What instructions should be given to a healthy adult patient when prescribing Monjauro to prevent side effects?

Patient Instructions for Mounjaro (Tirzepatide) to Prevent Side Effects

Start with the 2.5 mg dose and follow the gradual dose escalation schedule strictly—this is the single most important step to minimize gastrointestinal side effects, which are the most common adverse events with this medication. 1

Dosing Schedule and Titration

• Begin with 2.5 mg subcutaneously once weekly for 4 weeks (this starter dose is specifically for reducing side effects, not for glucose control) 1
• After 4 weeks, increase to 5 mg once weekly 1
• If additional glucose control is needed, increase by 2.5 mg increments only after at least 4 weeks on the current dose 1
• Never rush the dose escalation—slower titration significantly reduces gastrointestinal problems 2

Dietary Modifications to Minimize GI Side Effects

Implement these eating strategies from day one to prevent nausea, vomiting, and diarrhea:

• Reduce meal portion sizes significantly 2
• Practice mindful eating and stop eating immediately once you feel full 2
• Decrease intake of high-fat foods 2
• Avoid spicy foods 2
• Eat smaller, more frequent meals rather than large meals 2

Administration Instructions

• Inject once weekly, any time of day, with or without meals 1
• Rotate injection sites between abdomen, thigh, and upper arm with each dose 1
• Inspect the solution before use—it should be clear and colorless to slightly yellow; do not use if you see particles or discoloration 1
• If using with insulin, inject separately in different sites (not adjacent to each other) 1

Missed Dose Protocol

• If you miss a dose, take it as soon as possible within 4 days (96 hours) 1
• If more than 4 days have passed, skip the missed dose and resume your regular schedule 1
• Maintain at least 3 days (72 hours) between any two doses 1

Critical Warning Signs Requiring Immediate Medical Attention

Discontinue Mounjaro immediately and contact your physician if you experience:

• Severe, persistent abdominal pain (possible pancreatitis)—this has been reported with GLP-1 receptor agonists 1, 2
• Symptoms of thyroid tumors: neck mass, difficulty swallowing, difficulty breathing, or persistent hoarseness 1
• Symptoms of gallbladder disease: right upper abdominal pain, fever, jaundice 2
• Signs of allergic reaction: rash, difficulty breathing, swelling 1

Contraindications and High-Risk Situations

Do not use Mounjaro if you have:

• Personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 1
• Known hypersensitivity to tirzepatide 1
• Active gastroparesis 2

Special Monitoring for High-Risk Patients

• If you have diabetic retinopathy or have had diabetes for ≥10 years: Require close ophthalmologic monitoring during treatment 2
• If you are at high risk for pancreatitis: Mounjaro should not be initiated; it has not been studied in patients with prior pancreatitis 1, 2
• If you have gallbladder disease risk factors: Avoid use or monitor closely for cholelithiasis or cholecystitis 2

Drug Absorption Considerations

• If taking oral contraceptives or other oral medications: Be aware that drug absorption may be impaired during dose titration 2
• Discuss alternative contraceptive methods or timing adjustments with your physician during the initial titration period 2

Hypoglycemia Prevention

• If taking Mounjaro with insulin or insulin secretagogues (sulfonylureas): carry a source of quick-acting carbohydrates at all times 2
• Do not skip meals when on combination therapy 2
• Your insulin or sulfonylurea dose may need reduction to prevent low blood sugar 2

Follow-Up Expectations

• Report persistent gastrointestinal side effects that do not resolve after a few weeks—slower dose titration may be needed 2
• Routine monitoring of serum calcitonin or thyroid ultrasound is not recommended but may increase unnecessary procedures 1
• If gastrointestinal side effects are debilitating despite dietary modifications, discuss slower titration with your physician 2

Surgical Procedures

• Provide guidance on discontinuation prior to surgical procedures due to potential risk of ileus 2
• Inform your surgeon that you are taking Mounjaro well in advance of any planned surgery 2