How to use Terzipatide (generic name) for treatment?

How to Use Tirzepatide

Tirzepatide should be administered as a subcutaneous injection once weekly, starting at 2.5 mg and titrating upward every 4 weeks through 5 mg, 7.5 mg, 10 mg, 12.5 mg, to a maximum maintenance dose of 15 mg weekly for optimal weight loss and glycemic control. 1, 2

Dosing Protocol and Titration Schedule

Starting and Maintenance Doses:

• Begin with 2.5 mg subcutaneously once weekly (this is a tolerability dose, not therapeutic) 1, 3
• Increase to 5 mg after 4 weeks 1, 2
• Continue escalating every 4 weeks: 7.5 mg → 10 mg → 12.5 mg → 15 mg 1, 2
• The FDA-approved therapeutic doses are 5 mg, 10 mg, and 15 mg weekly 2
• Maximum dose is 15 mg weekly, which provides the greatest efficacy (20.9% weight loss at 72 weeks) 1, 2

Dose-Dependent Efficacy:

• 5 mg weekly: 15.0% mean weight loss 1
• 10 mg weekly: 19.5% mean weight loss 1
• 15 mg weekly: 20.9% mean weight loss (maximum efficacy) 1, 2

Administration Technique

Injection Details:

• Administer subcutaneously once weekly on the same day each week 2, 4
• Can be given at any time of day, with or without meals 2
• Inject into the abdomen, thigh, or upper arm 5
• Each prefilled pen delivers 20 mcg per dose for up to 28 days 5

Patient Selection Criteria

Indications:

• BMI ≥30 kg/m² (obesity) OR BMI ≥27 kg/m² with at least one weight-related comorbidity (hypertension, dyslipidemia, obstructive sleep apnea, cardiovascular disease) 1
• Type 2 diabetes requiring improved glycemic control 4, 6, 7

Absolute Contraindications:

• Personal or family history of medullary thyroid carcinoma 1
• Multiple Endocrine Neoplasia syndrome type 2 1

Monitoring Schedule

Initial Phase (First 3 Months):

• Assess effectiveness and safety at least monthly 1, 2
• Monitor weight and BMI 1
• Check blood pressure 1
• Evaluate gastrointestinal symptoms (nausea, diarrhea, vomiting, constipation) 1, 2

Maintenance Phase (After 3 Months):

• Assess at least quarterly 1, 2
• Continue monitoring weight, BMI, blood pressure 1
• Watch for signs of cholelithiasis and gallstone-related complications 1
• Monitor for delayed absorption of oral medications with narrow therapeutic indices 1, 2

Treatment Evaluation Timepoint:

• Evaluate response at 12-16 weeks on the maximum tolerated dose 3
• Expect at least 4-5% body weight loss by 16 weeks to justify continuation 3
• Do not assess efficacy at one month on the 2.5 mg starting dose 3

Common Adverse Events and Management

Gastrointestinal Side Effects (Most Common):

• Nausea: 13-18% of patients 2, 6
• Diarrhea: 12-17% 2, 6
• Constipation: 12-18% 2, 6
• Vomiting: 6-10% 6
• Decreased appetite: 10-12% 2

These are typically mild to moderate and decrease over time with continued use 6, 8. The gradual dose escalation strategy minimizes these effects 2.

Hypoglycemia Risk:

• Very low when used without insulin or insulin secretagogues (0.2-1.7%) 6, 9

Special Populations and Considerations

Renal Impairment:

• No dose adjustment needed for mild to moderate renal impairment 2
• In severe renal impairment (CrCl <30 mL/min), AUC and half-life increase by 73% and 77% respectively 5

Hepatic Impairment:

• No specific studies performed 5

Perioperative Management:

• Consider stopping before elective procedures due to delayed gastric emptying 2

Contraception:

• For patients using oral hormonal contraception, advise using or adding a non-oral method for 4 weeks after initiation and each dose escalation 2

Ramadan Fasting:

• Can be continued at established dose 2
• Some experts recommend reaching at least 7 mg dose 2-3 weeks before Ramadan begins 2

Comparative Efficacy

Superior to Other Agents:

• Produces 5.5 kg more weight loss than semaglutide 1.0 mg at 40 weeks 1
• Achieves 20.2% mean weight reduction versus 13.7% with semaglutide at 72 weeks 1, 3
• Greater HbA1c reduction than semaglutide 1 mg (difference of -0.15 to -0.45 percentage points) 6
• Weight loss comparable to bariatric surgery 1, 3

Glycemic Control in Type 2 Diabetes:

• HbA1c reduction of 1.87-2.59% across doses 4, 8, 9
• 23.0-62.4% of patients achieve HbA1c <5.7% (normoglycemia) 4

When to Escalate Dose

Continue Current Dose If:

• Patient has achieved ≥5% weight loss after 3 months 3
• Continued weight loss is occurring 3
• Absence of cravings and good exercise adherence 3
• No significant adverse effects 3

Escalate Dose If:

• Weight loss plateaus completely for 8-12 weeks despite continued lifestyle modifications 3
• Less than 5% total body weight loss after 3-4 months on 5 mg 3

Discontinuation

When to Stop:

• Less than 4-5% body weight loss at 16 weeks on maximum tolerated dose 3

How to Discontinue:

• Simply stop at current dose without tapering 3
• No physiological dependence or withdrawal syndrome 3
• Weight regain is expected and typically begins within weeks 3

Post-Discontinuation Monitoring:

• Reassess metabolic parameters (HbA1c if diabetic, lipids, blood pressure) within 3 months 3

Cost Considerations

• Average wholesale price: $1,272 per 30-day supply 1
• National average drug acquisition cost: $1,017 1