What is the recommended dosing regimen for Monjarou in an adult patient with no known medical conditions and normal kidney function?

How to Administer Mounjaro (Tirzepatide)

Start Mounjaro at 2.5 mg subcutaneously once weekly, then escalate to 5 mg after 4 weeks, with further increases in 2.5 mg increments every 4 weeks as needed for glycemic control, up to a maximum of 15 mg weekly. 1

Starting Dose and Escalation Schedule

• Initial dose: 2.5 mg subcutaneously once weekly for the first 4 weeks 1

  • This starting dose is specifically for treatment initiation and gastrointestinal tolerability—it is not intended to provide glycemic control 1

• After 4 weeks: Increase to 5 mg once weekly 1

• Further titration: If additional glycemic control is needed, increase the dose in 2.5 mg increments (to 7.5 mg, 10 mg, 12.5 mg, or 15 mg) after at least 4 weeks on each current dose 1

• Maximum dose: 15 mg subcutaneously once weekly 1

Administration Technique

• Inject subcutaneously in the abdomen, thigh, or upper arm 1

• Rotate injection sites with each dose to minimize injection site reactions 1

• Administer once weekly, any time of day, with or without meals—the timing relative to food does not matter 1

• Inspect the solution before use: It should appear clear and colorless to slightly yellow; do not use if particulate matter or discoloration is present 1

• For single-dose vials: Use an appropriate syringe (e.g., 1 mL syringe capable of measuring a 0.5 mL dose) 1

Missed Dose Management

• If a dose is missed: Administer as soon as possible within 4 days (96 hours) after the missed dose 1

• If more than 4 days have passed: Skip the missed dose and administer the next dose on the regularly scheduled day 1

• The day of weekly administration can be changed as long as at least 3 days (72 hours) separate the two doses 1

Concomitant Insulin Use

• When using Mounjaro with insulin: Administer as separate injections and never mix the two medications 1

• Injections may be given in the same body region (abdomen, thigh, or upper arm), but should not be adjacent to each other 1

Critical Safety Considerations

Absolute Contraindications

• Do not use in patients with personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) 1

• Do not use in patients with known serious hypersensitivity to tirzepatide or any excipients, including those with prior anaphylaxis or angioedema 1

Important Warnings

• Pancreatitis risk: Mounjaro has not been studied in patients with a history of pancreatitis 1

  • Monitor for persistent severe abdominal pain; discontinue if pancreatitis is suspected 1, 2

• Gastrointestinal adverse reactions: The dose escalation schedule is specifically designed to reduce the risk of nausea, vomiting, diarrhea, and decreased appetite 1, 3

• Hypoglycemia: Risk is low when used as monotherapy but increases when combined with insulin or insulin secretagogues 3

Renal Function Considerations

• No specific dose adjustment is provided in the FDA label for renal impairment 1
  • However, patients with normal kidney function can use standard dosing as outlined above 1
  • Clinical judgment and monitoring are essential in patients with significant renal impairment, though specific guidance is limited 4

Patient Education Points

• Train patients and caregivers on proper injection technique before initiating therapy 1

• Counsel patients about thyroid tumor symptoms: neck mass, difficulty swallowing, difficulty breathing, or persistent hoarseness 1

• Advise patients that gastrointestinal side effects are most common (nausea, diarrhea, decreased appetite, vomiting) and are typically mild to moderate 3, 5