How do I transition from Wegovy (semaglutide) to Mounjaro (tirzepatide)?

Transitioning from Wegovy (Semaglutide) to Mounjaro (Tirzepatide)

When transitioning from Wegovy (semaglutide) to Mounjaro (tirzepatide), you should stop the weekly semaglutide injection and begin tirzepatide at the starting dose of 2.5 mg weekly, then follow the standard dose escalation protocol regardless of your previous semaglutide dose.

Pharmacological Differences

Understanding the pharmacological differences between these medications is important for a safe transition:

• Mechanism of Action:

  • Semaglutide (Wegovy) is a GLP-1 receptor agonist only 1
  • Tirzepatide (Mounjaro) is a dual GIP/GLP-1 receptor agonist with different binding properties 1

• Pharmacokinetics:

  • Semaglutide has an elimination half-life of 7 days 1
  • Tirzepatide has an elimination half-life of 5 days 1
  • Both are administered subcutaneously once weekly 1

Transition Protocol

1. Discontinuation of Wegovy:

   • Administer the last dose of semaglutide as scheduled
   • Do not overlap medications due to potential additive gastrointestinal side effects

2. Starting Mounjaro:

   • Begin tirzepatide one week after the last semaglutide dose
   • Start with the initial dose of 2.5 mg weekly
   • Follow the standard dose escalation protocol:
     • Weeks 1-4: 2.5 mg once weekly
     • Weeks 5-8: 5 mg once weekly
     • Weeks 9-12: 7.5 mg once weekly
     • Weeks 13-16: 10 mg once weekly
     • Weeks 17 and beyond: 12.5 mg or 15 mg once weekly (maximum dose)

3. Dose Titration:

   • Do not skip the titration process even if you were on a high dose of semaglutide
   • Gradual titration helps minimize gastrointestinal side effects
   • Allow 4 weeks at each dose level before increasing

Monitoring During Transition

1. Glycemic Control:

   • Monitor blood glucose more frequently during the first 4 weeks of transition
   • Be aware that glycemic control might fluctuate initially

2. Side Effects Management:

   • Gastrointestinal effects (nausea, vomiting, diarrhea) are common with both medications but may differ in intensity 2, 3
   • Stay well hydrated and consider smaller, more frequent meals
   • If side effects are severe, contact your healthcare provider

Efficacy Considerations

Research shows that tirzepatide may offer additional benefits compared to semaglutide:

• Tirzepatide demonstrates greater HbA1c reduction compared to semaglutide (2.01-2.30% vs. 1.86%) 2
• Tirzepatide shows superior weight loss compared to semaglutide (additional 1.9-5.5 kg weight loss) 2, 4
• Tirzepatide may have a more pronounced effect on insulin sensitivity and beta-cell function 3

Safety Considerations

1. Hypoglycemia Risk:

   • Both medications have low risk of hypoglycemia when used alone
   • Hypoglycemia rates: tirzepatide (0.2-1.7%) vs. semaglutide (0.4%) 2

2. Psychiatric Adverse Events:

   • Monitor for mood changes, depression, or anxiety
   • Both medications have been associated with rare psychiatric adverse events (1.2% of reports) 5

3. Cardiovascular Effects:

   • Both medications have shown cardiovascular benefits in patients with type 2 diabetes
   • Recent evidence suggests tirzepatide may have greater cardiovascular benefit than semaglutide in certain populations 6

Common Pitfalls to Avoid

1. Skipping the titration process: This increases risk of gastrointestinal side effects
2. Overlapping medications: This may increase side effect burden
3. Expecting immediate results: The full effect of tirzepatide may take several weeks to manifest
4. Discontinuing abruptly: If stopping either medication, gradual dose reduction is preferred to avoid rebound weight gain 1

Special Considerations

• If you experience severe or persistent side effects during transition, contact your healthcare provider
• For patients with diabetes, more frequent blood glucose monitoring is recommended during the transition period
• Insurance coverage may differ between these medications, as Mounjaro may be approved for diabetes but used off-label for weight management 1