What is the recommended dose of Mounjaro (tirzepatide) for an adult patient with type 2 diabetes mellitus?

Mounjaro (Tirzepatide) Dosing for Type 2 Diabetes

Start tirzepatide at 2.5 mg subcutaneously once weekly for 4 weeks, then increase to 5 mg once weekly, with further 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 1
• After 4 weeks, increase to 5 mg once weekly 1
• This initial 2.5 mg dose serves as a tolerability phase to minimize gastrointestinal side effects 1

Dose Escalation Strategy

• If additional glycemic control is needed after at least 4 weeks on 5 mg, increase to 10 mg once weekly 1
• For maximum glycemic control, further increase to 15 mg once weekly after at least 4 weeks on the 10 mg dose 1
• The gradual titration schedule minimizes transient nausea and vomiting 1

Renal Function Considerations

• No dosage adjustments are required regardless of renal function status 1
• Tirzepatide can be used without dose modification in patients with normal renal function or mild to moderate renal impairment 1
• This represents a significant advantage over some other antidiabetic medications that require renal dose adjustments 1

Concomitant Medication Management

• Reduce doses of insulin or insulin secretagogues when initiating tirzepatide to minimize hypoglycemia risk 1
• This is particularly important as tirzepatide has demonstrated a low intrinsic risk of hypoglycemia when used without these medications 2, 3

Contraindications

• Avoid tirzepatide in patients with personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 (MEN2) 1
• Do not use in patients with history of serious hypersensitivity reaction to tirzepatide 1

Special Precautions

• Use with caution in patients with clinically meaningful gastroparesis or prior gastric/bariatric surgery 1
• Discontinue at least 3 days before planned surgery to prevent postoperative ketoacidosis risk related to delayed gastric emptying 1
• Avoid during pregnancy or breastfeeding 1

Expected Outcomes

• Tirzepatide produces marked reductions in HbA1c ranging from 1.87% to 2.59% across the dose range 3
• Body weight reductions of 6.2 to 12.9 kg are typical 3, 4
• The 15 mg dose provides maximum glycemic efficacy 1

Common Adverse Effects

• Gastrointestinal events are most common, including nausea, diarrhea, decreased appetite, and vomiting 2
• These are typically mild to moderate in severity and diminish with the gradual dose titration 2, 3
• Genital mycotic infections and urinary tract infections may occur, similar to other incretin-based therapies 5