What is the dosing for Tizepatide (Tirzepatide)?

From the Guidelines

Tirzepatide dosing should start at 2.5 mg subcutaneously once weekly for the first 4 weeks, then increase to 5 mg weekly for at least 4 weeks, with a maximum recommended dose of 15 mg weekly, as indicated in the most recent guidelines 1. The dosing regimen for tirzepatide is designed to minimize gastrointestinal side effects, which are common with the initiation of GLP-1 receptor agonists.

• The initial dose of 2.5 mg weekly for 4 weeks helps to reduce the risk of nausea, vomiting, and diarrhea.
• After the initial 4 weeks, the dose can be increased to 5 mg weekly for at least 4 weeks.
• Further dose escalation can be done in 2.5 mg increments every 4 weeks until the target dose is reached, with a maximum recommended dose of 15 mg weekly. For patients with type 2 diabetes, the maintenance dose is typically in the range of 5-15 mg weekly, while for weight management, doses of 10-15 mg weekly are often targeted 2. It is essential to administer the injection on the same day each week, but the day can be changed if needed, as long as the last dose was given at least 3 days prior. The medication should be injected subcutaneously in the abdomen, thigh, or upper arm. Tirzepatide works by activating both GLP-1 and GIP receptors, which helps improve insulin secretion, reduce glucagon levels, slow gastric emptying, and increase satiety, leading to improved glycemic control and weight loss, as supported by recent pharmacologic approaches to glycemic treatment 3, 4.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Tizepatide Dosing

• The optimal dose of tirzepatide for type 2 diabetes mellitus was evaluated in a meta-analysis and trial sequential analysis 5.
• The study found that tirzepatide 15 mg was more effective than tirzepatide 10 mg and 5 mg in reducing glycosylated hemoglobin type A1c (HbA1c), fasting serum glucose (FSG), and weight.
• However, the study also found that tirzepatide 5 mg had a better safety profile compared to tirzepatide 10 mg and 15 mg, with fewer adverse events.
• Based on the study, it is recommended to start with tirzepatide 5 mg and adjust the dose to 15 mg if necessary to achieve better glycemic control 5.
• Another study compared the efficacy and safety of once-weekly tirzepatide with semaglutide in patients with type 2 diabetes, and found that tirzepatide was noninferior and superior to semaglutide in reducing HbA1c levels 6.
• The study also found that tirzepatide had a greater effect on weight reduction compared to semaglutide.

Dosage Comparison

• A comparison of the dosage of tirzepatide and other GLP-1 receptor agonists, such as semaglutide, found that tirzepatide had a more profound effect on reducing HbA1c levels and weight 6.
• The study found that tirzepatide 15 mg was more effective than semaglutide 1 mg in reducing HbA1c levels and weight.
• However, the study also found that tirzepatide had a similar safety profile to semaglutide, with similar rates of adverse events.

Safety and Efficacy

• A systematic review and meta-analysis of randomized trials found that long-acting GLP-1 receptor agonists, including tirzepatide, reduced the incidence of major adverse cardiovascular events (MACE) and all-cause mortality in patients with type 2 diabetes 7.
• The study found that there was no significant difference in the safety profile of long-acting GLP-1 receptor agonists, including tirzepatide, compared to placebo.
• Another study found that the use of GLP-1 receptor agonists, including tirzepatide, was not associated with an increased risk of pancreatitis in patients with type 2 diabetes 8.