Mounjaro
Mounjaro (tirzepatide) is a prescription injection that's used together with diet and exercise to improve blood sugar control in adults with Type 2 diabetes. Mounjaro (tirzepatide) was approved by the FDA in May 2022 as the first one in a new class of medications called GIP and GLP-1 agonists. The dosage is convenient because it's injected under the skin once a week. Some common side effects of Mounjaro (tirzepatide) include nausea, vomiting, and diarrhea.
What is Mounjaro (tirzepatide)?
What is Mounjaro (tirzepatide) used for?
Type 2 diabetes, in addition to diet and exercise
How Mounjaro (tirzepatide) works
Mounjaro (tirzepatide) is a glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist. It works by acting like GLP-1 and GIP, two hormones released by your gut after you eat to help control blood sugar. These hormones tell your body to release more insulin, release less sugar, and slow down digestion. All of these actions help lower blood sugar levels.
In people who have Type 2 diabetes, GLP-1 and GIP don't work as well as they should. By acting just like GLP-1 and GIP, Mounjaro (tirzepatide) helps control blood sugar.
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What are the side effects of Mounjaro (tirzepatide)?
Common Side Effects
- Nausea (12-18%)
- Diarrhea (12-17%)
- Low appetite (5-11%)
- Vomiting (5-9%)
- Stomach upset or indigestion (5-8%)
- Constipation (6-7%)
- Stomach pain (5-6%)
Other Side Effects
- Rise in heart rate
- Injection site reaction
Serious Side Effects
- Serious allergic reaction: hives; trouble breathing; swelling of your lips, tongue, throat, or face
- Dangerously low blood sugar: feeling hungry, fast heartbeat, shakiness, anxiety, sweating, tingling, dizziness, weakness, drowsiness, confusion
- Kidney damage: nausea, vomiting, trouble urinating, muscle cramps, feeling confused, swelling in the ankles or feet, trouble breathing
- Inflammation of the pancreas (pancreatitis): severe stomach pain, back pain, vomiting
Source: DailyMed
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The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Change in vision
- Dehydration—increased thirst, dry mouth, feeling faint or lightheaded, headache, dark yellow or brown urine
- Fast or irregular heartbeat
- Gallbladder problems—severe stomach pain, nausea, vomiting, fever
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Pancreatitis—severe stomach pain that spreads to your back or gets worse after eating or when touched, fever, nausea, vomiting
- Thyroid cancer—new mass or lump in the neck, pain or trouble swallowing, trouble breathing, hoarseness
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Constipation
- Diarrhea
- Loss of appetite
- Nausea
- Upset stomach
Pros and cons of Mounjaro (tirzepatide)
Pros
Given once weekly
Lowers A1C (average blood sugar over time) by up to 2.4% on average
Injections can be given with or without food
Comes as ready-to-use injectable pens with a pre-attached needle
Can use if you have liver or kidney problems
Cons
Only available as an injection
Can cause unpleasant stomach side effects (e.g., nausea, vomiting, diarrhea)
Available as brand name only
Not approved for children
Might not be safe during pregnancy
Pharmacist tips for Mounjaro (tirzepatide)
Before you use Mounjaro (tirzepatide), get familiar with the Instructions for Use. Ask your prescriber or pharmacist for help if you have questions.
Store Mounjaro (tirzepatide) in the refrigerator in its original container until you're ready to use it. But if needed, you can leave it at room temperature (up to 86 degrees Fahrenheit) for up to 3 weeks. Never freeze Mounjaro (tirzepatide) or use the medication if it's frozen.
Check to make sure the medication inside of your Mounjaro (tirzepatide) pen or vial isn't cloudy, doesn't have particles (solid chunks), and is colorless or slightly yellow. Contact your pharmacist or prescriber about a refill if it looks different or if you accidentally drop your pen on a hard surface.
You can inject Mounjaro (tirzepatide) at any time of the day. Mark your calendar so you inject it on the same day of every week.
Inject Mounjaro (tirzepatide) under the skin of your stomach or thigh. You can also inject it under the skin of the back of your upper arm, but it might be helpful to have someone inject the medication for you. Remember to choose a different area to inject each week to lower your chances of skin irritation or damage.
After your injection, place your used pen or syringe in a sharps container or other puncture-resistant container (such as an empty laundry detergent bottle) to prevent other people from getting a needle-stick injury. For more information, visit the FDA's website on safely disposing your sharps.
If you're taking birth control pills, Mounjaro (tirzepatide) can cause them to work less well and put you at risk for pregnancy. Speak with your gynecologist or primary care provider about switching to the patch or ring or adding a barrier method (e.g., condoms). You'll need to take these precautions for about a month after you start Mounjaro (tirzepatide) and about a month after each time your dose is raised.
Let your prescriber know if you're taking a medication where even a small change in dose can affect the way it works (for example, warfarin (Coumadin)). Your prescriber might need to monitor you more closely for side effects while you're taking Mounjaro (tirzepatide). This is because Mounjaro (tirzepatide) can change the way your body absorbs other medications.
If you missed your dose and it has been 4 days or less since you were supposed to take Mounjaro (tirzepatide), inject the medication as soon as possible. If more than 4 days have passed, skip the dose and inject Mounjaro (tirzepatide) on your next regularly scheduled day. Let your prescriber know about any missed doses so they can track your blood sugar levels properly. Contact them if you have any questions about your dosing schedule.
If you're pregnant or thinking of becoming pregnant, speak with your primary care provider about the best options to control your blood sugar. There haven't been enough studies looking at how safe Mounjaro (tirzepatide) is during pregnancy. But animal studies showed that Mounjaro (tirzepatide) might harm unborn babies and pregnant mothers. Mounjaro (tirzepatide) should only be used during pregnancy if the potential benefits are greater than the potential risks.
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Frequently asked questions about Mounjaro (tirzepatide)
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What are the risks and warnings for Mounjaro (tirzepatide)?
Mounjaro (tirzepatide) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of thyroid cancer
Risk factors: Personal or family history of certain thyroid cancers
It's not known whether Mounjaro (tirzepatide) causes certain thyroid cancers in humans. But based on animal studies, there's a possibility that the medication can put you at higher risk. Let your prescriber know if you have a personal or family history of thyroid cancers because they might need to discuss with you about other treatment options for your high blood sugar.
Get medical attention right away if you notice a lump on your neck or have trouble breathing, trouble swallowing, or hoarseness that won't go away while you're taking Mounjaro (tirzepatide) — these might be signs of thyroid cancer.
Inflammation of the pancreas (pancreatitis)
Some people taking Mounjaro (tirzepatide) have experienced inflammation of their pancreas, or pancreatitis. Contact your care team if you have symptoms of pancreatitis, such as severe stomach pain, back pain, or vomiting. You might need to stop using Mounjaro (tirzepatide).
Low blood sugar (hypoglycemia) when used with other diabetes medications
Risk factors: Using insulin | Using medications that raise the amount of insulin in your body
Taking Mounjaro (tirzepatide) with medications that raise the amount of insulin in your body, like sulfonylureas or insulins, can put you at risk for low blood sugar. If you're taking one of these medications, ask your prescriber whether you need any changes to your doses before you start Mounjaro (tirzepatide) to prevent low blood sugar.
Make sure you're trained on what to do if you have low blood sugar. It's important to keep glucose tablets or hard candy with you at all times so you can take them when your blood sugar drops too low. Get medical help right away if you still feel shaky, nervous, dizzy, irritated, weak, or confused, even after you've treated yourself for low blood sugar.
Allergic reactions
Risk factors: Allergy to GLP-1 receptor agonist medications
Though rare, Mounjaro (tirzepatide) can cause serious allergic reactions. People who've had a severe reaction to medications similar to Mounjaro (tirzepatide), such as Trulicity (dulaglutide) or Ozempic (semaglutide), in the past might be at a higher risk for these reactions. Get emergency medical help if you have trouble breathing; swelling of your lips, tongue, throat, or face; rash; or hives.
Stomach problems
Mounjaro (tirzepatide) can cause stomach problems, including stomach pain, nausea, vomiting, and diarrhea. Sometimes, these problems can be severe. For this reason, Mounjaro (tirzepatide) isn't recommended for people with a history of severe stomach issues, such as gastroparesis (slowed emptying of your stomach). Contact your prescriber if you have concerns.
Kidney damage
Risk factors: History of kidney problems | Low fluids in the body
Some people who took medications like Mounjaro (tirzepatide) developed new or worsening kidney problems. Keep in mind that Mounjaro (tirzepatide) can cause stomach-related side effects (such as nausea, vomiting, and diarrhea), which can lead to dehydration. And if dehydration is severe enough, it could cause kidney damage.
Make sure to drink plenty of fluids and stay hydrated if you're experiencing nausea, vomiting, or diarrhea while you're taking Mounjaro (tirzepatide). Let your prescriber know if you don't urinate or if you're not urinating normally. If you've had kidney problems in the past, you might need regular lab tests while you're taking this medication to make sure your kidneys stay healthy.
Eye problems related to high blood sugar (complications of diabetic retinopathy)
Risk factors: Diabetic retinopathy
If you have diabetic retinopathy (damaged blood vessels in the eye), using Mounjaro (tirzepatide) might make it worse. The risk might be higher when you first start this medication or when your prescriber raises the dose. If you have diabetic retinopathy, you'll need to get your vision checked regularly while you're using Mounjaro (tirzepatide). Get medical attention if you notice changes in your vision.
Gallbladder problems
Though rare, some people who took Mounjaro (tirzepatide) experienced gallbladder problems, such as gallstones. Call your prescriber right away if you have severe pain in the upper part of your stomach, nausea, vomiting, or fever. These can be signs of gallbladder issues.
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Mounjaro (tirzepatide) dosage forms
Typical dosing for Mounjaro (tirzepatide)
The typical starting dose is 2.5 mg injected under the skin of the stomach, thigh, or upper arm once weekly.
After 4 weeks, your prescriber will raise your dose to 5 mg injected once weekly.
Depending on how well the medication works, your prescriber might continue to raise your dose every 4 weeks or so until you're at a dose that works for you. The maximum recommended dose is 15 mg once weekly.
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How much does Mounjaro (tirzepatide) cost?
Mounjaro (tirzepatide) contraindications
Personal or family history of medullary thyroid cancer (MTC) or multiple endocrine neoplasia type 2 (MEN 2)
What are alternatives to Mounjaro (tirzepatide)?
Type 2 diabetes, in addition to diet and exercise
Manage Type 2 diabetes in people 10 years and older, along with diet and exercise
Lower the risk of heart problems like heart attack, stroke, or death in adults with Type 2 diabetes who have heart disease or heart-related risk factors
Lower the risk of heart attack, stroke, and death due to heart problems in adults with Type 2 diabetes and heart disease
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References
Best studies we found
Eli Lilly and Company. (2022). Food and drug administration approves Lilly's Mounjaro™ (tirzepatide) injection, the first and only GIP and GLP-1 receptor agonist for the treatment of adults with type 2 diabetes.
Eli Lilly and Company. (2022). Instructions for use.
Eli Lilly and Company. (2023). Mounjaro- tirzepatide injection, solution [package insert]. DailyMed.
He, L., et al. (2022). Association of glucagon-like peptide-1 receptor agonist use with risk of gallbladder and biliary diseases: A systematic review and meta-analysis of randomized clinical trials. JAMA Internal Medicine.
National Cancer Institute. (2019). Medullary thyroid cancer (MTC) . My Pediatric and Adult Rare Tumor Network.
National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Pregnancy if you have diabetes.
National Institute of Diabetes and Digestive and Kidney Diseases. (2023). Managing diabetes.
National Organization for Rare Disorders. (2024). Multiple endocrine neoplasia type 2.
Patel, H., et al. (2023). Gastrointestinal adverse events and weight reduction in people with type 2 diabetes treated with tirzepatide in the SURPASS clinical trials. Diabetes, Obesity and Metabolism.
Rizvi, A.A., et al. (2022). The emerging role of dual GLP-1 and GIP receptor agonists in glycemic management and cardiovascular risk reduction. Diabetes, Metabolic Syndrome and Obesity.
Rosenstock, J., et al. (2021). Efficacy and safety of a novel dual GIP and GLP-1 receptor agonist tirzepatide in patients with type 2 diabetes (SURPASS-1): A double-blind, randomised, phase 3 trial. Lancet.
Society for Endocrinology. (2021). Insulin. You and Your Hormones.
U.S. Food and Drug Administration. (2021). Safely using sharps (needles and syringes) at home, at work and on travel.
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