What is the recommended starting dose of Mounjaro (tirzepatide)?

Recommended Starting Dose of Mounjaro (Tirzepatide)

The recommended starting dose of tirzepatide (Mounjaro) is 2.5 mg administered as a subcutaneous injection once weekly for the first 4 weeks. 1

Dosing Schedule and Titration

• Initiate tirzepatide therapy with 2.5 mg weekly subcutaneous injections for the first 4 weeks 1
• After 4 weeks at the initial dose, increase to 5 mg once weekly 1
• Further dose escalations should occur based on clinical response and tolerability:
  • Increase to 10 mg once weekly after at least 4 weeks on the 5 mg dose 1
  • Maximum dose of 15 mg once weekly can be reached after at least 4 weeks on the 10 mg dose 1

Administration Considerations

• Administer tirzepatide as a subcutaneous injection once weekly 1
• The injection can be given at any time of day, regardless of meals 1
• No dose adjustments are required for patients with renal impairment 1

Clinical Efficacy

• Tirzepatide has demonstrated significant efficacy in reducing HbA1c (1.24-2.58%) and body weight (5.4-11.7 kg) in clinical trials 2
• In the SURPASS clinical trial program, tirzepatide showed superior efficacy compared to selective GLP-1 receptor agonists and basal insulin 2, 3
• Recent evidence shows tirzepatide also has benefits for patients with heart failure with preserved ejection fraction and obesity 4

Side Effect Management

• Common side effects include nausea (10-31%), diarrhea (7-23%), vomiting (2-12%), constipation (3-5%), and abdominal pain (3-5%) 1
• Gastrointestinal adverse events are generally dose-dependent and tend to decrease over time 5
• The gradual dose escalation schedule is designed to improve tolerability 1, 3

Important Precautions

• Monitor for signs of pancreatitis and discontinue tirzepatide if suspected 1, 6
• Use caution in patients with kidney disease when initiating or increasing the dose due to potential risk of acute kidney injury 1
• Tirzepatide carries a black box warning regarding the risk of thyroid C-cell tumors in rodents (human relevance not determined) 1
• Contraindicated in patients with personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia type 2 1

Special Populations

• Tirzepatide has been studied in adolescents with type 2 diabetes, showing similar efficacy and safety profiles to adults, though the starting dose remains 2.5 mg weekly 5
• The medication has a half-life of approximately 5 days, which is important to consider for perioperative management 1

Following this gradual titration schedule is essential to minimize gastrointestinal side effects while achieving optimal therapeutic benefits. The low starting dose allows the body to adjust to the medication before increasing to more therapeutically effective doses.