How should a patient with type 2 diabetes restart Mounjaro (tirzepatide) 7.5 mg after a 2-week hiatus?

Restarting Mounjaro (Tirzepatide) 7.5 mg After a 2-Week Hiatus

After a 2-week interruption of Mounjaro 7.5 mg, you should restart at the same 7.5 mg dose without re-titration, as the hiatus is brief and does not require returning to lower doses. 1

Restart Protocol

Resume at your current dose of 7.5 mg weekly if you tolerated the medication well before the interruption 1. The 2-week gap (equivalent to 2 missed doses) falls within the timeframe where clinical judgment allows continuation at the same dose, particularly if you experienced no significant adverse effects previously 1.

Specific Restart Instructions

• Administer 7.5 mg subcutaneously once weekly as soon as you resume treatment 2, 3
• Continue your standard injection day (the same day of the week you were using before the interruption) 1
• No dose reduction is necessary for this duration of interruption, as you were already tolerating 7.5 mg 1

When Re-Titration Would Be Required

If you had missed 3 or more consecutive doses (≥3 weeks), you would need to restart the titration schedule beginning at 2.5 mg weekly 1. However, your 2-week hiatus does not meet this threshold 1.

The standard tirzepatide titration schedule (which you would NOT need in this case) progresses as follows: 2.5 mg weekly for 4 weeks → 5 mg weekly for 4 weeks → 7.5 mg weekly for 4 weeks → 10 mg weekly for 4 weeks → 15 mg weekly (maximum dose) 1.

Critical Monitoring After Restart

First 2-4 Weeks After Resumption

• Monitor for gastrointestinal symptoms (nausea, diarrhea, vomiting, constipation), which may temporarily recur even though you previously tolerated this dose 4, 5
• Check blood glucose levels closely if you have diabetes, particularly if you're also taking insulin or sulfonylureas 1
• Assess for signs of hypoglycemia if on concomitant glucose-lowering medications 4

Hypoglycemia Prevention (If Applicable)

If you're taking insulin or sulfonylureas alongside tirzepatide, your doses may need adjustment 1:

• Reduce basal insulin by 20% when restarting tirzepatide to prevent hypoglycemia 1
• Consider discontinuing or reducing sulfonylurea doses by 50% to minimize hypoglycemia risk 1
• Monitor blood glucose before meals and at bedtime for the first 2 weeks after restart 1

Expected Gastrointestinal Effects

Mild-to-moderate nausea, diarrhea, or decreased appetite may recur temporarily even though you previously tolerated 7.5 mg, as the 2-week break may have reduced your GI tolerance 4, 5. These symptoms typically:

• Occur in 17-22% of patients taking tirzepatide 4
• Are predominantly mild-to-moderate in severity 5
• Decrease over time with continued exposure (usually within 4-8 weeks) 5

Strategies to Minimize GI Symptoms

• Eat smaller, more frequent meals rather than large portions 1
• Avoid high-fat, greasy, or spicy foods during the first 2 weeks 1
• Stay well-hydrated to prevent dehydration from potential diarrhea 1
• Limit alcohol and carbonated beverages 1

Contraindications and Safety Concerns

Do not restart tirzepatide if you experienced any of the following during your previous treatment 1, 2:

• Persistent severe abdominal pain (potential pancreatitis) 1, 2
• Signs of gallbladder disease (right upper quadrant pain, jaundice) 1
• Severe allergic reactions to tirzepatide 1
• New diagnosis of medullary thyroid cancer or MEN2 syndrome 1, 2

Ongoing Monitoring Schedule

First Month After Restart

• Assess at 4 weeks for gastrointestinal tolerance, weight, blood pressure, and glucose control (if diabetic) 1
• Monitor for signs of pancreatitis or gallbladder disease 1, 2

After Stabilization

• Evaluate every 3 months for weight stability, HbA1c (if diabetic), cardiovascular risk factors, and medication adherence 1
• Continue monitoring blood pressure as weight loss may necessitate antihypertensive medication adjustment 1

Important Caveats

Do not assume you need to "restart from scratch" with lower doses after only 2 weeks off medication—this is a common misconception that leads to unnecessary delays in achieving therapeutic benefit 1. The 2-week interruption is brief enough that your body retains tolerance to the 7.5 mg dose 1.

If you experience intolerable side effects after restarting at 7.5 mg, contact your healthcare provider to discuss whether a temporary dose reduction to 5 mg might be appropriate, but this should be a clinical decision rather than an automatic protocol 1.

Ensure you understand proper injection technique before resuming, as improper administration can affect both efficacy and tolerability 2, 3.