Select a medication above to begin.
Mounjaro
tirzepatide
Black Box Warnings .
Thyroid C-cell Tumor Risk
contraindicated in pts w/ medullary thyroid carcinoma (MTC) hx or family hx, or in pts w/ multiple endocrine neoplasia syndrome type 2 (MEN 2); dose-related and duration-dependent incr. in thyroid C-cell tumor incidence observed in rodents, but human relevance unknown; uncertain value of routine serum calcitonin or thyroid ultrasound monitoring; advise pts of potential MTC risk and thyroid tumor sx (e.g., neck mass, dysphagia, dyspnea, persistent hoarseness)
Adult Dosing .
Dosage forms: INJ (pen): 2.5 mg per injection, 5 mg per injection, 7.5 mg per injection, 10 mg per injection, 12.5 mg per injection, 15 mg per injection
diabetes mellitus, type 2
- [5-15 mg SC qwk]
- Start: 2.5 mg SC qwk x4wk, then 5 mg SC qwk, then may incr. by 2.5 mg/wk no more frequently than q4wk; Max: 15 mg/wk
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- medullary thyroid CA hx
- medullary thyroid CA family hx
- multiple endocrine neoplasia syndrome type 2
- diabetes mellitus, type 1
- caution: hypersensitivity to GLP-1 agonists
- caution: volume depletion
- caution: GI dz, severe
- caution: gastroparesis, severe
- caution: pancreatitis hx
- caution: diabetic retinopathy hx
- caution: surgery
Drug Interactions .
Overview
tirzepatide
GLP-1/GIP agonist
- antidiabetic agent
- decreases gastrointestinal motility
- caution advised w/ oral drugs, esp. narrow therapeutic index; tirzepatide delays gastric emptying, may alter absorption of concomitant oral drugs
Contraindicated
- potassium chloride
- potassium citrate
Avoid/Use Alternative
- desogestrel (contraceptive)
- dienogest (contraceptive)
- drospirenone (contraceptive)
- estetrol (contraceptive)
- estradiol (contraceptive)
- ethinyl estradiol (contraceptive)
- ethynodiol (contraceptive)
- exenatide
- levonorgestrel (contraceptive)
- levonorgestrel (post-coital contraceptive)
- norethindrone (contraceptive)
- norgestimate (contraceptive)
- norgestrel (contraceptive)
- semaglutide
- ulipristal (post-coital contraceptive)
Monitor/Modify Tx
- alclometasone topical
- alpelisib
- amcinonide topical
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- arsenic trioxide
- asenapine
- asparaginase
- atazanavir
- betamethasone
- betamethasone topical
- bortezomib
- brentuximab vedotin
- brexpiprazole
- brigatinib
- budesonide
- bumetanide
- calaspargase
- capivasertib
- cariprazine
- carvedilol
- ceritinib
- chlorothiazide
- chlorthalidone
- ciprofloxacin
- clobetasol topical
- clocortolone topical
- clozapine
- copanlisib
- corticotropin
- cortisone
- dabrafenib
- danazol
- darunavir
- decitabine
- deflazacort
- delafloxacin
- desonide topical
- desoximetasone topical
- dexamethasone
- diazoxide
- diflorasone topical
- digoxin
- enfortumab vedotin
- ensartinib
- ephedra
- epinephrine
- estradiol (hormone replacement)
- estrogens, conjugated (hormone replacement)
- estrogens, esterified (hormone replacement)
- ethacrynic acid
- ethinyl estradiol (hormone replacement)
- etonogestrel (contraceptive)
- everolimus
- fludrocortisone
- fluocinolone otic
- fluocinolone topical
- fluocinonide topical
- flurandrenolide topical
- fluticasone propionate topical
- fosamprenavir
- fosphenytoin
- furosemide
- ginkgo
- glimepiride
- glipizide
- glyburide
- goserelin
- halcinonide topical
- halobetasol topical
- histrelin
- hydrochlorothiazide
- hydrocortisone
- hydrocortisone topical
- iloperidone
- inavolisib
- indapamide
- insulin
- isoniazid
- lanreotide
- leuprolide
- levofloxacin
- levothyroxine
- liothyronine
- lopinavir/ritonavir
- lorlatinib
- lumateperone
- lurasidone
- lurbinectedin
- lutetium Lu 177 dotatate
- medroxyprogesterone (contraceptive)
- megestrol
- methylprednisolone
- metolazone
- mometasone topical
- moxifloxacin
- nadolol
- nateglinide
- nelfinavir
- niacin (vitamin B3)
- norelgestromin (contraceptive)
- norepinephrine
- octreotide
- ofloxacin
- olanzapine
- omacetaxine mepesuccinate
- paliperidone
- pasireotide
- pegaspargase
- peginterferon alfa 2a
- pentamidine
- phenylephrine
- phenytoin
- pindolol
- prednicarbate topical
- prednisolone
- prednisone
- pseudoephedrine
- quetiapine
- repaglinide
- risperidone
- ritonavir
- sacrosidase
- segesterone (contraceptive)
- sirolimus albumin-bound
- somapacitan
- somatrogon
- somatropin
- sotalol
- spironolactone
- sucralfate
- temsirolimus
- teprotumumab
- tesamorelin
- thyroid
- tipranavir
- torsemide
- triamcinolone
- triamcinolone topical
- triamterene
- triptorelin
- vamorolone
- vorinostat
- warfarin
- ziprasidone
Caution Advised
- acetaminophen
- amoxicillin
- ampicillin
- azithromycin
- barium
- bedaquiline
- cefaclor
- cefadroxil
- cefdinir
- cefixime
- cefpodoxime
- cefprozil
- cefuroxime axetil
- cephalexin
- clarithromycin
- clindamycin
- cycloserine
- dapsone
- demeclocycline
- dicloxacillin
- doxazosin
- doxycycline
- erythromycin
- ethionamide
- fosfomycin
- lefamulin
- linezolid
- metoclopramide
- metronidazole
- mexiletine
- minocycline
- omadacycline
- penicillin V
- potassium acid phosphate
- potassium gluconate
- potassium phosphate
- rifabutin
- rifampin
- rifapentine
- sarecycline
- secnidazole
- sulfadiazine
- sulfamethoxazole
- sulfasalazine
- tedizolid phosphate
- tetracycline
- tinidazole
- trimethoprim
Adverse Reactions .
Serious Reactions
- thyroid C-cell tumor (animal studies)
- medullary thyroid CA risk
- hypersensitivity rxn
- anaphylaxis
- angioedema
- GI rxn, severe
- cholelithiasis
- pancreatitis
- ileus
- acute kidney injury
- chronic renal failure exacerbation
- perioperative aspiration
Common Reactions
- nausea
- diarrhea
- appetite decr.
- tachycardia
- vomiting
- constipation
- dyspepsia
- abdominal pain
- injection site rxn
- eructation
- flatulence
- abdominal distension
- hypersensitivity rxn
- GERD
- amylase incr.
- lipase incr.
Safety/Monitoring .
Monitoring Parameters
no routine tests recommended
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; inadequate human data available; risk of teratogenicity and decr. fetal wt based on animal data at 0.2-0.5x MRHD
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: proteolytic degradation, oxidation, hydrolysis; CYP450: unknown
Excretion: urine (none unchanged), feces (none unchanged); Half-life: 5 days
Subclass: Diabetes: GIP/GLP-1 Agonists
Mechanism of Action
activates glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors, increasing insulin secretion, decreasing glucagon secretion, increasing insulin sensitivity, and delaying gastric emptying
Formulary .
No Formulary Selected
Join Now to View Patient Handouts!
Create a FREE epocrates Online account to access patient medication instructions. Your patients and caregivers will appreciate you printing these friendly handouts, available in English and Spanish. Each handout addresses common concerns such as how to take the medication, and possible side effects.
Current Members: Sign In.
Pill Pictures
Join Now to View Pill Pictures!
Create a FREE epocrates Online account to access full-color images of medications within the drug monograph.
Current Members: Sign In.