Tirzepatide

Evidence / context

Evidence: Strong approved-drug evidence exists for the molecule; formulation and indication matter.

Available vial formats

Titration schedule

• Weeks 1-4: 2.5 mg once weekly
• Weeks 5-8: 5 mg once weekly
• Weeks 9-12: 7.5 mg once weekly if needed and tolerated
• Weeks 13-16: 10 mg once weekly if needed and tolerated
• Weeks 17-20: 12.5 mg once weekly if needed and tolerated
• Week 21+: 15 mg once weekly maximum if needed and tolerated
• 2.5 mg is a starting dose, not usually the long-term maintenance target.
• Increase in 2.5 mg steps after at least 4 weeks on the current dose.
• Maintenance often lands at 5 mg, 10 mg, or 15 mg depending on response and tolerability.
• Hold the current dose longer if GI side effects or appetite suppression are too strong.

Reconstitution

1. Swab vial tops with alcohol
2. Draw 3.0 mL bacteriostatic water
3. Inject slowly down vial wall (don't blast powder)
4. Gently swirl - do not shake
5. Rest 5-10 min to dissolve
6. Refrigerate 2-8 C

Dosing, cycle & timing

• Conservative 2.5 mg once weekly (75 units per weekly injection)
• Standard 5-10 mg once weekly (150-300 units per weekly injection)
• Aggressive 12.5-15 mg once weekly (375-450 units per weekly injection; requires adequate total vial quantity) only if tolerated
• Cycle length 12-24+ weeks
• Best timing Same weekday each week, often evening.
• Concentration note at 10 mg / 3.0 mL (3.33 mg/mL) a 12.5-15 mg dose is 3.75-4.5 mL, which exceeds one U-100 syringe and a single 10 mg vial. To reach maintenance doses, reconstitute a larger total vial quantity at a higher concentration so the weekly draw fits, and split if still over 1 mL.

Support / expected effects

• Appetite suppression + improved glucose control.
• Often strong fat-loss response with adherence.
• Reduced cravings/food noise in many.

Side effects / tolerability

• Nausea.
• Constipation/diarrhea.
• Fatigue early.

Tirzepatide Screening Notes

Screening should follow clinician guidance and the approved-drug context for GLP-1/GIP medicines.

• Personal or family history of medullary thyroid carcinoma (MTC) or MEN2: clinician review before use.
• Prior pancreatitis: clinician review is needed.
• Significant gallbladder disease or severe gallbladder events: clinician review is needed.
• Severe GI disease, severe gastroparesis, or major motility issues: clinician review is needed.
• Pregnancy, trying to conceive, or breastfeeding: avoid unless directed by a qualified clinician.
• Diabetes medications, insulin, sulfonylureas, or hypoglycemia risk: clinician review because blood glucose can change.
• Vomiting, diarrhea, or poor intake can raise dehydration risk; pause escalation and address fluids/electrolytes if this occurs.
• Persistent tachycardia, palpitations, or unstable cardiovascular symptoms: clinician review before escalation.

Practical tips

• Smaller meals; avoid very fatty meals early.
• Hold dose longer if sides.
• Protein + lifting to preserve muscle.

Storage

Refrigerated: ~45-60 days.

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