Monjaro (Tirzepatide) Dosing
Monjaro (tirzepatide) should be initiated at 2.5 mg subcutaneously once weekly for 4 weeks, then increased to 5 mg once weekly, with further dose escalation in 2.5 mg increments every 4 weeks as tolerated up to a maximum of 15 mg once weekly to optimize glycemic control and weight loss. 1
Starting Dose and Titration Schedule
- Begin with 2.5 mg subcutaneously once weekly for the first 4 weeks as the initial dose 1
- Increase to 5 mg once weekly after the initial 4-week period 1
- Escalate by 2.5 mg increments every 4 weeks based on tolerability and glycemic response 1
- Maximum dose is 15 mg once weekly for optimal glucose lowering and weight reduction 1
Administration Details
- Tirzepatide is administered as a once-weekly subcutaneous injection 1, 2
- Available as single-dose prefilled pens and single-dose vials 1
- Should be used as an adjunct to diet and exercise for improving glycemic control in adults with type 2 diabetes 1, 2
Efficacy Considerations
- The dose-dependent efficacy was demonstrated across the 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, and 15 mg dose range in the SURPASS clinical trials 1, 2
- Higher doses provide superior glycemic control and greater weight loss compared to lower doses 1
- Tirzepatide showed superior efficacy to GLP-1 receptor agonists (dulaglutide 0.75 mg and semaglutide 1 mg) as well as basal and prandial insulin 1
Safety and Tolerability
- Most common adverse events are gastrointestinal: nausea, diarrhea, decreased appetite, and vomiting, which are typically mild to moderate 1, 2
- The safety profile is consistent with GLP-1 receptor agonists 1
- Low risk of clinically significant or severe hypoglycemia when used without insulin or sulfonylureas 1
- No increased risk of major adverse cardiovascular events was observed 1
Important Clinical Pearls
- The gradual dose escalation every 4 weeks minimizes gastrointestinal side effects while allowing assessment of tolerability 1
- Patients who cannot tolerate higher doses can remain on lower doses (5 mg, 7.5 mg, or 10 mg) that still provide meaningful glycemic benefit 1
- Tirzepatide represents a dual GIP/GLP-1 receptor agonist, which is a novel mechanism distinct from pure GLP-1 agonists 1, 2