From the Guidelines
When switching from Mounjaro (tirzepatide) to Wegovy (semaglutide), patients should stop Mounjaro and start Wegovy at the lowest dose of 0.25 mg once weekly for the first month, regardless of their previous tirzepatide dose. This approach is based on the understanding that GLP-1 receptor agonists like semaglutide have shown cardiovascular and CKD benefits, as evidenced by studies such as the one published in Kidney International 1. The dose escalation schedule for Wegovy should then follow the standard protocol: 0.5 mg weekly for one month, then 1 mg weekly for one month, then 1.7 mg weekly for one month, and finally reaching the maintenance dose of 2.4 mg weekly.
Key Considerations
- There is no need for a washout period between medications, and the switch can occur at the time the next Mounjaro dose would have been due.
- The gradual titration approach is necessary because cross-tolerance between these medications is not complete, despite both being GLP-1 receptor agonists.
- Semaglutide (Wegovy) works primarily on GLP-1 receptors, while tirzepatide (Mounjaro) acts on both GLP-1 and GIP receptors.
- Starting at the lowest Wegovy dose helps minimize gastrointestinal side effects like nausea, vomiting, and diarrhea that commonly occur when initiating these medications, as noted in the consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) 1.
Monitoring and Adjustment
- Patients should be monitored for side effects during the transition and maintain consistent dietary habits to help their bodies adjust to the new medication.
- It's also important to consider the patient's kidney function, as GLP-1 receptor agonists have shown benefits in reducing albuminuria and slowing eGFR decline, but dose adjustments may be necessary for patients with severe kidney disease, as outlined in Table 4 of the study published in Kidney International 1.
From the Research
Switching from Mounjaro to Wegovy
There are no specific guidelines provided in the available studies for switching from Mounjaro (tirzepatide) to Wegovy (semaglutide). However, the following points can be considered:
- Efficacy and Safety: Studies have shown that tirzepatide is more effective in reducing HbA1c and body weight compared to semaglutide 2, 3, 4.
- Adverse Effects: Both tirzepatide and semaglutide have similar adverse effects, including nausea, vomiting, diarrhea, and constipation 2, 4.
- Dose Titration: When switching between GLP-1 agonists, it is essential to follow appropriate dose titration protocols to minimize the risk of adverse effects 5.
- Clinical Awareness: Healthcare providers should be aware of the potential risks associated with switching between GLP-1 agonists, including the risk of acute pancreatitis 5.
Key Considerations
- Monitor Patient Response: Closely monitor patients for adverse effects and adjust the dose or switch to a different medication if necessary.
- Follow Dose Titration Protocols: Adhere to recommended dose titration protocols when switching between GLP-1 agonists to minimize the risk of adverse effects.
- Patient Education: Educate patients on the potential risks and benefits of switching from Mounjaro to Wegovy and the importance of reporting any adverse effects. Some studies compared the efficacy of tirzepatide and semaglutide, including 2, 3, 4, but none of these studies provided specific guidelines for switching from one medication to the other.