How Mounjaro is used

Which Mounjaro forms exist in Türkiye?

In the TİTCK list of licensed products, Mounjaro appears in two different forms; both contain doses of 2.5, 5, 7.5, 10, 12.5 and 15 mg. ^[3]

According to the KwikPen SmPC, the pen is discarded after the 4-week dose. After four doses have been given correctly, a small amount of solution may remain in the pen; the SmPC asks that patients be told not to try to use this remaining solution. ^[1] The FDA label states that a KwikPen pen should not be shared between patients even if the needle is changed, as this carries a risk of blood-borne infection. ^[5]

How is the dose started and increased according to the SmPC?

The posology section of the Turkish SmPC is as follows: the starting dose of tirzepatide is 2.5 mg once a week; this dose should be raised to 5 mg once a week at the end of 4 weeks. If necessary, the dose can be increased in 2.5 mg increments after the current dose has been used for at least 4 weeks. The recommended maintenance doses are 5, 10 and 15 mg; the maximum dose is 15 mg once a week. ^[1]

These steps are the same as the scheme used in the licensing trials: according to the EMA product information, in the SURPASS and SURMOUNT trials, all participants started with 2.5 mg for 4 weeks and the dose was increased by 2.5 mg every 4 weeks until the assigned dose was reached. ^[4] According to the FDA label, this dose-escalation scheme is followed in all indications in order to reduce the risk of digestive side effects. ^[5]

There are small differences between countries:

• EU: In children and adolescents aged 10 and over with type 2 diabetes, the maintenance doses are 5 and 10 mg and the highest dose is 10 mg. ^[4] According to the Turkish SmPC, however, safety and efficacy under 18 years have not been established. ^[1]
• US: In the Zepbound label, the maintenance doses for weight reduction are 5, 10 or 15 mg; for obstructive sleep apnea, 10 or 15 mg. The label states that treatment response and tolerability are taken into account in choosing the maintenance dose. ^[5]

What does the SmPC say together with other diabetes drugs?

According to the SmPC, when tirzepatide is added to metformin and/or SGLT2 inhibitor treatment, the current dose of these drugs can be continued. When added to sulfonylurea and/or insulin treatment, a reduction in the dose of these drugs can be considered to reduce the risk of hypoglycemia; monitoring of the person’s own blood glucose is needed to adjust the dose and a stepwise approach to insulin reduction is recommended. ^[1] The type 2 diabetes indication in the Turkish SmPC does not cover adding tirzepatide to DPP-4 inhibitors and other GLP-1 receptor analogues. ^[1] The FDA label also does not recommend use together with other tirzepatide-containing products or any GLP-1 receptor agonist. ^[5]

What does the SmPC provide if a dose is skipped?

According to the SmPC, when a dose is skipped, it should be administered as soon as possible within 4 days after it was skipped. If more than 4 days have passed, the skipped dose is cancelled and the next dose is administered on the regularly scheduled day; in both cases the regular once-weekly schedule can be continued. ^[1] The FDA label gives the same rule as “4 days (96 hours).” ^[5]

The weekly administration day can be changed when necessary; for this, the SmPC requires that the last dose was administered at least 3 days earlier. ^[1]

Where and when is it administered?

According to the SmPC, Mounjaro is injected subcutaneously into the abdomen, thigh or upper arm; it can be administered at any time of day, with meals or apart from them. The injection site is changed with each dose; if the same person also uses insulin, Mounjaro is administered at a different site. ^[1] The EMA product information states that administration into the upper arm is done by another person. ^[4]

The vial SmPC states that patients and caregivers should be trained in the appropriate injection technique before administration. ^[2] Both SmPCs ask that careful reading of the patient information leaflet before administration be advised. This page does not describe injection technique; the technique is in the product’s patient information leaflet and in the training given by the health care team.

How is it stored?

The storage conditions in the SmPCs are as follows: ^{[1] [2]}

• It is stored in the refrigerator between 2–8 °C; it is not frozen. Frozen product is not used.
• It is stored in its original packaging to protect from light.
• Vial: It can be stored outside the refrigerator at room temperature below 30 °C for up to a total of 21 days; afterwards the vial is discarded.
• KwikPen: According to the Turkish SmPC, after first use it can be stored below 30 °C without refrigeration for up to 30 days; after this period the pen is discarded. The EU product information (EMA) allows the opened pen to be stored in the refrigerator (2–8 °C) or below 30 °C; on this point the two texts differ. ^[4]
• It is visually inspected before use; if there are particles or color change, it is not used.
• Unused products and waste are disposed of in accordance with the Medical Waste Control Regulation (Tıbbi Atıkların Kontrolü Yönetmeliği) and the Packaging Waste Control Regulation (Ambalaj Atıklarının Kontrolü Yönetmeliği).

What does the SmPC say in special situations?

• Kidney and liver failure: Dose adjustment is not necessary; experience in severe failure is limited and caution is recommended. ^[1]
• Older people: No age-based dose adjustment is needed; data at age 85 and over are extremely limited. ^[1]
• Pregnancy plan: If pregnancy is planned or occurs, tirzepatide is stopped; because of its long half-life, it needs to be stopped at least 1 month before a planned pregnancy. ^[1]
• Oral contraceptive pill: The Turkish SmPC and the EMA do not consider the decrease in pill levels after a single dose of tirzepatide clinically significant and state that no dose adjustment is needed. ^{[1] [4]} The FDA label, however, recommends switching to a non-oral method or adding a barrier method for 4 weeks after the start of treatment and after each dose increase. ^[5]
• Driving: Tirzepatide has no or negligible effect on the ability to drive; when used together with a sulfonylurea or insulin, taking precautions to avoid hypoglycemia is advised. ^[1]

What happens if too much is taken?

According to the SmPC, in overdose, supportive treatment is started according to the person’s signs; digestive side effects including nausea may occur. Tirzepatide has no specific antidote. Because the half-life is about 5 days, symptoms may need to be monitored and treated for a long time. ^[1]

Contraindications and warnings in the SmPC before use

• Thyroid: The Turkish SmPC lists a personal or family history of medullary thyroid carcinoma and MEN 2 syndrome as contraindications. ^[1] The US label gives this contraindication together with a boxed warning on thyroid C-cell tumors seen in rats; the relevance in humans is unknown. ^[5]
• Reliability of the product: In Türkiye, a letter from the Erzurum Provincial Health Directorate to the pharmacists’ chamber (chamber registration date May 20, 2026), referring to the TİTCK letter dated May 14, 2026, relays that reports of suspected counterfeiting of medicines containing GLP-1 receptor agonists have increased markedly; in pharmacy and pharmaceutical warehouse inspections, Ozempic, Saxenda and Wegovy pens and Mounjaro solution for injection are stated to carry a high counterfeit risk. The letter emphasizes that medicines should not be bought over the internet and that medicines that cannot be registered in the Medicine Track and Trace System (İTS) should not be kept or used. ^[6]

Limits of this page

This page transfers the relevant sections of the TİTCK-approved SmPCs and the EU and US product information; it does not recommend a personal dose, a dose escalation schedule or injection technique. Product information can be updated; what is valid is the current SmPC and patient information leaflet supplied with the product. How the drug is obtained is not the subject of this page.