What are the considerations for switching from Ozempic (semaglutide) to Mounjaro (tirzepatide)?

From the Guidelines

Switching from Ozempic (semaglutide) to Mounjaro (tirzepatide) should be done under medical supervision, with a straightforward transition that does not require a washout period between medications, as both are GLP-1 receptor agonist medications used for type 2 diabetes and weight management. When transitioning, if you're on Ozempic 1 mg weekly, you would generally start Mounjaro at the initial dose of 2.5 mg weekly for four weeks, then increase to 5 mg weekly, with potential further increases as needed and tolerated 1. The transition is straightforward because both medications work through similar mechanisms, though Mounjaro also activates the GIP receptor, potentially offering additional benefits for glucose control and weight loss, as noted in the 2024 standards of care in diabetes 1.

Key Considerations

• Both Ozempic and Mounjaro are associated with gastrointestinal side effects, including nausea, vomiting, and diarrhea, which often improve over time 1.
• Monitoring of blood glucose is crucial during the transition, as the response to the new medication may differ 1.
• Insurance coverage and cost considerations should be addressed before switching, as Mounjaro may have different coverage requirements than Ozempic.
• The dual GIP and GLP-1 RA action of Mounjaro may offer additional benefits for weight loss and glucose control compared to Ozempic, which is a GLP-1 RA alone 1.

Clinical Implications

• The choice to switch from Ozempic to Mounjaro should be based on individual patient needs and responses to therapy, considering factors such as efficacy, side effects, and cost 1.
• Healthcare providers should closely monitor patients during the transition to ensure a smooth adjustment to the new medication and to address any concerns or side effects that may arise.

From the FDA Drug Label

When initiating MOUNJARO, consider reducing the dose of concomitantly administered insulin secretagogues (e.g., sulfonylureas) or insulin to reduce the risk of hypoglycemia [see Warnings and Precautions (5.3)]. The main consideration for switching from Ozempic (semaglutide) to Mounjaro (tirzepatide) is to reduce the dose of concomitantly administered insulin secretagogues or insulin to minimize the risk of hypoglycemia 2.

• Monitor patients on oral medications dependent on threshold concentrations for efficacy and those with a narrow therapeutic index (e.g., warfarin) when concomitantly administered with MOUNJARO.
• Caution should be exercised when oral medications are concomitantly administered with MOUNJARO, as it delays gastric emptying and may impact the absorption of concomitantly administered oral medications 2.

From the Research

Considerations for Switching from Ozempic (Semaglutide) to Mounjaro (Tirzepatide)

• The decision to switch from semaglutide to tirzepatide should be based on individual patient needs and medical history, as there is limited data on direct comparisons between the two medications 3.
• Tirzepatide has been shown to have a greater mean weight loss compared to semaglutide, with a difference of -3.78 kg (95% CI = -5.52, -2.04) 4.
• The SURPASS-2 trial found that tirzepatide was noninferior and superior to semaglutide in terms of glycated hemoglobin level reduction, with estimated mean changes from baseline of -2.01, -2.24, and -2.30 percentage points for tirzepatide 5 mg, 10 mg, and 15 mg, respectively, compared to -1.86 percentage points for semaglutide 3.
• When switching from one GLP-1 receptor agonist to another, an individualized approach is recommended, taking into account factors such as reimbursement requirements, treatment duration and dose of previous GLP-1RA, patient experience, concomitant treatment, and clinical characteristics 5.
• Transient gastrointestinal adverse effects that may occur when switching to another GLP-1RA can be reduced by slow up-titration and advising patients to reduce food portion sizes and fat intake 5.
• Medical triggers for switching to another GLP-1RA may include HbA1c targets not being met, a desire for additional weight loss, poor adherence, increased CV risk status, and adverse effects with the current GLP-1RA 5.
• Non-medical triggers for switching may include patient preference, cost, formulary changes, and insurance mandates 5.