What is the recommended dose and frequency of Monjaro (tirzepatide) for type 2 diabetes treatment?

Mounjaro (Tirzepatide) Dosing for Type 2 Diabetes

Start Monjaro at 2.5 mg subcutaneously once weekly for 4 weeks, then increase to 5 mg once weekly, with potential escalation to 10 mg and ultimately 15 mg once weekly at 4-week intervals based on glycemic response and tolerability. 1

Initial Dosing Protocol

• Begin with 2.5 mg subcutaneously once weekly for the first 4 weeks as the starting dose 1
• Increase to 5 mg once weekly after the initial 4-week period 1
• The 2.5 mg starting dose serves as a titration dose to minimize gastrointestinal side effects, not as a therapeutic maintenance dose 1

Dose Escalation Strategy

If additional glycemic control is needed:

• Escalate to 10 mg once weekly after at least 4 weeks on the 5 mg dose 1
• For maximum glycemic control, increase to 15 mg once weekly after at least 4 weeks on the 10 mg dose 1
• Each dose escalation should occur at minimum 4-week intervals to allow for tolerability assessment 1

Administration Details

• Administer once weekly on the same day each week, regardless of meals 2
• Available as single-dose prefilled pens and single-dose vials for subcutaneous injection 2
• The once-weekly dosing schedule provides convenience compared to daily injectable therapies 2

Renal Function Considerations

• No dosage adjustments are required for patients with normal renal function or mild to moderate renal impairment 1
• This represents an advantage over some other antidiabetic medications that require dose modification in kidney disease 1

Concomitant Medication Adjustments

Critical safety consideration:

• Reduce doses of insulin or insulin secretagogues when initiating tirzepatide to minimize hypoglycemia risk 1
• This dose reduction is particularly important as tirzepatide enhances insulin secretion and improves glycemic control 1

Expected Outcomes with Proper Dosing

• Tirzepatide at 5-15 mg weekly reduces HbA1c by 1.87% to 3.02% across the dose range 3
• Body weight reductions of 5.4 to 12.9 kg occur with proper titration over treatment periods up to 104 weeks 3
• Higher doses (10-15 mg) demonstrate superior glycemic control, with mean HbA1c reductions of -2.40% and -2.34% respectively compared to -0.86% with placebo 4
• Between 85-90% of patients achieve HbA1c <7% with tirzepatide doses of 10-15 mg 4

Managing Gastrointestinal Side Effects

• Inform patients about potential transient nausea and vomiting, which are minimized by the gradual dose titration schedule 1
• The most common adverse events are gastrointestinal: nausea (13-18%), diarrhea (12-21%), decreased appetite, and vomiting 2, 4
• These events are mostly mild to moderate in severity and decrease over time with continued therapy 2

Contraindications to Initiation

Avoid tirzepatide in patients with:

• Personal or family history of medullary thyroid cancer 1
• Multiple endocrine neoplasia type 2 (MEN2) 1
• History of serious hypersensitivity reaction to tirzepatide 1

Special Cautions

Use with caution in:

• Patients with clinically meaningful gastroparesis 1
• Prior gastric surgery, including bariatric surgery 1
• Pregnancy or breastfeeding 1
• Perioperative settings due to delayed gastric emptying that may increase aspiration risk during anesthesia 1