What is the equivalent dose of Mounjaro (tirzepatide) to Ozempic (semaglutide) 2 mg subcutaneously (subcu) weekly?

Mounjaro Dose Equivalent to Ozempic 2 mg Weekly

Tirzepatide 15 mg weekly is the most appropriate equivalent to semaglutide (Ozempic) 2 mg weekly, based on superior efficacy for both glycemic control and weight loss. However, it's critical to understand that these are mechanistically different medications—tirzepatide is a dual GIP/GLP-1 receptor agonist while semaglutide is a selective GLP-1 receptor agonist—making direct dose equivalency imperfect 1, 2.

Evidence-Based Dose Comparison

Glycemic Control Equivalency

For HbA1c reduction, tirzepatide 10-15 mg demonstrates comparable or superior efficacy to semaglutide 2 mg:

• Tirzepatide 15 mg reduces HbA1c by approximately 2.30 percentage points, compared to semaglutide 1 mg at 1.86 percentage points 2
• In direct comparison trials, tirzepatide 15 mg achieved HbA1c reductions of 21.61 mmol/mol (1.96%) versus semaglutide 2.0 mg at 17.74 mmol/mol (1.59%) when compared to placebo 3
• Tirzepatide 10 mg was associated with statistically significant greater HbA1c reduction versus semaglutide 2.4 mg in indirect treatment comparisons 4

Weight Loss Equivalency

Tirzepatide demonstrates dose-dependent superiority over semaglutide for weight reduction:

• Tirzepatide 15 mg achieves 20.9% weight loss at 72 weeks, compared to semaglutide 2.4 mg at 14.9% 1, 5
• In head-to-head comparison with semaglutide 1 mg, tirzepatide produced 5.5 kg greater weight loss at the 15 mg dose 2
• Tirzepatide 15 mg was associated with 9.57 kg weight reduction versus semaglutide 2.0 mg at 4.97 kg when compared to placebo 3
• Indirect treatment comparisons showed tirzepatide 15 mg had statistically significant greater weight reduction versus semaglutide 2.4 mg 4

Practical Dosing Algorithm

Starting from Ozempic 2 mg

If switching from semaglutide 2 mg to tirzepatide:

1. Discontinue semaglutide and wait one week before initiating tirzepatide 1
2. Start tirzepatide at 5 mg weekly (the FDA-approved starting dose) to minimize gastrointestinal adverse events 6, 7
3. Titrate every 4 weeks: 5 mg → 10 mg → 15 mg weekly based on tolerance and response 6
4. Target maintenance dose is 15 mg weekly for equivalent or superior efficacy to semaglutide 2 mg 1, 6

Important Caveats

Do not combine these medications—they have overlapping mechanisms and combining them is contraindicated 1. The dual receptor activation of tirzepatide provides enhanced metabolic benefits including delayed gastric emptying, suppressed appetite, and improved insulin secretion compared to semaglutide's single-receptor action 1.

Safety Profile Comparison

Both medications share similar adverse effect profiles:

• Gastrointestinal effects (nausea, diarrhea, vomiting) are the most common, occurring in 17-22% with tirzepatide versus 18-40% with semaglutide for nausea 1
• Both carry identical contraindications: personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 1, 6
• Pancreatitis and gallbladder disease risks are present with both agents 1
• Hypoglycemia risk is minimal when used as monotherapy for both medications 1

Cardiometabolic Considerations

Semaglutide 2 mg has proven cardiovascular benefit, while tirzepatide data is emerging:

• Semaglutide 2.4 mg reduces cardiovascular death, nonfatal MI, or nonfatal stroke by 20% (HR 0.80) in patients with established cardiovascular disease 1
• Tirzepatide was associated with greater predicted 10-year CVD risk reduction (2.4% absolute reduction) compared with semaglutide (1.4% reduction) in post-hoc analysis 8
• For patients with established cardiovascular disease, semaglutide may be preferred due to proven cardiovascular outcomes data 1

Clinical Decision Framework

Choose tirzepatide 15 mg when:

• Maximum weight loss is the primary goal (20.9% vs 14.9%) 1, 5
• Patient has type 2 diabetes with obesity requiring superior HbA1c reduction 4, 3
• No established cardiovascular disease requiring proven CV benefit 1

Consider maintaining semaglutide 2 mg when:

• Patient has established cardiovascular disease and proven CV benefit is priority 1
• Patient is already well-controlled and tolerating current therapy 1
• Cost or insurance authorization favors semaglutide 1

Monitoring Requirements

After switching to tirzepatide, monitor:

• Every 4 weeks during titration for gastrointestinal tolerance and weight loss progress 6
• Every 3 months after reaching maintenance dose for weight, blood pressure, and cardiovascular risk factors 1
• HbA1c at 3 months to assess glycemic response 1
• Signs of pancreatitis or gallbladder disease throughout treatment 1, 6