What is the maintenance dose for Tirzepatide (Dual GIP and GLP-1 receptor agonist)?

Tirzepatide Maintenance Dosing

The FDA-approved maintenance dose for tirzepatide is 15 mg administered subcutaneously once weekly, which provides maximum efficacy for both glycemic control and weight management. 1

Dosing Protocol and Titration

• Tirzepatide is available in three maintenance dose options: 5 mg, 10 mg, and 15 mg administered once weekly 2, 1
• A gradual dose escalation strategy is recommended to minimize gastrointestinal side effects 1:
  • Start at 2.5 mg once weekly
  • Increase by 2.5 mg every 4 weeks until the target maintenance dose is reached 1, 3
• The 15 mg dose demonstrates the greatest efficacy with 20.9% weight loss at 72 weeks compared to 19.5% with 10 mg and 15.0% with 5 mg 1, 4

Efficacy by Dose

• 5 mg weekly: Reduces HbA1c by approximately 2.11% from baseline 5
• 10 mg weekly: Reduces HbA1c by approximately 2.40% from baseline 5
• 15 mg weekly: Reduces HbA1c by approximately 2.34% from baseline 5
• In Japanese patients, tirzepatide reduced HbA1c from 8.5-8.6% to 5.6-6.0% across all doses 6

Monitoring and Follow-up

• Assess effectiveness and safety at least monthly for the first 3 months and quarterly thereafter 1
• Monitor for gastrointestinal side effects, which are the most common adverse events (nausea 13-18%, diarrhea 12-21%) 1, 5
• No dose adjustment is necessary for patients with mild to moderate renal impairment 1

Special Considerations

• Tirzepatide may delay gastric emptying, which could affect the absorption of oral medications with narrow therapeutic indices 1, 3
• For patients using oral hormonal contraception, advise using or adding a non-oral contraception method for 4 weeks after initiation and dose escalations 1
• Consider stopping tirzepatide before elective procedures due to its effect on gastric emptying 1

Common Pitfalls and Management Strategies

• Gastrointestinal side effects are most common but can be minimized through:
  • Slow upward titration schedule 1, 3
  • Reducing meal size 3
  • Limiting alcohol and carbonated drinks 3
  • Avoiding high-fat diets 3
• Treatment discontinuation due to adverse events occurs in approximately 4.3% of patients on 5 mg, 7.1% on 10 mg, and 6.2% on 15 mg 4

Clinical Pearls

• Long-term use is necessary to maintain benefits, and the medication must be used in conjunction with lifestyle modifications for optimal results 3
• Tirzepatide is a dual GIP/GLP-1 receptor agonist, which provides greater efficacy than GLP-1 receptor agonists alone 2, 7
• The average wholesale price is approximately $1,228 for a 30-day supply of the 15 mg dose 2