Tirzepatide
MOUNJARO
What it isDual GIP and GLP-1 receptor agonist; type 2 diabetes and obesity.
Why this oneIt generally produces greater glucose and weight reductions than single-pathway incretins, making it the escalation benchmark.
What limits itGI intolerance drives discontinuation, so titrate slowly. Delayed gastric emptying matters before anesthesia.
FDA-approved for
- type 2 diabetes (2022)
- obesity (2023)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Type 2 diabetes mellitus | Adults | 2.5 mg SC once weekly x4 weeks, then 5 mg weekly | increase by 2.5 mg after ≥4 weeks as needed | 15 mg weekly |
| Type 2 diabetes mellitus | Pediatric ≥10 yr | 2.5 mg SC once weekly x4 weeks, then 5 mg weekly | increase by 2.5 mg after ≥4 weeks as needed | 10 mg weekly |
Titration Increase in 2.5 mg increments after at least 4 weeks on current dose
Renal No adjustment needed
Hepatic No adjustment needed
At least 3 days (72 hours) between doses
Instructions
- Inject subcutaneously in abdomen, thigh, or upper arm; rotate sites
- Administer once weekly at any time of day, with or without meals
- 2.5 mg dose is for initiation only, not for glycemic control
- Missed dose: give within 4 days (96 h); otherwise skip; keep doses ≥3 days apart
- Do not mix with insulin; give as separate injections
- Never share a KwikPen between patients
Contraindications
- Personal or family history of medullary thyroid carcinoma (MTC) or MEN 2
Cautions
- Acute pancreatitis
- Hypoglycemia with concomitant insulin secretagogues or insulin
- Serious hypersensitivity reactions (anaphylaxis, angioedema)
- Acute kidney injury from volume depletion
- Severe GI reactions; not recommended in severe gastroparesis
- Diabetic retinopathy complications
- Acute gallbladder disease
- Pulmonary aspiration during anesthesia/deep sedation
Adverse reactions
- Nausea
- Diarrhea
- Decreased appetite
- Vomiting
- Constipation, dyspepsia, abdominal pain
Pregnancy Insufficient human data; animal studies show possible fetal harm; use only if benefit justifies risk
Lactation Undetectable or low in breast milk; consider benefits and risks
⚠ BOXED WARNING
- Thyroid C-cell tumors in rodents
Cost, est. cash$900–$1,400/month
Generic entry2036 est.
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilityGI intolerance, gallbladder disease and rare pancreatitis; hypoglycemia is uncommon without insulin or sulfonylureas.
Mechanism of action: Tirzepatide ballicule
Open Tirzepatide in the interactive console ↗
Memory aids: mascots and interaction avatars
Tide pod → GLP-1 agonist
