From the Guidelines
When switching from Wegovy (semaglutide) to Mounjaro (tirzepatide), the recommended protocol is to discontinue Wegovy and start Mounjaro at the initial dose of 2.5 mg once weekly for 4 weeks. After this initial period, gradually increase the Mounjaro dose at 4-week intervals, following the standard titration schedule: 2.5 mg to 5 mg, then potentially to 7.5 mg, 10 mg, 12.5 mg, and finally 15 mg as tolerated and needed for glycemic control or weight management. There is no need for a washout period between medications, as both work through similar mechanisms. Patients should administer their last dose of Wegovy, then begin Mounjaro the following week on their regular injection day. During the transition, patients should monitor for potential side effects, which commonly include nausea, vomiting, diarrhea, and constipation. These effects may be less pronounced in patients already acclimated to GLP-1 receptor agonists like Wegovy. The gradual titration approach is important because it allows the body to adjust to tirzepatide's dual GLP-1 and GIP receptor agonism, which differs from semaglutide's single GLP-1 receptor mechanism, potentially offering additional metabolic benefits while minimizing gastrointestinal side effects during the transition 1.
Key Considerations
- The transition from Wegovy to Mounjaro should be managed with careful consideration of the patient's individual needs and medical history.
- Monitoring for side effects and adjusting the dose as needed is crucial for minimizing adverse effects and maximizing the therapeutic benefits of Mounjaro.
- The dual mechanism of action of tirzepatide, targeting both GLP-1 and GIP receptors, may offer additional benefits for weight management and glycemic control compared to semaglutide's single GLP-1 receptor agonism 1.
- Patients should be educated on the importance of adherence to the prescribed titration schedule and the potential for gastrointestinal side effects, which can be mitigated with gradual dose escalation and dietary adjustments 1.
Clinical Evidence
The recommendation for switching from Wegovy to Mounjaro is based on the most recent and highest quality clinical evidence available, including studies published in reputable medical journals such as Anaesthesia, Gastroenterology, and JAMA 1. These studies demonstrate the efficacy and safety of tirzepatide for weight management and glycemic control, as well as its potential benefits over semaglutide in certain patient populations. However, it is essential to consider the individual patient's needs and medical history when making treatment decisions.
From the Research
Changeover Guide from Wegovy to Mounjaro
There are no direct studies that provide a changeover guide from Wegovy (semaglutide) to Mounjaro (tirzepatide). However, several studies have compared the efficacy and safety of these two medications for weight management and type 2 diabetes treatment.
Efficacy Comparison
- Studies have shown that tirzepatide is more effective than semaglutide in reducing body weight and HbA1c levels in adults with type 2 diabetes 2, 3, 4.
- A systematic review and network meta-analysis found that tirzepatide had a more pronounced effect on HbA1c and weight reduction compared to semaglutide in people with type 2 diabetes 2.
- Another study found that tirzepatide 10 and 15 mg resulted in greater reductions in percentage change in body weight compared to semaglutide 2.4 mg 3.
Safety Comparison
- Both tirzepatide and semaglutide have been associated with gastrointestinal adverse events, but the incidence of these events was higher with tirzepatide 2, 4.
- A study found that the most common adverse events in both treatment groups were gastrointestinal, and most were mild to moderate in severity and occurred primarily during dose escalation 4.
Switching from Semaglutide to Tirzepatide
- There is no established protocol for switching from semaglutide to tirzepatide, but it is recommended to consult with a healthcare professional before making any changes to medication regimens.
- Healthcare professionals should consider the individual patient's response to semaglutide, their medical history, and potential interactions with other medications when deciding to switch to tirzepatide.
- Patients should be closely monitored for adverse events and efficacy after switching to tirzepatide, and the dose should be adjusted as needed to minimize adverse events and optimize efficacy.