Converting Ozempic 1 mg to Mounjaro Dosing
When converting from Ozempic (semaglutide) 1 mg weekly to Mounjaro (tirzepatide), the recommended equivalent starting dose is 5 mg of tirzepatide weekly, with titration to higher doses as needed for optimal glycemic control.
Rationale for Conversion
Ozempic (semaglutide) and Mounjaro (tirzepatide) are both injectable medications for type 2 diabetes, but they have different mechanisms of action:
- Ozempic is a GLP-1 receptor agonist
- Mounjaro is a dual GIP/GLP-1 receptor agonist with potentially greater efficacy
Dosing Comparison
Based on the available evidence, here's how the medications compare:
| Medication | Available Doses | Maximum Approved Dose |
|---|---|---|
| Ozempic (semaglutide) | 0.25 mg, 0.5 mg, 1 mg, 2 mg weekly | 2 mg weekly [1] |
| Mounjaro (tirzepatide) | 2.5 mg, 5 mg, 10 mg, 15 mg weekly | 15 mg weekly [1] |
Conversion Protocol
Initial Conversion: Start with tirzepatide 5 mg once weekly when converting from semaglutide 1 mg
Dose Titration:
- After 4 weeks on 5 mg, consider increasing to 10 mg weekly if additional glycemic control is needed
- After another 4 weeks, may increase to maximum dose of 15 mg weekly if needed
Monitoring: Assess glycemic response and tolerability at each dose level before titrating up
Evidence for Efficacy Comparison
Clinical trials directly comparing these medications show:
- Tirzepatide demonstrated superior glycemic control compared to semaglutide in head-to-head trials 2
- The SURPASS-2 trial showed tirzepatide at all doses (5 mg, 10 mg, 15 mg) was superior to semaglutide 1 mg for HbA1c reduction 2
- Mean HbA1c reductions were:
- Tirzepatide 5 mg: -2.01%
- Tirzepatide 10 mg: -2.24%
- Tirzepatide 15 mg: -2.30%
- Semaglutide 1 mg: -1.86%
Important Clinical Considerations
- Gastrointestinal Side Effects: Both medications commonly cause GI effects (nausea, vomiting, diarrhea), but tirzepatide may have slightly higher rates, especially at higher doses 2, 3
- Hypoglycemia Risk: Low risk with both medications when used as monotherapy, but monitor if combined with insulin or sulfonylureas
- Cost Considerations: Both medications have similar cost profiles according to AWP/NADAC data 1
Common Pitfalls to Avoid
Skipping Titration: Do not start directly at higher tirzepatide doses (10 mg or 15 mg) when converting from semaglutide, as this increases risk of GI side effects
Overlapping Medications: Discontinue semaglutide before starting tirzepatide to avoid duplicate incretin effects
Inadequate Monitoring: Both medications have long half-lives (approximately 5-7 days), so effects of dose changes may not be immediately apparent
In summary, when converting from Ozempic 1 mg to Mounjaro, start with 5 mg weekly of tirzepatide and titrate as needed based on glycemic response and tolerability.