What is the dosing for Ozempic (semaglutide)?

From the Guidelines

Zepbound (tirzepatide) should be dosed as a once-weekly subcutaneous injection, starting at 2.5 mg for the first 4 weeks, then increasing to 5 mg weekly for 4 weeks, with further increments of 2.5 mg every 4 weeks until reaching the target maintenance dose of 15 mg weekly or the maximum tolerated dose. This dosing schedule is based on the most recent and highest quality study available, which provides guidance on the management of adults taking glucagon-like peptide-1 receptor agonists, glucose-dependent insulinotropic peptide agonists, and sodium-glucose cotransporter-2 inhibitors 1. The study highlights the importance of gradual titration to minimize gastrointestinal side effects, and notes that no dose change is necessary for tirzepatide in patients with mild to moderate renal impairment.

Key points to consider when dosing Zepbound include:

• Starting dose: 2.5 mg once weekly for the first 4 weeks
• Dose escalation: increase to 5 mg weekly for 4 weeks, then further increments of 2.5 mg every 4 weeks as needed
• Target maintenance dose: 15 mg weekly or the maximum tolerated dose
• Administration route: subcutaneous injection
• Injection site: abdomen, thigh, or upper arm, rotating sites with each dose
• Missed dose: administer as soon as possible if at least 3 days (72 hours) until the next scheduled dose, otherwise skip the missed dose and resume at the next scheduled time. The medication works by activating GLP-1 and GIP receptors, which helps regulate appetite, slow gastric emptying, and improve insulin sensitivity, as noted in the study 1.

From the Research

Zepbound Dosing Information

• The optimal dose of tirzepatide for type 2 diabetes mellitus has been evaluated in several studies, with doses of 5 mg, 10 mg, and 15 mg being compared 2.
• A meta-analysis and trial sequential analysis found that tirzepatide 15 mg was the most effective dose for lowering glycemia and reducing weight, but also had a higher risk of adverse events compared to the 5 mg and 10 mg doses 2.
• The study suggested that tirzepatide 5 mg may be the best initial dose for patients with type 2 diabetes to minimize adverse events while still reducing glycemia and weight 2.
• If patients are unable to effectively control their glycemia with the 5 mg dose, increasing to 15 mg may be considered to achieve better glycemic control 2.
• In patients with chronic kidney disease undergoing hemodialysis, tirzepatide doses of 2.5-7.5 mg per week have been used, with significant reductions in glycated albumin and dry weight observed 3.

Dosing Considerations

• The dosing of tirzepatide may need to be individualized based on patient response and tolerability 4, 2.
• Patients with renal impairment may require dose adjustments, although the optimal dosing strategy in this population is not yet established 3, 5.
• Tirzepatide has been shown to have a good safety profile, with a low risk of hypoglycemia and serious adverse events 6, 4.

Study Findings

• The SURPASS-2 clinical trial found that tirzepatide 5 mg, 10 mg, and 15 mg were all effective in reducing glycated hemoglobin and body weight, with the 15 mg dose being the most effective 4.
• A post hoc analysis of the SURPASS-4 trial found that tirzepatide decreased albuminuria and total estimated glomerular filtration rate slopes, and nearly halved the risk of a pre-specified composite kidney endpoint 5.