How to Administer Mounjaro (Tirzepatide)
Mounjaro (tirzepatide) should be administered subcutaneously in the abdomen, thigh, or upper arm once weekly, with rotation of injection sites with each dose. 1
Dosing Protocol
Initial Titration
- Start with 2.5 mg subcutaneously once weekly for 4 weeks
- Increase to 5 mg once weekly for at least 4 weeks
- Further titration as tolerated:
- 7.5 mg once weekly
- 10 mg once weekly
- 12.5 mg once weekly
- Maximum dose: 15 mg once weekly
Administration Guidelines
- Can be administered at any time of day
- Can be given with or without meals
- Rotate injection sites with each dose
- Administer in the abdomen, thigh, or upper arm
Practical Administration Steps
Preparation:
- Remove the pen from refrigerator and allow to warm to room temperature for 30 minutes if refrigerated
- Inspect the solution - it should be clear and colorless to slightly yellow
- Do not use if particles are visible or if solution is cloudy
Injection Technique:
- Wash hands thoroughly
- Clean injection site with alcohol swab
- Pinch skin at injection site
- Insert needle at 90-degree angle
- Press injection button and hold for 5-10 seconds
- Remove needle and dispose of pen properly
Site Rotation:
- Document injection sites
- Rotate between abdomen, thigh, and upper arm
- Maintain at least 1 inch distance from previous injection site
Managing Side Effects
The most common adverse effects are gastrointestinal:
- Nausea (occurs in 12-20% of patients)
- Constipation (14-18%)
- Vomiting
- Diarrhea
Strategies to Minimize GI Effects:
- Start at low dose and titrate slowly
- Reduce meal size
- Avoid high-fat foods
- Limit alcohol and carbonated drinks
Special Considerations
Renal Impairment
- No dose adjustment required for patients with renal impairment, including those with eGFR less than 30 mL/min/1.73 m² 1
Concomitant Insulin Use
- Monitor closely as insulin requirements may need to be reduced by 9-22% after transitioning
- Particularly important if baseline A1c is ≤8.0% 1
Contraception
- Patients using oral hormonal contraception should use or add a non-oral method for 4 weeks after initiation and after each dose escalation 1
Perioperative Management
Storage
- Store in refrigerator (36°F to 46°F or 2°C to 8°C)
- Can be kept at room temperature (below 86°F or 30°C) for up to 21 days
- Do not freeze
- Protect from light
Following this administration protocol will help maximize the efficacy of tirzepatide while minimizing potential side effects, supporting optimal outcomes for glycemic control and weight management.