Here’s a comprehensive guide to Mounjaro (tirzepatide) 5 mg/0.5 mL, the first therapeutic dose in the titration schedule:
Mounjaro 5 mg/0.5 mL – Essential Guide
🔹 Key Features
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First Therapeutic Dose: After 4 weeks on 2.5 mg starter dose
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FDA Approval: For type 2 diabetes (off-label for weight loss)
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Mechanism: Dual GIP/GLP-1 receptor agonist
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Administration: Weekly subcutaneous injection (prefilled pen)
🔹 Dosing Protocol
Week | Dose | Purpose |
---|---|---|
1-4 | 2.5 mg | Initial tolerance building |
5-8 | 5 mg | First therapeutic dose |
9+ | Increase by 2.5 mg every 4 weeks (max 15 mg) |
Critical Notes:
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5 mg is where significant metabolic effects begin
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Continue for at least 4 weeks before considering increase
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Some patients may stay at 5 mg long-term if:
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A1c targets are met
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Weight loss is satisfactory
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Higher doses aren’t tolerated
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🔹 Expected Effects
Glycemic Control:
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Average A1c reduction: 1.4-1.8% (from baseline)
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Fasting glucose decrease: 40-60 mg/dL
Weight Loss:
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Month 1 (2.5 mg): 2-5% body weight
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Month 2 (5 mg): 5-9% body weight
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Similar efficacy to Zepbound (same active drug)
🔹 Side Effect Profile
Frequency | Side Effects | Management Strategies |
---|---|---|
Very Common (>30%) | Nausea, decreased appetite | – Inject in thigh – Eat smaller, bland meals |
Common (10-30%) | Diarrhea, constipation | – Increase soluble fiber – Stay hydrated |
Less Common (<10%) | Dyspepsia, fatigue | – Take with proton pump inhibitor if needed |
Pro Tip: Most GI side effects peak at 3 days post-injection and improve by week 3 at this dose.
🔹 Clinical Monitoring
At This Dose:
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Check A1c after 8 weeks (2 months)
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Monitor for hypoglycemia if on insulin/sulfonylureas
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Assess tolerance at week 6 (mid-dose period)
Renal Considerations:
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No dose adjustment needed for mild/moderate CKD
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Use caution if eGFR <30 (limited data)
🔹 Cost & Access
Option | Cost | Notes |
---|---|---|
With Insurance (T2D) | $25-100/month | Requires prior auth |
Cash Price | ~$1,023/month | Use GoodRx coupons |
Savings Card | As low as $25/month | Income restrictions apply |
Prescribing Tip: Many insurers require:
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T2D diagnosis +
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Step therapy (metformin failure)
🔹 Conversion Scenarios
From Other GLP-1s:
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Ozempic/Semaglutide:
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If on 0.5 mg → Start Mounjaro 5 mg
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If on 1 mg → May start at 7.5 mg
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Trulicity/Dulaglutide:
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If on 1.5 mg → Start at 5 mg
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If on 3-4.5 mg → Start at 7.5 mg
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To Zepbound:
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Direct 1:1 conversion possible
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Requires new prescription (different indications)
🔹 Patient Counseling Points
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Timing:
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“Best injection day is Friday evening to manage side effects over weekend”
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Nutrition:
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“Prioritize 30g protein per meal to prevent muscle loss”
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Safety:
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“Report persistent vomiting or severe abdominal pain immediately”
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Expectations:
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“This is where we typically start seeing significant changes”
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🔹 Comparison to Similar Doses
Medication | Equivalent Dose | Avg A1c Reduction | Avg Weight Loss |
---|---|---|---|
Mounjaro 5 mg | – | 1.4-1.8% | 5-9% |
Ozempic 1 mg | ~70% as potent | 1.1-1.4% | 4-7% |
Trulicity 3 mg | ~50% as potent | 0.8-1.2% | 3-5% |
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