What is the recommended protocol for stopping Mounjaro (tirzepatide) after achieving weight loss?

Protocol for Stopping Mounjaro (Tirzepatide) After Achieving Weight Loss

When stopping Mounjaro (tirzepatide) after achieving weight loss goals, a gradual tapering approach is strongly recommended rather than abrupt discontinuation to minimize weight regain.

Understanding Weight Regain Risk

Research shows that sudden discontinuation of GLP-1 receptor agonists like tirzepatide results in significant weight regain:

• Studies demonstrate that stopping tirzepatide abruptly leads to regaining one-half to two-thirds of lost weight within 1 year 1
• The physiological effects of tirzepatide on appetite, satiety, and gastric emptying cease when the medication is discontinued

Recommended Discontinuation Protocol

Step 1: Assess Readiness to Stop

• Confirm weight loss goal has been achieved and maintained for at least 3 months
• Evaluate if patient has established sustainable lifestyle changes
• Consider metabolic parameters (blood pressure, lipids, glucose control)

Step 2: Implement Gradual Tapering

1. From 15mg weekly dose:

   • Reduce to 10mg weekly for 4 weeks
   • Then reduce to 5mg weekly for 4 weeks
   • Then reduce to 2.5mg weekly for 4 weeks before stopping

2. From 10mg weekly dose:

   • Reduce to 5mg weekly for 4 weeks
   • Then reduce to 2.5mg weekly for 4 weeks before stopping

3. From 5mg weekly dose:

   • Reduce to 2.5mg weekly for 4 weeks before stopping

Step 3: Monitoring During and After Discontinuation

• Monthly weight monitoring during tapering
• Continue weight monitoring every 2 weeks for 3 months after complete discontinuation
• If weight increases by >3% of target weight, consider restarting at the previous effective dose

Special Considerations

Perioperative Management

For patients requiring surgery while on tirzepatide:

• Consider the risk of delayed gastric emptying and potential for pulmonary aspiration 1
• For elective procedures, follow the anesthesia consensus recommendations to temporarily discontinue the medication

Diabetes Management

For patients with diabetes who achieved weight loss with tirzepatide:

• Monitor blood glucose closely during tapering
• Have a plan to adjust other diabetes medications if glycemic control worsens
• Consider maintaining a lower maintenance dose rather than complete discontinuation if diabetes control is a priority

Alternative to Complete Discontinuation

For patients at high risk of weight regain, consider:

1. Maintenance Dosing: Continue at the lowest effective dose (often 2.5mg or 5mg weekly) indefinitely
2. Intermittent Therapy: Use tirzepatide for 3-month periods when weight begins to increase by >5% of target

Important Caveats

• Weight regain is common after stopping any weight loss medication
• Patients should be informed about this risk before discontinuation
• Lifestyle modifications must be maintained after medication discontinuation
• The longer the medication was used, the more gradual the tapering should be
• There are currently no specific FDA guidelines on discontinuation protocols for tirzepatide

This protocol prioritizes minimizing weight regain and maintaining the metabolic benefits achieved during treatment, which directly impacts long-term morbidity and mortality outcomes.