From the Guidelines
When transitioning from Ozempic (semaglutide) to Mounjaro (tirzepatide), it is recommended to discontinue Ozempic and initiate Mounjaro at the starting dose of 2.5 mg once weekly for 4 weeks. This approach is based on the most recent evidence available, including the consensus statement from the Association of Anaesthetists, Association of British Clinical Diabetologists, and other reputable organizations 1.
Key Considerations
- The patient's current dose of Ozempic is 2mg, but the transition to Mounjaro should start with a dose of 2.5 mg once weekly, as this is the recommended starting dose for Mounjaro.
- After the initial 4-week period, the dose of Mounjaro can be increased to 5 mg once weekly for at least 4 weeks, and subsequent dose increases can be made in 2.5 mg increments every 4 weeks based on clinical response and tolerability, up to a maximum dose of 15 mg once weekly.
- It is essential to monitor patients for gastrointestinal side effects during the transition and adjust the dose as needed based on individual response and tolerability.
- The gradual titration schedule is crucial to minimize the risk of overlapping side effects while maintaining glycemic control, as both medications work on similar pathways but have different mechanisms 1.
Transitioning from Ozempic to Mounjaro
- Patients should not take their last Ozempic dose and first Mounjaro dose on the same day; instead, they should start Mounjaro the following week after their last Ozempic dose.
- This approach allows for a smooth transition and reduces the risk of adverse effects.
- The properties of GLP-1RA and GIP, as outlined in the consensus statement, support this approach, highlighting the importance of careful dose titration and monitoring during the transition period 1.
From the FDA Drug Label
The recommended starting dosage of MOUNJARO is 2.5 mg injected subcutaneously once weekly. The recommended dose to start Mounjaro is 2.5 mg injected subcutaneously once weekly, regardless of the patient's previous dose of Ozempic.
- The dosage can be escalated after 4 weeks to reduce the risk of gastrointestinal adverse reactions.
- The maximum dosage of Mounjaro is 15 mg injected subcutaneously once weekly 2.
From the Research
Transitioning from Ozempic to Mounjaro
When transitioning a patient from Ozempic (semaglutide) to Mounjaro (tirzepatide), the recommended dosing is not directly stated in the provided studies. However, we can look at the dosing comparisons between semaglutide and tirzepatide in the studies:
- A study comparing tirzepatide and semaglutide found that tirzepatide at doses of 5 mg, 10 mg, and 15 mg was noninferior and superior to semaglutide at a dose of 1 mg 3.
- Another study found that 5 mg, 10 mg, and 15 mg of tirzepatide demonstrated superior efficacy in reducing HbA1c and body weight compared to 1 mg of semaglutide 4.
- There is no direct comparison of dosing when transitioning from semaglutide to tirzepatide, but the studies suggest that tirzepatide is effective at doses of 5 mg, 10 mg, and 15 mg.
Key Points to Consider
- The studies provided do not offer a specific recommendation for transitioning from Ozempic to Mounjaro.
- Tirzepatide has been shown to be effective at doses of 5 mg, 10 mg, and 15 mg in reducing HbA1c and body weight.
- The decision to transition a patient from Ozempic to Mounjaro and the dosing of Mounjaro should be based on individual patient needs and medical judgment.
- It is essential to consider the potential for gastrointestinal adverse events when transitioning to tirzepatide, as these events were more common in patients taking tirzepatide compared to semaglutide 3, 4, 5.
Dosing Considerations
- If a patient is currently taking 2 mg of Ozempic, the closest comparison would be to the 1 mg dose of semaglutide used in the studies.
- Based on the studies, a possible starting dose of Mounjaro could be 5 mg, but this should be determined on a case-by-case basis, considering the individual patient's response to semaglutide and their overall health status.