What is the proper dosing and administration of Mounjaro (tirzepatide) for an adult patient with type 2 diabetes?

How to Take Mounjaro (Tirzepatide)

Starting Dose and Administration

Start Mounjaro at 2.5 mg injected subcutaneously once weekly, then increase to 5 mg after 4 weeks, with further escalation by 2.5 mg every 4 weeks as needed for glycemic control, up to a maximum of 15 mg weekly. 1, 2

• Inject Mounjaro subcutaneously once weekly at any time of day, with or without meals 3, 4
• The medication comes as single-dose prefilled pens and single-dose vials 3
• Administer the injection on the same day each week for consistency 5

Dose Escalation Schedule

• Week 0-4: Start at 2.5 mg once weekly 1
• Week 4-8: Increase to 5 mg once weekly 1
• Week 8-12: May increase to 7.5 mg once weekly if additional glycemic control needed 1
• Week 12-16: May increase to 10 mg once weekly if additional glycemic control needed 1
• Week 16-20: May increase to 12.5 mg once weekly if additional glycemic control needed 1
• Week 20+: May increase to maximum dose of 15 mg once weekly if additional glycemic control needed 1

Each dose escalation occurs after at least 4 weeks on the current dose 1, 2

Expected Outcomes

• HbA1c reductions of 1.87% to 2.59% can be expected across the dose range 2
• Body weight reductions of 6.2 kg to 12.9 kg are typical 2
• At the 10 mg and 15 mg doses, mean HbA1c reductions of approximately 2.4% were observed in clinical trials 1
• 85-90% of patients achieve HbA1c <7% on tirzepatide therapy 1

Common Side Effects and Management

• Gastrointestinal effects are the most common: nausea (13-18%), diarrhea (12-21%), decreased appetite, and vomiting 3, 1
• These side effects are typically mild to moderate and often diminish over time 3, 5
• The gradual dose escalation schedule helps minimize gastrointestinal symptoms 1

Critical Safety Considerations

• Hypoglycemia risk is low when Mounjaro is used without insulin or sulfonylureas 3, 2
• When adding Mounjaro to insulin therapy (as in SURPASS-5), consider reducing insulin doses to minimize hypoglycemia risk 1
• Discontinue Mounjaro at least 3 days before planned surgery to prevent postoperative ketoacidosis, similar to other incretin-based therapies 6
• Monitor for signs of delayed gastric emptying, particularly in the perioperative setting 7

Use with Other Diabetes Medications

• Mounjaro can be used as monotherapy or in combination with metformin, SGLT2 inhibitors, or insulin 3, 4
• When added to insulin glargine, Mounjaro provides superior glycemic control compared to placebo, with mean HbA1c reductions of 2.11-2.40% 1
• Continue metformin unless contraindicated when starting Mounjaro 7
• Consider reducing or stopping sulfonylureas to minimize hypoglycemia risk 8

Renal Considerations

• No dosage adjustments are required for patients with kidney disease 7
• Mounjaro can be used in patients with eGFR ≥45 mL/min/1.73 m² without dose modification 7

Injection Technique

• Rotate injection sites to prevent lipodystrophy 5
• Common injection sites include the abdomen, thigh, or upper arm 5
• Proper injection technique and site rotation should be taught to all patients 5

When to Contact Your Healthcare Provider

• If you experience persistent nausea, vomiting, or abdominal pain that doesn't improve 5
• If you have signs of hypoglycemia (particularly if on insulin or sulfonylureas) 1
• If HbA1c remains above target after 3-6 months on maximum tolerated dose 2
• Before any planned surgical procedures (discontinue at least 3 days prior) 6