What is the recommended dosing regimen for prescribing Zepbound (tirzepatide) 7.5 mg?

Prescribing Zepbound (Tirzepatide) 7.5 mg

Tirzepatide (Zepbound) 7.5 mg should be administered as a once-weekly subcutaneous injection, with a recommended dose escalation schedule starting at lower doses before reaching the 7.5 mg maintenance dose. 1

Dosing Schedule

• Start with 2.5 mg once weekly for the first 4 weeks 1, 2
• Increase to 5.0 mg once weekly for the next 4 weeks 1, 2
• Then advance to the target maintenance dose of 7.5 mg once weekly 1
• Administer subcutaneously in the abdomen, thigh, or upper arm 2
• Inject on the same day each week, but the time of day and injection site can be changed if needed 2

Clinical Efficacy

• At 7.5 mg weekly maintenance dose, patients can expect approximately 15% weight reduction from baseline over 72 weeks of treatment 2
• Higher doses (10 mg and 15 mg) provide incrementally greater weight loss (19.5% and 20.9% respectively) if needed for patients not achieving adequate response 2
• Tirzepatide demonstrates superior weight loss compared to GLP-1 receptor agonists like liraglutide (3 mg daily) with a mean difference of 13.0% greater weight reduction 1

Administration Considerations

• Administer with or without food 1
• If a dose is missed and it has been >4 days since the missed dose, skip that dose and administer the next dose on the regularly scheduled day 2
• If a dose is missed and it has been <4 days, administer as soon as possible 2
• The medication should be stored in the refrigerator (36°F to 46°F or 2°C to 8°C) 2

Monitoring and Follow-up

• Evaluate weight loss response after 12 weeks at the maintenance dose 1
• If a patient has not lost at least 5% of initial body weight, consider discontinuation or dose escalation to 10 mg if appropriate 1
• Monitor for gastrointestinal side effects, which typically occur during dose escalation 2
• Assess improvements in cardiometabolic parameters including blood pressure, lipid profile, and glycemic control 2, 3

Special Considerations

• For patients with renal impairment, no dose adjustment is needed 2
• For patients with hepatic impairment, use caution as clinical experience is limited 2
• Tirzepatide has shown cardiovascular benefits in patients with type 2 diabetes and obesity, with reduced risk of major adverse cardiovascular events compared to other GLP-1 receptor agonists 3
• The medication has also demonstrated improvements in insulin sensitivity within 12 weeks of treatment initiation 4

Common Side Effects and Management

• Gastrointestinal effects are most common: nausea, vomiting, diarrhea, and constipation 2
• These side effects are typically mild to moderate and occur primarily during dose escalation 2
• Advise patients to stay hydrated and consider anti-emetics if needed for significant nausea 2
• The gradual dose escalation schedule helps minimize these side effects 2

Cost Considerations

• The average wholesale price for a 30-day supply of tirzepatide is approximately $1,272 1
• The National Average Drug Acquisition Cost is approximately $1,017 1
• Check for patient assistance programs or insurance coverage options 1

Remember that tirzepatide is a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, which provides a unique mechanism of action for weight management and metabolic improvement 5, 2.