What is the dosing for Ozempic (semaglutide)?

From the Guidelines

Zepbound (tirzepatide) dosing should be initiated at 2.5 mg subcutaneously once weekly for the first 4 weeks, then increased to 5 mg once weekly, with further increments of 2.5 mg every 4 weeks as needed, up to a maximum dose of 15 mg once weekly, as this regimen has been shown to minimize gastrointestinal side effects and optimize weight loss outcomes 1. The dosing regimen for Zepbound is designed to balance efficacy and tolerability, with the initial lower dose helping to reduce the risk of gastrointestinal adverse effects.

• The medication should be administered via subcutaneous injection in the abdomen, thigh, or upper arm.
• Patients should aim to inject Zepbound on the same day each week, but can adjust the day if necessary, provided the last dose was given at least 3 days (72 hours) prior.
• If a dose is missed, it should be administered as soon as possible if there are at least 3 days until the next scheduled dose; otherwise, the missed dose should be skipped, and the next dose given on the regularly scheduled day. Key properties of tirzepatide, the active ingredient in Zepbound, include a total dose range of 15 mg weekly, with a bioavailability of 80%, and an elimination half-life of approximately 5 days 1. Tirzepatide works by activating both GLP-1 and GIP receptors, which helps reduce appetite, increase feelings of fullness, and slow gastric emptying, ultimately leading to reduced caloric intake and weight loss 1. In comparison to other GLP-1 receptor agonists, such as semaglutide and dulaglutide, tirzepatide has a distinct pharmacokinetic profile, with a higher bioavailability and longer elimination half-life 1.

From the Research

Zepbound Dosing Information

• Zepbound, also known as tirzepatide, is a dual GIP and GLP-1 receptor agonist used for the treatment of type 2 diabetes and obesity.
• The dosing of tirzepatide varies depending on the study, but common doses include 5 mg, 10 mg, and 15 mg administered subcutaneously once weekly 2, 3, 4.
• In the SURPASS-4 trial, participants were randomly assigned to receive tirzepatide (5 mg, 10 mg, or 15 mg) or insulin glargine, with the primary endpoint being non-inferiority of tirzepatide versus glargine in HbA1c change from baseline to 52 weeks 2.
• The SURPASS-3 trial compared tirzepatide (5 mg, 10 mg, or 15 mg) with insulin degludec, with the primary endpoint being non-inferiority of tirzepatide versus insulin degludec in mean change from baseline in HbA1c at week 52 4.
• In the SURMOUNT-5 trial, tirzepatide (10 mg or 15 mg) was compared with semaglutide (1.7 mg or 2.4 mg) for the treatment of obesity, with the primary endpoint being the percent change in weight from baseline to week 72 5.

Efficacy and Safety

• Tirzepatide has been shown to be effective in reducing HbA1c levels and body weight in patients with type 2 diabetes and obesity 2, 3, 4, 5.
• The most common adverse events associated with tirzepatide are gastrointestinal, including nausea, diarrhea, decreased appetite, and vomiting 2, 4, 5.
• Tirzepatide has been shown to have a similar safety profile to other GLP-1 receptor agonists, with a low risk of hypoglycemia when used without insulin or insulin secretagogues 3, 4.

Clinical Implications

• Tirzepatide has the potential to be a valuable addition to the treatment of type 2 diabetes and obesity, with its dual mechanism of action and favorable efficacy and safety profile 3, 6.
• Further studies are needed to fully determine the place of tirzepatide in therapy and to assess its long-term implications on cardiovascular outcomes 6.