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Tirzepatide

Tirzepatide

Dual GIP / GLP-1 agonist

Tirzepatide adds a second receptor, GIP, to the GLP-1 mechanism. In the trials that dual action produced more weight loss than GLP-1 alone, which is why it is usually the second thing people ask about.

The trade-off is patience. The ladder is longer and the side-effect window at each step is wider, so a physician will hold you at a dose until it is genuinely comfortable rather than moving on schedule.

Titration scheduleweek / dose
1–42.5mg
5–85.0mg
9–127.5mg
13+15mg

Your clinician sets the actual schedule. This is the standard ladder and the one they start from.

Physician reviewed before it ships
Charged only if approved
Cold-chain, tracked, free
Strong human evidence

Multiple large randomised controlled trials in people, published in peer-reviewed journals, with regulatory approval behind them.

−20.9%

Mean body-weight change at 72 weeks on 15mg weekly, against −3.1% on placebo

SURMOUNT-1 · NEJM 2022
−15.0%

Mean change on the lowest 5mg dose in the same trial

SURMOUNT-1 · NEJM 2022
2,539

Adults randomised

SURMOUNT-1 · NEJM 2022

What it is

Tirzepatide acts on two incretin receptors rather than one — GIP as well as GLP-1. FDA-approved for type 2 diabetes in 2022 and for chronic weight management in 2023. It produced the largest average weight reduction published for a drug in this class.

How it works

The GLP-1 half does what semaglutide does. The GIP half appears to add an independent effect on energy intake and insulin sensitivity. The trade-off for the bigger number is a longer ladder and a wider side-effect window at each step.

What the evidence actually says

  1. 2022

    SURMOUNT-1

    2,539 adults. Mean −20.9% at 72 weeks on 15mg against −3.1% on placebo, with a clear dose response from 5mg upward.

  2. 2024

    Shortage resolved

    FDA declared the tirzepatide shortage over in December 2024, ending shortage-based compounding of it.

What the first months look like

  • Weeks 1–4A 2.5mg starting dose that is not intended to be therapeutic.
  • Weeks 5–20Steps up slowly. A physician will hold you at a dose until it is genuinely comfortable rather than moving on schedule — the ladder is longer than semaglutide's for a reason.
  • Month 6+Maintenance at whatever dose you tolerated, which is often not the maximum.

Who this is not for

  • A personal or family history of medullary thyroid carcinoma, or MEN2.
  • Pregnancy, or planning pregnancy within two months.
  • A history of pancreatitis, without discussing it first.
Sources
  1. Jastreboff AM et al. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med 2022;387:205–216. PMID 35658024.

Figures are quoted from the published trials and were last checked in August 2026. We update this page when the evidence changes.