Mounjaro (Tirzepatide) Dosing and Administration

Dosing Schedule and Titration

The American Diabetes Association recommends starting tirzepatide therapy with 2.5 mg weekly subcutaneous injections for the first 4 weeks, followed by a dose increase to 5 mg once weekly after 4 weeks at the initial dose 1, 2
Further dose escalations can occur based on clinical response and tolerability, with possible increases to 10 mg once weekly after at least 4 weeks on the 5 mg dose, and a maximum dose of 15 mg once weekly after at least 4 weeks on the 10 mg dose 3

The American College of Clinical Pharmacology recommends administering tirzepatide as a subcutaneous injection once weekly, which can be given at any time of day, regardless of meals 1, 4
No dose adjustments are required for patients with renal impairment, according to the National Kidney Foundation 5, 6

Common side effects of tirzepatide include nausea (10-31%, dose-dependent), diarrhea (7-23%), vomiting (2-12%), constipation (3-5%), and abdominal pain (3-5%) 1

The American Association of Clinical Endocrinologists recommends monitoring for signs of pancreatitis and discontinuing tirzepatide if suspected, and using caution in patients with kidney disease when initiating or increasing the dose due to potential risk of acute kidney injury 3
Tirzepatide carries a black box warning regarding the risk of thyroid C-cell tumors in rodents (human relevance not determined), and is contraindicated in patients with personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia type 2 1, 2

The American Society of Anesthesiologists recommends considering the effects of tirzepatide on gastric emptying and the pharmacokinetics of the medication (elimination half-life of 5 days) when planning perioperative management 4

If no response after 6-8 weeks, attempt appropriate dose escalation per FDA labeling before discontinuing, as defined as <1-2 g/dL increase in hemoglobin A1c reduction or inadequate weight loss 7