keeping alcohol light and avoiding drinking to the point of feeling intoxicated is the safest approach.

Cystitis after intercourse is common, especially in women, and is called “postcoital cystitis” or “honeymoon cystitis.” Here are the main reasons for its occurrence:

1. Anatomical features. In women, the urethra is short (about 4 cm) and located close to the vagina and anus. During sexual intercourse, bacteria, including E. coli, can easily enter the urethra and bladder.

2. Mechanical irritation. Friction during sex can cause microdamage to the lining of the urethra, making it easier for bacteria to enter and multiply.

3. Changes in microflora. Sexual intercourse temporarily disrupts the balance of the normal microflora of the vagina and urethral zone.

4. Urinary retention. If you don't urinate immediately after sex, bacteria remain in the urethra and have the opportunity to multiply.

What to do for prevention:

• Urinate immediately after intercourse (within 15-20 minutes) - this flushes bacteria from the urethra.
  — Maintain intimate hygiene before and after sex.
  — Drink enough water throughout the day (1.5–2 liters).
  — For recurrent postcoital cystitis, the doctor may prescribe a single prophylactic dose of an antibiotic after sexual intercourse.

If episodes recur more than 2-3 times a year, it is important to contact a urologist or gynecologist for a full examination (urine culture, ultrasound of the bladder) and selection of an individual prevention regimen. Self-medication with antibiotics without consulting a doctor is unacceptable - this leads to the development of bacterial resistance!

Cystitis after sex usually happens because intercourse can move bacteria (often E. coli) from the skin/vaginal area into the urethra and up to the bladder, where they cause an infection. It’s more likely if you’re prone to UTIs, use spermicides, have low estrogen after menopause, or don’t fully empty your bladder. If it’s recurring, it’s worth getting a urine culture during symptoms and asking about prevention; seek urgent care if you get fever, chills, or back/flank pain.

Spanish
It is very common and has a clear explanation: during intercourse, especially with vaginal penetration, a "massage" of the urethra and bladder occurs, and bacteria from the perianal or vaginal area (generally E. coli) can ascend to the bladder. Additionally, rubbing and friction can irritate the urethra, facilitating infection. That's why it's called "honeymoon cystitis." To prevent it, it is key to urinate immediately after sex to "wash away" the bacteria, drink enough water, maintain good hygiene (without excesses), and sometimes the doctor can recommend a prophylactic antibiotic or a single postcoital dose if it is very recurrent.

English
This is very common and has a clear explanation: during intercourse, especially with vaginal penetration, the urethra and bladder get "massaged," and bacteria from the perianal or vaginal area (usually E. coli) can travel up into the bladder. Also, friction can irritate the urethra, making infection easier—that's why it's sometimes called "honeymoon cystitis." To prevent it, the key is to urinate right after sex to "flush out" bacteria, drink plenty of water, maintain good hygiene (without overdoing it), and if it's very recurrent, your doctor may consider a prophylactic antibiotic or a single postcoital dose.

Cystitis after intercourse is often caused by the ascent of bacteria, especially Escherichia coli, towards the bladder. In some women the symptoms may appear only occasionally, while in others almost after every intercourse. Sexual intercourse can in fact favor the migration of bacteria already present in the perineal area or in the urethra and, through mechanical friction, facilitate their proliferation and the onset of infection. If the episodes are sporadic, urinating after intercourse and drinking abundantly is usually sufficient. However, if cystitis occurs almost every time, it is important to contact your doctor to evaluate a personalized preventive strategy, which may also include specific supplements or, in selected cases, a targeted prophylaxis.

Many people get cystitis after sex because bacteria that normally live around the vaginal and urethral area can be pushed toward the bladder during intercourse. The urethra is short, so once bacteria enter it, they can reach the bladder easily and cause irritation or infection. Friction during sex can also make the area more sensitive, and not urinating afterward gives bacteria more time to move upward. You may be more susceptible if you have vaginal dryness, are peri‑ or post‑menopausal, use spermicides or diaphragms, have a history of recurrent UTIs, or naturally carry more bacteria around the urethral area — especially under conditions of dehydration, when urine becomes more concentrated and bacteria can accumulate more easily.
Cystitis can usually be treated easily with antibiotics through an online consultation after a doctor evaluates your symptoms. If severe symptoms appear — such as fever, chills, nausea, vomiting, or pain in the lower back or sides — this can mean the infection has travelled upward toward the kidneys, and emergency care should then be sought.

Look, everything is simpler than it seems. Ozempic and Vegovi are the same substance, semaglutide. Difference in purpose: Ozempic is prescribed for type 2 diabetes, so that sugar does not jump. Many people lose weight on it, but formally that’s not what it’s for. And Vegovi is the same semaglutide, only officially for weight loss, and the dose is higher, 2.4 mg per week.
Munjaro is a different molecule, tirzepatide. The fundamental difference is that it works through two mechanisms simultaneously, and not through one, like semaglutide. It is used for diabetes and for weight loss. According to a large comparative study, tirzepatide produced approximately 20% weight loss versus 14% for semaglutide over a year and a half. It is clear that the numbers are average and everyone has their own result, but the trend is in favor of Munjaro.
The side effects of all three are similar - nausea, digestive problems, loss of appetite. From a serious point of view: gallstones, pancreatitis, kidneys can be damaged if you don’t drink enough water. It is not possible if you have medullary thyroid cancer or MEN-2 syndrome (multiple endocrine neoplasia type 2) in the family.
Essentially: if the task is sugar, they usually go to Ozempic or Munjaro. If the goal is weight, consider Vegovi or Munjaro. So far Munjaro has shown the maximum effect on weight. But in any case, these are not vitamins - the doctor must select them taking into account the whole picture: tests, concomitant diseases, other medications and what else is available.

Hello

Ozempic, Wegovy and Mounjaro are all injectable medications used for weight management and/or diabetes, but they are not exactly the same.

• Ozempic contains semaglutide and is officially approved mainly for type 2 diabetes, although many people also lose weight with it.

• Wegovy also contains semaglutide, but at a higher target dose specifically approved for obesity and weight loss treatment.

So, Ozempic and Wegovy are essentially the same active medication, but with different dosing and official indications.

• Mounjaro contains tirzepatide, which works differently because it activates two hormonal pathways (GIP and GLP-1) instead of only GLP-1. In clinical studies, this tends to produce greater average weight loss and stronger metabolic effects in many patients.

In practical terms:

• Ozempic → diabetes first, moderate-to-strong weight loss
• Wegovy → weight loss focused semaglutide
• Mounjaro → newer dual-action option, often associated with greater weight reduction

However, the “best” option depends on the individual patient:

• BMI and weight-loss goals
• diabetes or insulin resistance
• side effects tolerance
• thyroid/pancreatic history
• cardiovascular risk
• medication availability and cost

All of them require medical supervision and work best when combined with nutrition, exercise and long-term lifestyle changes. They are powerful tools, but not magic injections — the real value comes from sustained metabolic improvement and habit change.

The real difference is in their active ingredient and what they are prescribed for. Ozempic and Wegovy both contain semaglutide, but Ozempic is primarily used for type 2 diabetes and cardiovascular risk, while Wegovy has a higher dose and is approved specifically for weight loss. Mounjaro contains tirzepatide, which acts on two receptors (GLP-1 and GIP), and has been associated with greater weight loss compared to semaglutide. The choice depends on your main objective and should be evaluated by your doctor.

The real difference is in their active ingredient and approved use. Ozempic and Wegovy both contain semaglutide, but Ozempic is mainly for type 2 diabetes and cardiovascular risk, while Wegovy has a higher dose and is specifically approved for weight loss. Mounjaro contains tirzepatide, which targets two receptors (GLP-1 and GIP), and tends to produce more weight loss than semaglutide. Which one is right for you depends on your main goal and should be discussed with your doctor.

Ozempic and Wegovy contain the same molecule, semaglutide. The difference is not in the active ingredient, but in the therapeutic indication and dosages: Ozempic was developed mainly for the treatment of type 2 diabetes, while Wegovy is the formulation approved for the treatment of obesity, with higher doses. For this reason, from the name of the drug it is often possible to understand whether the main goal of therapy is diabetes control or weight reduction. Even though they contain the same molecule, the two drugs are not automatically interchangeable, as they have different authorized indications and therapeutic schemes.

Mounjaro, however, contains tirzepatide, a different molecule. It acts on two receptors involved in the regulation of blood sugar and appetite (GIP and GLP-1). In addition to reducing appetite, it helps many people achieve a sense of satiety more easily after meals, better control hunger throughout the day and further improve blood sugar levels. For this reason, it can lead to greater weight reduction in many patients than semaglutide.

However, this doesn't mean Mounjaro is always the best choice. In patients with type 2 diabetes, semaglutide has solid evidence on cardiovascular benefits and renal protection, gained over many years of clinical studies. Also for tirzepatide the available results are very promising and the evidence continues to strengthen, but the clinical experience is more recent.

In people without diabetes, the choice between semaglutide and tirzepatide is not based solely on effectiveness in weight loss. The doctor evaluates the clinical picture as a whole, considering the degree of obesity, any associated diseases, the tolerability of the treatment, the possible contraindications, the risk of side effects and the long-term therapeutic objectives. In some patients semaglutide is an excellent choice, while in others tirzepatide may offer greater benefit

Side effects are similar for both therapies (nausea, vomiting, diarrhea or constipation) and often depend more on the speed with which the dose is increased than on the drug itself. Furthermore, after suspension it is possible to regain part of the weight lost with both treatments: for this reason it is essential to accompany the therapy with a balanced diet, an adequate intake of proteins and physical activity, so as to encourage weight maintenance and preserve muscle mass.

A frequent mistake is to choose the drug exclusively based on the kilos it allows you to lose. In reality, the ideal treatment is one that allows you to obtain a stable result over time, with good tolerability and without having to be suspended due to unwanted effects. More gradual, but long-lasting, weight loss is often preferable to very rapid weight loss followed by weight regain.

Ultimately, the question should not be "which drug is the strongest?", but "which drug is best suited to my clinical situation?". There is no best drug for everyone: the choice depends on the presence of diabetes, cardiovascular or renal disease, the amount of weight to lose, tolerability, contraindications and the objectives of the therapy. In any case, none of these drugs replace a healthy lifestyle: nutrition, physical activity and medical follow-up remain an integral part of the treatment and are essential to obtain lasting benefits. Greetings, Dr. Lina Travkina

Ozempic and Wegovy are the same drug (semaglutide). The only difference is in the dosage and purpose of use: Ozempic - low doses (up to 2 mg), officially prescribed for type 2 diabetes. Wegovy - high doses (2.4 mg), officially prescribed for weight loss. Mounjaro is a different drug (tirzepatide). Its key difference is that it acts on two hormones at once (GIP and GLP-1), and not on one, like semaglutide. Because of this, it often provides greater benefits for weight loss and sugar control.

Ozempic, Wegovy and Mounjaro are all once‑weekly injectable medications used in metabolic care, but they differ in important ways. Ozempic and Wegovy contain the same active ingredient, semaglutide, a GLP‑1 receptor agonist that helps regulate appetite, slow gastric emptying and improve blood sugar control. The distinction between them lies mainly in their approved use and dosing: Ozempic is authorized for type 2 diabetes and cardiovascular risk reduction, while Wegovy uses a higher target dose of the same medication and is specifically approved for obesity treatment.
Mounjaro, on the other hand, contains tirzepatide, which activates two hormonal pathways — GIP and GLP‑1 — rather than just one. This dual mechanism often leads to stronger metabolic effects and greater average weight loss compared with semaglutide. All three medications share similar side‑effect profiles, most commonly nausea, reduced appetite and digestive discomfort, with less frequent but important risks such as gallbladder issues and pancreatitis. They should not be used by individuals with a personal or family history of medullary thyroid carcinoma or MEN‑2.
Choosing between these medications depends on the patient’s primary goals and medical context. For diabetes control, clinicians often consider Ozempic or Mounjaro. For weight management, Wegovy or Mounjaro may be more appropriate. The final decision requires an individualized medical evaluation that considers comorbidities, tolerance, treatment objectives and overall health status.

Hello!
Fordyce granules are a benign condition that does not require treatment. If they cause aesthetic discomfort, tretinoin cream may be used. In some patients, the elements become less noticeable, but usually do not disappear completely.
During treatment, redness, dryness and irritation of the skin may occur, so the drug should be used only as prescribed by a doctor and according to the recommended regimen.
If the desired cosmetic effect is not achieved, hardware removal methods remain the most effective.

Hello. Thank you for your inquiry. Yes, prescriptions can be made, as long as there is clinical criteria that validates it.

Good afternoon,

Indeed, ADHD is an area of our specialty and as such, we can prescribe drugs while in Spain. Usually an initial approach is carried out to assess whether there is presence of ADHD; if the patient already has the diagnosis, it is necessary to include the corresponding report in the consultation for verification before starting treatments.

Good day, yes, we have the opportunity to prescribe treatment to correct the symptoms of ADHD, but after consultation, diagnosis, observation of the treatment process with other drugs) We may have many options on the platform) We will be very happy for you)

Good afternoon. Yes, I could take care of issuing the prescription after checking the name of the medication. All the best

Se debe valorar que antibiotico precisa para su infeccion de orina. Además, siempre recomendamos probiotiocos posterior al tratamiento, asi como tratamientos preventivos como por ejemplo cistitus de farmacia.

Good morning. If the prescription was issued by one of the doctors on our platform, you can contact support: the case will be verified and, if necessary, the prescription can be modified.
However, if the prescription was issued by another doctor, you can use the "Prescription Renewal" service, attaching the prescription you already have and explaining that the drug is not available in Spain. Your doctor will evaluate an appropriate alternative.

Hello, please contact our customer support, they will be happy to support you.