What is the equivalent dose of Mounjaro (tirzepatide) for a patient being stepped up from Ozempic (semaglutide) 1 milligram?

From the Guidelines

When stepping up from Ozempic 1 mg to Mounjaro, the equivalent starting dose would be Mounjaro 5 mg weekly, as both medications are glucagon-like peptide 1 (GLP-1) receptor agonists, but Mounjaro also has the added benefit of activating the glucose-dependent insulinotropic polypeptide (GIP) receptor, potentially offering enhanced weight loss and glycemic control benefits 1.

Key Considerations for Transition

• Mounjaro comes in multiple dose strengths (2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, and 15 mg), with 5 mg being a typical starting point for patients already on Ozempic (semaglutide) 1 mg.
• The transition involves stopping Ozempic and starting Mounjaro at the 5 mg dose the following week, with potential dose escalation every 4 weeks until reaching the target or maximum tolerated dose of 15 mg.
• This gradual increase helps minimize gastrointestinal side effects, which are a common consideration when initiating or escalating GLP-1 receptor agonists like Mounjaro 1.

Pharmacological Rationale

• Both Ozempic (semaglutide) and Mounjaro (tirzepatide) work as GLP-1 receptor agonists, enhancing glucose-dependent insulin secretion, suppressing glucagon secretion, and slowing gastric emptying.
• Mounjaro's additional action on the GIP receptor may provide further benefits in terms of weight loss and glycemic control, as suggested by its classification as a dual GIP and GLP-1 receptor agonist 1.

Clinical Guidance

• Patients should follow their provider's specific instructions regarding the timing of the last Ozempic dose and the first Mounjaro dose to ensure continuous therapeutic coverage.
• Monitoring for gastrointestinal side effects and adjusting the dose escalation schedule as needed is crucial for minimizing adverse effects and maximizing the therapeutic benefits of Mounjaro 1.

From the Research

Stepping up Ozempic 1 mg to equivalent of Mounjaro

• The decision to step up Ozempic (semaglutide) 1 mg to an equivalent dose of Mounjaro (tirzepatide) should be based on individual patient needs and response to treatment, as well as consideration of potential side effects and costs 2, 3, 4, 5.
• Studies have shown that tirzepatide is more efficacious than semaglutide in reducing HbA1c and body weight in patients with type 2 diabetes 3, 4.
• However, the cost-effectiveness of tirzepatide and semaglutide is a concern, with high costs and uncertain long-term benefits 5.
• The therapeutic potential of semaglutide and tirzepatide in type 1 diabetes and latent autoimmune diabetes in adults is being explored, with promising results in improving glucose control and promoting weight loss 6.

Comparison of Semaglutide and Tirzepatide

• Tirzepatide has been shown to be more effective than semaglutide in reducing HbA1c and body weight in patients with type 2 diabetes 3, 4.
• Both medications have been associated with gastrointestinal adverse events, but the risk of serious adverse events and severe hypoglycemia is low 3, 4.
• The cost-effectiveness of tirzepatide and semaglutide is a concern, with high costs and uncertain long-term benefits 5.

Clinical Considerations

• The decision to step up Ozempic 1 mg to an equivalent dose of Mounjaro should be based on individual patient needs and response to treatment, as well as consideration of potential side effects and costs 2, 3, 4, 5.
• Patients should be closely monitored for adverse events and adjustments to treatment should be made as needed 3, 4.
• Further research is needed to fully understand the long-term benefits and risks of tirzepatide and semaglutide in patients with type 2 diabetes and other conditions 2, 5, 6.