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The Peptide Effect
Dosage Guide

Tirzepatide Dosage Chart & Titration Schedule

Complete tirzepatide dosage chart with titration schedule, dose escalation timeline, reconstitution instructions for compounded forms, and side effect management strategies. Educational reference based on published clinical trial data.

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Medical Disclaimer

This guide is for educational and informational purposes only. It is not medical advice. Dosages described reflect ranges discussed in published research and clinical practice literature — they are not recommendations. Always consult a licensed healthcare provider before using any peptide. Legality and availability vary by jurisdiction.

Overview

Tirzepatide is a dual GIP/GLP-1 receptor agonist that has been studied extensively in the SURMOUNT and SURPASS clinical trial programs for weight management and type 2 diabetes. Unlike single-target GLP-1 agonists, tirzepatide activates both the glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors, a mechanism discussed in research literature as potentially offering enhanced glycemic control and greater body weight reduction. The FDA-approved brand (Mounjaro/Zepbound) is supplied in pre-filled injection pens, while compounded versions require reconstitution from lyophilized powder. A structured titration schedule is considered important for tolerability, as gastrointestinal side effects are the most commonly reported adverse events in published trials.

Dosing Protocols

Starting Dose

Route: Subcutaneous injection (abdomen, thigh, or upper arm)
Dose: 2.5 mg
Frequency: Once weekly (same day each week)
Duration: 4 weeks minimum

The 2.5 mg starting dose is not considered a therapeutic dose for weight loss — it is an initiation dose designed to improve gastrointestinal tolerability before escalation.

Standard Titration Schedule

Route: Subcutaneous injection
Dose: 2.5 mg → 5 mg → 7.5 mg → 10 mg → 12.5 mg → 15 mg
Frequency: Once weekly, increasing dose every 4 weeks
Duration: 20–24 weeks to reach maximum dose

Each dose increase occurs in 2.5 mg increments at minimum 4-week intervals. In clinical trials, investigators were permitted to hold dose escalation if participants experienced tolerability issues. The full titration from 2.5 mg to 15 mg takes approximately 20 weeks if all escalation steps proceed on schedule.

Maintenance Dose (Weight Management)

Route: Subcutaneous injection
Dose: 10 mg, 12.5 mg, or 15 mg
Frequency: Once weekly
Duration: Ongoing — weight regain reported in studies upon discontinuation

In the SURMOUNT-1 trial, the 15 mg dose was associated with a mean body weight reduction of approximately 22.5% at 72 weeks. Maintenance at 10 mg or 12.5 mg may be appropriate for individuals who do not tolerate higher doses.

Type 2 Diabetes Dosing

Route: Subcutaneous injection
Dose: 5 mg, 10 mg, or 15 mg
Frequency: Once weekly
Duration: Ongoing as part of diabetes management

For glycemic control, 5 mg is considered the first therapeutic dose. In the SURPASS trials, all three maintenance doses (5, 10, 15 mg) demonstrated statistically significant HbA1c reductions compared to placebo and active comparators.

Reconstitution & Storage

Vial sizes5 mg, 10 mg, 15 mg, and 30 mg lyophilized vials (compounded forms)
Recommended water volumeVaries by vial size and desired concentration — typical reconstitution uses 1–2 mL bacteriostatic water (BAC water) per vial. For example, a 30 mg vial reconstituted with 2 mL yields 15 mg/mL.
StorageStore unreconstituted vials at room temperature or refrigerated. After reconstitution, refrigerate at 36–46 °F (2–8 °C). Do not freeze reconstituted solution.
Stability once reconstitutedReconstituted solution is generally considered stable for up to 28 days when refrigerated. Discard if solution appears cloudy or contains particulate matter.

Use our reconstitution calculator to determine exact syringe units for your dose.

Cycle Guidance

Tirzepatide is not typically cycled in the traditional sense. In published clinical trials, participants remained on therapy continuously for 72–88 weeks. The SURMOUNT-4 trial examined the effects of discontinuation after 36 weeks and reported significant weight regain in the group that switched to placebo, suggesting that continued use may be necessary to maintain weight loss outcomes. Dose reduction rather than full discontinuation has been discussed in clinical practice settings, though controlled trial data on this approach are limited.

Stacking Considerations

  • Tirzepatide should not be combined with other GLP-1 receptor agonists (e.g., semaglutide, liraglutide) due to overlapping mechanisms and additive gastrointestinal side effect risk.
  • Concurrent use with insulin may increase hypoglycemia risk — insulin dose reduction is commonly discussed when initiating tirzepatide in insulin-treated patients.
  • Tirzepatide slows gastric emptying, which may affect the absorption timing of oral medications. Oral contraceptives and medications with narrow therapeutic windows may require monitoring.
  • Some practitioners have discussed combining tirzepatide with metformin for type 2 diabetes management, as the mechanisms are complementary and this combination was used in several SURPASS trials.

Potential Side Effects

  • Nausea (most commonly reported, especially during dose escalation — reported in 24–33% of participants across SURMOUNT trials)
  • Diarrhea (reported in 17–25% of participants at higher doses)
  • Vomiting (reported in 7–12% across dose groups)
  • Constipation (reported in 6–11% of participants)
  • Decreased appetite (an intended pharmacological effect, reported as an adverse event in some participants)
  • Injection site reactions (erythema, pruritus — generally mild and transient)
  • Fatigue and dizziness (reported at low frequency in clinical trials)
  • Gallbladder-related events (cholelithiasis reported at higher rates than placebo in weight loss trials, consistent with rapid weight reduction)
  • Pancreatitis (rare but noted in prescribing information as a potential risk)

Contraindications & Cautions

  • Personal or family history of medullary thyroid carcinoma (MTC) — based on thyroid C-cell tumor findings in rodent studies
  • Multiple endocrine neoplasia syndrome type 2 (MEN 2)
  • Known hypersensitivity to tirzepatide or any formulation excipients
  • History of pancreatitis (use with caution; not an absolute contraindication but warrants careful risk-benefit discussion)
  • Severe gastrointestinal disease (gastroparesis, inflammatory bowel disease) — tirzepatide slows gastric emptying and may worsen symptoms
  • Pregnancy and breastfeeding (discontinue at least 2 months before planned conception per prescribing information)

Related

Tirzepatide Profileweight lossdiabetesfat losssemaglutide dosageretatrutide dosage

References

  1. Tirzepatide Once Weekly for the Treatment of Obesity (SURMOUNT-1) (2022) — PubMed
  2. Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes (SURPASS-2) (2021) — PubMed
  3. Tirzepatide Once Weekly for the Treatment of Obesity in People Without Diabetes (SURMOUNT-2) (2023) — PubMed
  4. Tirzepatide for the Treatment of Obesity — Maintaining Weight Loss (SURMOUNT-4) (2023) — PubMed

Frequently Asked Questions

What is the recommended starting dose for tirzepatide?
The recommended starting dose is 2.5 mg injected subcutaneously once per week. This initial dose is primarily for tolerability and is not considered a therapeutic dose for weight loss or glycemic control. The dose is typically increased by 2.5 mg every 4 weeks until the target maintenance dose is reached.
How long does the full tirzepatide titration take?
The standard titration from 2.5 mg to the maximum 15 mg dose takes approximately 20 weeks if each escalation step proceeds on the minimum 4-week schedule. However, dose escalation may be slowed or paused if gastrointestinal side effects are not well tolerated, extending the timeline for some individuals.
Can tirzepatide be injected at different body sites?
Yes, tirzepatide is administered as a subcutaneous injection and can be injected into the abdomen, front of the thigh, or upper arm. Rotating injection sites is generally recommended to reduce the risk of injection site reactions and lipodystrophy. The same body region can be used each week, but the exact injection spot should be varied.
What happens if you stop taking tirzepatide?
Published data from the SURMOUNT-4 trial indicate that participants who discontinued tirzepatide after 36 weeks of treatment regained approximately two-thirds of the weight they had lost over the following 52 weeks. This suggests that tirzepatide-mediated weight loss may require continued use to be maintained, similar to what has been observed with other GLP-1 receptor agonist therapies.
How should compounded tirzepatide be reconstituted?
Compounded tirzepatide is typically supplied as a lyophilized powder that is reconstituted with bacteriostatic water (BAC water). The exact volume depends on the vial size and desired concentration. The reconstituted solution should be refrigerated at 2–8 °C and used within 28 days. Always use an alcohol swab on the vial stopper before drawing and ensure the solution is clear before injection.
What is the difference between tirzepatide and semaglutide?
Tirzepatide is a dual GIP/GLP-1 receptor agonist, while semaglutide targets only the GLP-1 receptor. In head-to-head comparisons from the SURPASS-2 trial, tirzepatide at the 15 mg dose demonstrated greater HbA1c reduction and weight loss compared to semaglutide 1 mg. However, direct comparisons at equivalent maximum doses for weight management (tirzepatide 15 mg vs. semaglutide 2.4 mg) from randomized trials are still being evaluated.