What is the recommended dosage of Zepbound (tirzepatide) for a 14-year-old?

Zepbound (Tirzepatide) for 14-Year-Olds: Dosing Recommendations

Zepbound (tirzepatide) is not FDA-approved for use in adolescents aged 14 years. Based on the most recent evidence, tirzepatide should only be used in patients 18 years and older for weight management, or in adolescents with type 2 diabetes as part of clinical trials 1, 2.

Recent Clinical Evidence for Adolescents

• The SURPASS-PEDS trial (2025) is the first major study evaluating tirzepatide in youth with type 2 diabetes (ages 10-17), using doses of 5 mg and 10 mg weekly 2.
• In this trial, tirzepatide demonstrated significant improvements in glycemic control and BMI compared to placebo in adolescents with type 2 diabetes 2.
• The safety profile in adolescents was consistent with that reported in adults, with primarily gastrointestinal side effects that were mild to moderate in severity 2.

Dosing Considerations for Adolescents

• For adolescents with type 2 diabetes who might be considered for tirzepatide under clinical guidance:
  • Starting dose would typically be lower than adult doses, with gradual titration 3, 2.
  • Physiologically-based pharmacokinetic modeling suggests that adolescents aged 12-15 years may require dose adjustments to approximately 75-87.5% of adult doses 3.
  • For a 14-year-old, this would translate to starting at the lowest available dose (2.5 mg weekly for titration) with potential increases based on response and tolerability 3, 2.

Important Safety Considerations

• Common side effects include gastrointestinal symptoms (nausea, vomiting, diarrhea), which occur primarily during dose escalation 1, 2.
• More serious potential concerns include:
  • Risk of thyroid C-cell tumors (black box warning) 1.
  • Potential for gallstone-related complications 1.
  • Gastrointestinal disorders including severe constipation and small bowel obstruction 1.
  • Possible delayed absorption of oral medications 1.

Clinical Recommendations

• For weight management in 14-year-olds: Tirzepatide (Zepbound) is not currently recommended as it lacks FDA approval for this age group 1.
• For adolescents with type 2 diabetes:
  • Consider established treatments with pediatric approval first 1.
  • Tirzepatide could be considered in specialized settings, ideally as part of clinical trials or under close specialist supervision 2.
  • If used, implement careful dose titration starting at the lowest possible dose (2.5 mg weekly), with close monitoring for side effects 3, 2.

Monitoring Recommendations

• If tirzepatide is used in adolescents under specialist care:
  • Monitor for gastrointestinal side effects, especially during dose escalation 1, 2.
  • Evaluate glycemic control and weight response regularly 2.
  • Screen for potential complications including gallbladder issues 1.
  • Monitor for potential consequences of delayed absorption of other medications 1.

Conclusion

While tirzepatide shows promising results in the SURPASS-PEDS trial for adolescents with type 2 diabetes, it remains investigational in this age group. The medication is not currently FDA-approved for 14-year-olds, and its use should be limited to specialized clinical settings with appropriate monitoring and dose adjustments 3, 2.