What are the guidelines for prescribing Mounjaro (tirzepatide) to a patient with diabetes?

From the Guidelines

Mounjaro (tirzepatide) should be prescribed to patients with type 2 diabetes as an adjunct to diet and exercise, with a recommended initial dose of 2.5 mg once weekly by subcutaneous injection for the first 4 weeks, then increased to 5 mg weekly, as it has been shown to have a very high glucose-lowering efficacy and potential benefits on weight loss and cardiovascular outcomes 1. The medication is a dual GIP and GLP-1 receptor agonist, which stimulates insulin secretion and reduces glucagon levels in a glucose-dependent manner, while also slowing gastric emptying and reducing appetite, leading to improved glycemic control and often resulting in weight loss. Some key considerations for prescribing Mounjaro include:

• Initiating the dose at 2.5 mg weekly for the first 4 weeks, then increasing to 5 mg weekly, with potential further increases in 2.5 mg increments every 4 weeks as needed, up to a maximum of 15 mg weekly
• Injecting the medication into the abdomen, thigh, or upper arm, rotating injection sites with each dose
• Refrigerating the medication but warming it to room temperature before injection
• Using caution in patients with a history of pancreatitis, severe gastrointestinal disease, or diabetic retinopathy
• Monitoring patients for common side effects such as nausea, vomiting, diarrhea, and decreased appetite, which typically improve over time. It is essential to note that Mounjaro is not indicated for patients with type 1 diabetes or diabetic ketoacidosis, and its use should be individualized based on the patient's specific needs and medical history, as outlined in the standards of care in diabetes-2025 1.

From the FDA Drug Label

MOUNJARO® is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. The recommended starting dosage of MOUNJARO is 2.5 mg injected subcutaneously once weekly. MOUNJARO has not been studied in patients with a history of pancreatitis. MOUNJARO is not indicated for use in patients with type 1 diabetes mellitus.

The guidelines for prescribing Mounjaro (tirzepatide) to a patient with diabetes are:

• Indication: Mounjaro is indicated for adults with type 2 diabetes mellitus as an adjunct to diet and exercise to improve glycemic control.
• Dosage: The recommended starting dosage is 2.5 mg injected subcutaneously once weekly, with a maximum dosage of 15 mg.
• Contraindications: Mounjaro is contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
• Limitations of use: Mounjaro has not been studied in patients with a history of pancreatitis and is not indicated for use in patients with type 1 diabetes mellitus 2, 2, 2.

From the Research

Guidelines for Prescribing Mounjaro (Tirzepatide)

Mounjaro (tirzepatide) is approved for use as an adjunct to diet and exercise to improve glycaemic control in adults with type 2 diabetes mellitus (T2DM) 3. The guidelines for prescribing Mounjaro include:

• It can be used as monotherapy or add-on-therapy to oral glucose-lowering medications and insulin 3.
• It is administered via a single-dose prefilled pen or single-dose vial, given once-weekly by subcutaneous injection 3.
• The SURPASS clinical trials have demonstrated that tirzepatide has potent glucose lowering and weight loss with adverse effects comparable to GLP-1 receptor agonists 4, 5.

Administration and Dosing

The administration and dosing of Mounjaro are as follows:

• It is given by subcutaneous injection once-weekly 3.
• The dose may be adjusted based on the patient's response to treatment and tolerability 6.

Potential Side Effects and Contraindications

The potential side effects and contraindications of Mounjaro include:

• Gastrointestinal events such as nausea, diarrhoea, decreased appetite, and vomiting 3.
• A low risk of clinically significant or severe hypoglycaemia 3.
• No increased risk of major adverse cardiovascular events 3.
• Contraindications and cautions for use will be discussed in the nursing standard overview of tirzepatide therapy 6.

Place in Therapy

Mounjaro has a place in the management of type 2 diabetes as:

• A novel dual GIP/GLP-1 receptor agonist with potent glucose lowering and weight loss effects 4, 7, 5.
• A valuable addition to the treatment options for T2DM, with a safety profile consistent with that of GLP-1 RAs 3.