What is the recommended dosage schedule for switching from semaglutide (GLP-1 receptor agonist) 0.5mg to tirzepatide (dual GIP and GLP-1 receptor agonist)?

Switching from Semaglutide 0.5mg to Tirzepatide

Start tirzepatide at 2.5 mg once weekly immediately next week, then escalate to 5 mg after 4 weeks, with further increases to 7.5 mg or higher based on glycemic response and tolerability. 1

Initial Dosing Strategy

• Begin with tirzepatide 2.5 mg once weekly as the starting dose when switching from semaglutide 0.5 mg, regardless of your current semaglutide dose 1
• No washout period is required—you can switch directly on your next scheduled injection day 2
• The 2.5 mg starting dose minimizes gastrointestinal side effects (nausea, vomiting, diarrhea) that are most common when initiating or escalating GLP-1 receptor agonist therapy 3

Dose Escalation Schedule

After 4 weeks at 2.5 mg:

• Escalate to 5 mg once weekly if the 2.5 mg dose is well-tolerated 3
• This is the standard titration interval used in clinical trials 3

After an additional 4 weeks at 5 mg:

• Consider escalation to 7.5 mg once weekly if additional glycemic control or weight loss is needed 1
• Recent evidence suggests that patients switching from semaglutide 1.0 mg may benefit from early escalation to 10 mg tirzepatide for optimal glycemic control 1
• Since you're switching from the lower 0.5 mg semaglutide dose, the 7.5 mg tirzepatide dose may be sufficient, but escalation to 10 mg or even 15 mg can be considered based on your HbA1c response and tolerability 3

Key Monitoring Points

• Watch for gastrointestinal symptoms (nausea, vomiting, diarrhea) during the first 4-8 weeks, as these are dose-dependent and most common during initiation and dose escalation 3
• Monitor blood glucose more frequently during the switch, especially if you're also taking insulin or sulfonylureas, as hypoglycemia risk may change 2
• If you experience severe gastrointestinal side effects, the dose escalation can be delayed or the current dose maintained longer 3

Important Caveats

• No renal dose adjustment is needed for tirzepatide across all stages of kidney function, making it safe to switch regardless of your kidney function 4
• Tirzepatide has demonstrated superior efficacy compared to semaglutide 1.0 mg in clinical trials, with HbA1c reductions of 1.24-2.58% and weight loss of 5.4-11.7 kg depending on the final dose 3
• The gastrointestinal side effect profile is similar to semaglutide, so if you tolerated semaglutide well, you'll likely tolerate tirzepatide 3