What tirzepatide is
Tirzepatide is a once-weekly injection that acts on two gut hormone receptors, GLP-1 and GIP. It lowers appetite, slows stomach emptying and improves blood sugar. Eli Lilly sells it as Zepbound for weight management and Mounjaro for type 2 diabetes. The FDA approved Mounjaro in 2022 and Zepbound in 2023.
Zen IV Spa prescribes compounded tirzepatide, which has the same active ingredient but is made by a licensed compounding pharmacy. It is not FDA-approved. Our medical director uses the same dose schedule as the Zepbound label.
The full dose ladder
The schedule from the Zepbound label is simple. Start at 2.5 mg once a week for four weeks. Then move to 5 mg. After at least four weeks at any dose, the prescriber may increase by 2.5 mg. The available doses are 2.5, 5, 7.5, 10, 12.5 and 15 mg. The maximum is 15 mg once a week.
The 2.5 mg dose is for starting only. The maintenance doses listed on the label are 5, 10 and 15 mg. The 7.5 and 12.5 mg doses are stepping stones, but many people hold at one of them if it works well.
What to expect at each dose
At 2.5 mg, most people notice a little less hunger and sometimes mild nausea. Weight loss is usually small. This month is about adjustment.
At 5 mg, appetite control becomes clearer for most people. In the SURMOUNT-1 trial, published in the New England Journal of Medicine in 2022, people who stayed at 5 mg lost about 15 percent of their body weight over 72 weeks. That is a strong result at a modest dose.
At 10 mg, average weight loss in the same trial was about 19.5 percent. At 15 mg it was about 21 percent. Side effects also rose with dose, mainly nausea, diarrhea, constipation and decreased appetite. The highest dose is not the right dose for everyone. The right dose is the lowest one that gives you steady progress and tolerable side effects.
How fast to climb
Four weeks per step is the minimum. There is no maximum. If you are losing weight and feel good at 5 mg, there is no reason to rush to 7.5 mg. If side effects are strong, your prescriber can hold the dose longer or go back one step. Dose changes should be based on how you are doing, not a calendar.
A common pattern is to climb until weight loss is steady, then stay. Many people find their sweet spot between 7.5 and 12.5 mg.
Missed doses and timing
Take tirzepatide on the same day each week, at any time of day, with or without food. If you miss a dose, take it as soon as you remember as long as it is within four days, or 96 hours, of the scheduled time. If more than four days have passed, skip it and take your next dose on the usual day. Never take two doses within three days of each other.
You can change your injection day if needed, as long as at least three days pass between doses. Rotate injection sites between the stomach, thigh and upper arm, and stay at least two inches from the belly button.
Safety and who should not take it
Tirzepatide carries a boxed warning about thyroid C-cell tumors seen in rodents. People with a personal or family history of medullary thyroid cancer or a syndrome called MEN 2 should not take it. It is also not for people with a history of pancreatitis without careful review, and it should be stopped at least two months before a planned pregnancy.
It can lower the effect of birth control pills around dose increases, so a backup method is advised for four weeks after each step up. People on insulin or sulfonylureas need lower doses of those drugs to avoid low blood sugar. Tell your prescriber about all medications and conditions.
Getting started with Zen IV Spa
Everything begins with a free video visit with our medical director. A nurse comes to your home in New York and New Jersey to draw labs. If compounded tirzepatide is right for you, it ships to your door for $299 a month, and we guide each dose step with you. Visit /weight-loss/ or call (332) 239-2005 to begin.
Common Questions
What is the starting dose of tirzepatide?+
2.5 mg once a week for four weeks, then 5 mg. This is the schedule on the Zepbound label.
What is the maximum dose of tirzepatide?+
15 mg once a week.
How long do I stay at each dose?+
At least four weeks. You can stay longer if the dose is working or if you need more time to adjust.
What if I miss a dose of tirzepatide?+
Take it within four days of the missed time. If more than four days have passed, skip it and resume on your usual day.
Do I have to reach 15 mg?+
No. Many people get good results at 5 to 10 mg. The best dose is the one that gives steady progress with side effects you can live with.
Is compounded tirzepatide dosed the same as Zepbound?+
Zen IV Spa follows the same schedule as a guide. Compounded tirzepatide is not FDA-approved, and it comes in a vial you draw from rather than a pen.
Sources: FDA prescribing information for Zepbound and Mounjaro (Eli Lilly, 2024); Jastreboff et al., SURMOUNT-1, New England Journal of Medicine 2022.
All treatments are medical services. Every guest is screened, and every treatment is prescribed by a licensed provider. Nothing on this page is medical advice for you personally, and the opinions summarized here belong to the doctors named, not to Zen IV Spa. Talk to a provider before starting or stopping anything.
