Tirzepatide Starting Dose for Type 2 Diabetes
The starting dose of tirzepatide for type 2 diabetes is 2.5 mg subcutaneously once weekly for 4 weeks, then increased to 5 mg once weekly. 1
Dose Escalation Protocol
- Initial titration: Begin with 2.5 mg subcutaneously once weekly for the first 4 weeks 1
- Maintenance dosing: After the initial 4-week period, increase to 5 mg once weekly 1
- Further titration if needed: If additional glycemic control is required after at least 4 weeks on the 5 mg dose, increase to 10 mg once weekly 1
- Maximum dose: Can be increased to 15 mg once weekly after at least 4 weeks on the 10 mg dose if further glycemic control is needed 1
Dosing Rationale
The dose-dependent efficacy of tirzepatide has been well-established across the SURPASS clinical trial program, with higher doses achieving greater HbA1c reductions (1.24% to 2.58%) and weight loss (5.4 to 11.7 kg). 2 The 10 mg weekly dose produces approximately 12.8% weight loss from baseline, while the 15 mg weekly dose achieves 14.7% weight loss. 3
Special Considerations
- Insulin co-administration: When adding tirzepatide to existing insulin therapy, reassess and reduce insulin dosing to minimize hypoglycemia risk, as tirzepatide reduces severe hypoglycemia compared to insulin (RR 0.21). 3
- Renal impairment: Exercise caution when initiating or increasing the dose in patients with kidney disease. 3
- Gastrointestinal tolerability: The most common adverse events are nausea, vomiting, diarrhea, and esophageal reflux, which are more common at higher doses. 3, 2
Clinical Context
Tirzepatide demonstrates superior efficacy compared to semaglutide 1 mg weekly and basal insulin for both glycemic control and weight reduction. 2, 4 A substantial proportion of patients (23.0% to 62.4%) achieve normoglycemia (HbA1c <5.7%), and 20.7% to 68.4% lose more than 10% of baseline body weight. 2