Standard Tirzepatide Titration Schedule
The standard titration schedule for tirzepatide begins with 2.5 mg once weekly for 4 weeks, then increases by 2.5 mg every 4 weeks until the target dose of 5,10, or 15 mg is reached. 1 This gradual titration approach is designed to minimize gastrointestinal side effects while maximizing efficacy for weight loss and glycemic control.
Detailed Titration Protocol
Initial Phase
- Week 1-4: 2.5 mg subcutaneously once weekly
Titration Phase
- Week 5-8: 5.0 mg once weekly
- Week 9-12: 7.5 mg once weekly (if needed)
- Week 13-16: 10.0 mg once weekly (if needed)
- Week 17-20: 12.5 mg once weekly (if needed)
- Week 21 and beyond: 15.0 mg once weekly (maximum dose)
Dose Selection Considerations
The target maintenance dose should be selected based on:
- Clinical response (weight loss and/or glycemic control)
- Tolerability of side effects
- Most patients achieve optimal results at 10-15 mg doses 2
Managing Side Effects During Titration
Gastrointestinal side effects are common during titration:
- Nausea (31%)
- Diarrhea (23%)
- Vomiting (12%)
- Constipation (5%) 1
Strategies to Minimize GI Side Effects
- Reduce meal size during titration period
- Limit alcohol and carbonated beverages
- Avoid high-fat diets
- Consider temporary dose reduction rather than discontinuation if side effects are significant but tolerable 1
- If severe GI effects occur, maintain the current dose for longer than 4 weeks before attempting further increases
Special Considerations
- Renal Impairment: No dose adjustment is required for patients with renal impairment, including end-stage renal disease 2
- Hepatic Impairment: No dose adjustment is necessary 1
- Concomitant Medications: Consider dose reduction of insulin or sulfonylureas when initiating tirzepatide to prevent hypoglycemia 1
- Pre-surgical Planning: Consider stopping tirzepatide at least one week before elective procedures due to delayed gastric emptying 1
Monitoring During Titration
- Schedule follow-up 4 weeks after initiation and after each dose escalation
- Assess for:
- Weight loss progress
- Glycemic control (if treating diabetes)
- Side effect burden
- Need for adjustment of concomitant medications 1
This titration schedule has been shown to be effective in multiple clinical trials, with tirzepatide demonstrating superior weight loss compared to other GLP-1 receptor agonists when properly titrated 2, 3.