How to transition a patient from tirzepatide (GLP-1 and GIP receptor agonist) 10mg subcutaneous (subcut) weekly to zepbound

Transitioning from Tirzepatide 10mg to Zepbound

When transitioning a patient from tirzepatide 10mg subcutaneous weekly to Zepbound, no dose adjustment is necessary as they are the same medication with different brand names - simply continue the same 10mg weekly dose.

Understanding the Medications

Tirzepatide and Zepbound contain the identical active ingredient (tirzepatide), which is a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist. The only difference is branding and indication:

• Tirzepatide (Mounjaro): FDA-approved for type 2 diabetes management
• Zepbound: FDA-approved specifically for weight management 1

Transition Protocol

1. Direct Continuation:

   • Maintain the same 10mg weekly dose when switching from tirzepatide to Zepbound
   • No titration period is required as the patient is already on a stable dose
   • Continue the same day of administration for consistency

2. Administration Details:

   • Administer subcutaneously in the abdomen, thigh, or upper arm
   • Rotate injection sites with each dose
   • Can be administered at any time of day, with or without meals 1

Monitoring After Transition

• Assess treatment response at least quarterly 2
• Continue monitoring for common side effects, particularly gastrointestinal symptoms
• No need for additional laboratory monitoring specifically due to the transition

Important Considerations

Contraception

• If the patient is using oral hormonal contraception, they should use or add a non-oral method for 4 weeks after each dose escalation 2

Perioperative Management

• Be aware of the 5-day half-life of tirzepatide when planning for any surgical procedures 3, 2

Potential Side Effects

• Most common adverse effects are gastrointestinal (nausea, vomiting, diarrhea)
• These effects are typically mild to moderate and transient 3
• No increased risk of hypoglycemia when used without insulin 4

Cautions

• Acute Pancreatitis: Rare but documented adverse effect when switching between GLP-1 agonists 5
• Insulin Adjustment: If the patient is also on insulin, monitor closely as insulin requirements may need to be reduced by approximately 9-22% after transitioning, especially if baseline A1c is ≤8.0% 6

Long-Term Considerations

• Weight regain is likely if medication is discontinued, suggesting a need for long-term treatment 2
• Continued efficacy assessment is important, with consideration of dose adjustment if weight loss plateaus

This transition is straightforward since tirzepatide and Zepbound contain the identical active ingredient at the same concentration, allowing for direct continuation of the current dose and administration schedule.