Tirzepatide Dosage Chart: Units, Strengths, Schedule

The Tirzepatide Dosage Chart

Tirzepatide has one dosing ladder in the United States, and it belongs to Eli Lilly's labels. Mounjaro (NDA 215866) was approved on May 13, 2022 and Zepbound (NDA 217806) on November 8, 2023, both at six strengths, 2.5 to 15 mg per 0.5 mL. The Zepbound label, revised August 2026, sets the schedule: 2.5 mg once weekly for four weeks, then 5 mg, then 2.5 mg increases after at least four weeks at each dose, to a 15 mg maximum. The Mounjaro label keeps the same steps but ties each increase to glycemic control rather than a calendar. Compounded tirzepatide has no label of its own; these are the numbers every chart online copies.

Read the middle column as a floor, not a plan: the label fixes the minimum time at each dose, allows a lower maintenance dose when one is not tolerated, and plenty of people stop partway up.

Zepbound (tirzepatide) injection, U.S. Prescribing Information, revised 08/2026 (ZEP-0016-USPI-20260828). Sections 2.1, 2.2 and 3. Via DailyMed. View study

Mounjaro (tirzepatide) injection, U.S. Prescribing Information, revised 08/2026 (MOU-0012-USPI-20260827). Sections 2.1 and 3. Via DailyMed. View study

U.S. Food & Drug Administration, Drugs@FDA. NDA 215866, Mounjaro (tirzepatide), approved May 13, 2022; NDA 217806, Zepbound (tirzepatide), approved November 8, 2023. View study

How the ladder becomes a vial at PeRx

A compounded vial has no dose built in, so a clinic has to decide how six steps map onto what the patient draws. PeRx fixes the volume and moves the concentration. Every patient, at every step, draws 50 units, 0.5 mL on a U-100 insulin syringe, once a week; the step lives in the vial, six concentrations from 5 to 30 mg/mL. A 2 mL vial holds exactly four draws, so one vial is one 28-day cycle, and the provider sets the strength at each renewal rather than the patient at checkout.

Units on an Insulin Syringe: Why the Label Outranks Memory

A U-100 insulin syringe is marked in units, and units measure volume, not medication: 100 units is 1 mL. The milligrams in a draw depend on the concentration, so the conversion is one line: units equals milligrams divided by mg/mL, times 100. That is why "how many units is 2.5 mg of tirzepatide" has no answer on its own. The table runs 2.5 mg across concentrations compounding pharmacies use.

The last column is the point. Insulin syringes are marked in whole units, or half units on some 0.3 mL models, so a prescription that works out to 16.7 units cannot be drawn accurately by anyone. Fixing the draw and moving the concentration removes that problem, and it is not a PeRx invention: Section 3 of the Zepbound label lists a 2.4 mL multi-dose vial of the approved product in six concentrations, 4.17 to 25 mg/mL, each delivering its step in the same 0.6 mL dose. One practical note: 50 units is half of a 1 mL insulin syringe and the whole of a 0.5 mL one, so check the capacity before the first draw.

The reason to be strict is on the public record. The FDA reports adverse events, some requiring hospitalization, that may relate to dosing errors with compounded GLP-1 injections: patients measuring the wrong dose, prescribers sometimes miscalculating it, and doses beyond the label, meaning more per injection, more often, or steps taken faster than the schedule. A 2023 poison-center case series shows it one patient at a time: three people harmed by compounded semaglutide, two from tenfold overdoses, one dosing in milliliters and units rather than milligrams. The totals are in compounded tirzepatide: the 2026 rules Read nextCompounded Tirzepatide: The 2026 Rules, ExplainedCompounded tirzepatide is the same active molecule as Mounjaro and Zepbound, drawn from a multi-dose vial a state-licensed pharmacy prepared for one named patient. Everything around the molecule is different: who checked it, what the law allows, what a court has said about how it is sold, and what the safety reports show. This page walks through all of it, dated.Read article .

U.S. Food & Drug Administration, "FDA's Concerns with Unapproved GLP-1 Drugs Used for Weight Loss." Dosing concerns with compounded semaglutide and tirzepatide. Content current as of October 1, 2026. View study

Lambson JE, Flegal SC, Johnson AR. "Administration errors of compounded semaglutide reported to a poison control center-Case series." Journal of the American Pharmacists Association. 2023;63(5):1643-1645. PMID 37392810. View study

Larger datasets point the same way, with the caveat that spontaneous reports show association, not cause: 10,033 poison-center GLP-1 exposures from 2012 to 2023, mostly therapeutic errors; 3,348 accidental-overdose reports in FAERS; and, among 707 compounded-product FAERS reports, higher odds of prescribing errors and hospitalization, though lower odds of coded dosing errors, so the signal is real but not uniform.

Miller J, Miller R, Varney SM, Han D. "National Poison Center Trends in GLP-1 Receptor Agonist Exposures Following FDA Approval for Weight Loss." Journal of Medical Toxicology. 2026;22(2):275-285. PMID 41634285. View study

McIntyre RS, Kwan ATH. "Increased reporting of accidental overdose with glucagon-like peptide-1 receptor agonists: a population-based study." Expert Opinion on Drug Safety. 2026;25(4):677-682. PMID 39552465. View study

McCall KL, Mastro Dwyer KA, Casey RT, et al. "Safety analysis of compounded GLP-1 receptor agonists: a pharmacovigilance study using the FDA adverse event reporting system." Expert Opinion on Drug Safety. 2026;25(3):581-588. PMID 40285721. View study

The First Month: Starting Dose and the Four-Week Minimum

Everyone starts at 2.5 mg, and the label is explicit that 2.5 mg is for starting, not maintenance. The ladder exists, in the label's words, to reduce gastrointestinal reactions, and the four-week block has a pharmacological reason. Tirzepatide's half-life is about five to six days, and the label reports steady-state blood levels after four weeks of weekly dosing. For the first three weeks at any dose the level is still climbing, so a judgment about tolerance in week two is a judgment about a level that has not finished rising.

Zepbound (tirzepatide) injection, U.S. Prescribing Information, revised 08/2026. Section 12.3 Pharmacokinetics: steady state after 4 weeks of once-weekly dosing; half-life approximately 5 to 6 days; similar exposure from abdomen, thigh and upper arm. View study

At PeRx the first vial is the 5 mg/mL strength for nearly every new patient: four draws of 50 units, one a week on the same weekday, at any hour, with or without food. Exposure is similar from abdomen, thigh and upper arm, so rotate among them. Before the second vial ships you complete a check-in, and a licensed provider reads it before prescribing the next strength. The first weeks are covered in nausea and gut effects on a GLP-1 Read nextNausea & Gut Issues on GLP-1s: What HelpsGI side effects are the single biggest reason patients stop Ozempic, Wegovy, and Mounjaro. Here is why GLP-1 receptor activation hits the gut so hard, which simple changes resolve most cases, and which peptide helps when the basics have not been enough.Read article , and sleep in tirzepatide and insomnia Read nextTirzepatide Insomnia: Why GLP-1s Disrupt SleepYou started tirzepatide, the weight is moving, and now you are staring at the ceiling at 3 AM wondering whether the shot did this. The internet offers two contradictory answers. One says this drug family treats sleep apnea, which is true. The other is a wall of forum posts from people who suddenly cannot sleep on it, which is also real. Nobody ranking for this search explains both sides. This page does: what the trials and labels actually say, why a subset of GLP-1 users genuinely does sleep worse, and what to change this week.Read article .

How Escalation Is Decided at PeRx

The PeRx prescribing protocol moves the dose at monthly intervals and only when three conditions all hold: you tolerate the current dose, you are not losing weight too quickly, and no new contraindication has appeared since the last review, such as a pregnancy or a plan for one, a new medication, or symptoms pointing to the pancreas or gallbladder. The check-in before each renewal asks about each and reads your current weight against the previous cycle, so the rate is visible. If all three hold, the provider prescribes the next strength up. If any one fails, the next vial ships at the same strength, or a lower one.

Two things follow from the vial. You cannot move faster than one step per cycle, because one vial holds one concentration, and you cannot move between renewals, because a mid-cycle change means a second prescription and a second vial. Drawing more than 50 units does not move you up a step; it spends the vial early, skips the review the step exists for, and matches the behavior behind the FDA reports of titration faster than the label. The honest limit: the three conditions are a clinical rule bounded by the label's one-increment-per-four-weeks ceiling, and no study has compared this escalation with any other for a compounded vial.

Maintenance and Stepping Down

The label names 5, 10 and 15 mg as maintenance doses and allows a lower one when a dose is not tolerated. Under the PeRx protocol there is no fixed maintenance strength, because stepping down is patient-specific. Some people stay at the top strength as maintenance. Others step down, one vial at a time, to the lowest strength at which they still feel satisfied after meals and the food noise stays quiet. The step-down follows the same cadence as the step-up. Halving the draw is not a step-down; it is an unprescribed dose from a vial labeled for a different one.

Doses that are not on the label, such as 1.25 mg starts or stretched intervals, are not part of the PeRx protocol; GLP-1 microdosing and maintenance Read nextGLP-1 Microdosing: Safety, Evidence, and Maintenance"Microdosing Ozempic" went from a forum phrase to a TikTok trend to a survey statistic: as of 2026, about 15% of injectable GLP-1 users say they have tried it, and nearly half of them did it without asking a doctor. Meanwhile the person who actually reached goal weight on semaglutide or tirzepatide still gets two contradictory answers about maintenance. This page covers both: what microdosing means, why it spread, what evidence exists for sub-label doses (almost none), the difference between a prescriber-set lower dose and splitting a vial yourself, and why the dose belongs on a prescription rather than in a spreadsheet.Read article sets out what is and is not known about them. The maintenance question that matters more than the number on the vial is what the weight is made of, the subject of muscle loss on a GLP-1 Read nextKeep Muscle on Ozempic, Wegovy, or MounjaroUp to 40% of weight lost on GLP-1 medications is lean muscle. Here's what the research actually shows, why it happens, and which growth hormone peptides providers prescribe to protect lean mass during a caloric deficit.Read article .

Missed Doses and Late Doses

The PeRx instruction: if you miss a dose and your next one is more than two days away, take it as soon as you remember; otherwise skip it and resume your normal schedule. Never take two doses in the same week. The label states the same rule from the other direction, a missed dose taken within four days, 96 hours, of when it was due and skipped after that. Count it either way and the cutoff lands in the same place.

The label allows a change of injection day as long as at least 72 hours separate the two doses; pick the new day once and keep it. If you have missed two or more doses in a row, ask the care team before restarting; the label does not address re-initiation. If you skipped a dose because the last one made you ill, say so at the check-in rather than quietly resuming, since that is exactly what the escalation rule depends on. A vial that was left out or froze is a pharmacy question first; how to store peptides Read nextHow to Store Peptides: Fridge, Travel & Shelf LifeStoring peptides is simpler than most of the internet makes it sound, especially with PeRx. Because every vial ships fully reconstituted and ready to use, there is nothing to mix and no powder to manage. Keep it cold, keep it dark, do not freeze it. Here is the complete answer, product by product.Read article covers what cold-chain products tolerate.

Zepbound (tirzepatide) injection, U.S. Prescribing Information, revised 08/2026. Section 2.3 Recommendations Regarding Missed Dose: within 4 days (96 hours), otherwise skip; the weekly day may change if at least 72 hours separate doses. View study

What a Cycle Costs and What the Vial Contains

Tirzepatide at PeRx is $399 per 28-day cycle, the same at every strength from 5 to 30 mg/mL. That covers the provider review, the compounding, overnight refrigerated shipping, syringes and swabs, and nothing is charged until a provider approves the prescription. It is a subscription because the strength changes: one vial per cycle, no multi-month quantities, since those would ship vials of a strength nobody has approved you for yet, an email and a text about three days before each renewal, and cancellation in one step from your account. The price comparison with the approved vials is in compounded tirzepatide Read nextCompounded Tirzepatide: The 2026 Rules, ExplainedCompounded tirzepatide is the same active molecule as Mounjaro and Zepbound, drawn from a multi-dose vial a state-licensed pharmacy prepared for one named patient. Everything around the molecule is different: who checked it, what the law allows, what a court has said about how it is sold, and what the safety reports show. This page walks through all of it, dated.Read article .

Tirzepatide

A 2 mL multi-dose vial of compounded tirzepatide with vitamin B12 from a state-licensed 503A pharmacy. The label carries the tirzepatide concentration in mg/mL, the B12 strength separately, your name, the prescriber and a beyond-use date.

Four weekly draws of 50 units. It ships ready to use with no reconstitution needed; refrigerate at 36 to 46 degrees Fahrenheit and never freeze. $399 per 28-day cycle.

One vial, one concentration, four identical draws.

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On the B12, one plain sentence: it is listed with its own strength, it does not enter the units arithmetic, and no controlled study has tested the blend against tirzepatide alone, so this page claims nothing for it.

Compounded Vial vs Brand Pen: What Differs in Dosing Terms

Mounjaro and Zepbound are FDA-approved products; the compounded vial is not, and nothing in the approved products' trial record transfers to it. With the legal and safety questions left to compounded tirzepatide Read nextCompounded Tirzepatide: The 2026 Rules, ExplainedCompounded tirzepatide is the same active molecule as Mounjaro and Zepbound, drawn from a multi-dose vial a state-licensed pharmacy prepared for one named patient. Everything around the molecule is different: who checked it, what the law allows, what a court has said about how it is sold, and what the safety reports show. This page walks through all of it, dated.Read article , the dosing differences come down to who measures, what changes between steps, and what a package holds.

The measuring row is the whole safety difference. What compounding is at all is in what is compounded semaglutide Read nextWhat Is Compounded Semaglutide? Is It Safe?Compounded semaglutide is the same active molecule as Ozempic and Wegovy, prepared by a licensed pharmacy for one named patient instead of manufactured under an FDA approval. That one sentence carries a lot of legal weight. This page unpacks it: what compounding is, how the compounded product differs from the brands, what changed between 2022 and 2026, and what a legitimate prescription looks like from inside a clinic that writes them.Read article ; the choice between the two compounded GLP-1s PeRx prescribes, which differ in dose ladder as much as mechanism, is in semaglutide vs tirzepatide Read nextSemaglutide vs Tirzepatide: Which One Fits YouPeRx prescribes two compounded GLP-1 medications, one at $249 a month and one at $399. This is the decision guide we wish existed: what each molecule does, how the approved brands differ on their FDA labels, what the head-to-head research on those brands actually shows, and the questions a prescriber weighs before picking one for a specific patient.Read article .

What Changes the Dose and What Does Not

Body weight does not change the dose. The label doses are fixed amounts, not milligrams per kilogram, and the same six steps apply to everyone. Side effects do, in one direction: a dose that is not tolerated is held or lowered, never pushed through. Other medications matter more than people expect. The Zepbound label, written for the approved product, says to consider reducing insulin or a sulfonylurea when tirzepatide starts, because of hypoglycemia; warns that slowed stomach emptying can change how oral medications are absorbed, naming warfarin; and tells anyone on an oral hormonal contraceptive to use a non-oral or barrier method for four weeks after starting and after each dose increase. At PeRx every increase is a new vial, so each new strength restarts that window.

Zepbound (tirzepatide) injection, U.S. Prescribing Information, revised 08/2026. Section 7.1 Concomitant Use with Insulin or an Insulin Secretagogue; Section 7.2 Oral Medications, including oral hormonal contraceptives for 4 weeks after initiation and after each dose escalation. View study

A planned surgery is a dose question too: tell the surgeon and anesthesiologist, because delayed stomach emptying changes fasting instructions and some teams hold doses beforehand. What does not change the dose: a plateau on the scale, which is a check-in topic, not a reason to draw more; a week of feeling fine, which is the four-week minimum doing its job; and the B12. Effects that show up in training are not dose questions either; see tendon injuries and lifting after a GLP-1 Read nextTendon Injuries When Lifting After GLP-1 Weight LossA pattern keeps repeating in gyms right now. Someone loses sixty pounds on semaglutide or tirzepatide, gets back under the bar, watches the numbers climb for six weeks, and then an elbow or a patellar tendon shuts the whole thing down. Nobody warned them because almost nothing written about GLP-1s mentions connective tissue at all. This page is the warning, the physiology behind it, and the plan.Read article and peptides to take with a GLP-1 Read nextPeptides to Take With a GLP-1: The EvidenceSearch this question and you get a stack. Every result recommends four or five peptides, none of them ranks the options, and none of them tells you which ones have human data behind them. This page sorts the same list into three tiers and says out loud which tier each one lands in.Read article .

When to Contact a Provider

The PeRx prescribing instructions name three reasons to contact the care team: nausea or vomiting that stops you keeping fluids down, constipation lasting more than a few days, and injection-site irritation that does not settle within a few days. Four call for emergency help: severe abdominal pain, especially spreading to the back or with vomiting; yellowing of the skin or eyes; a neck lump or swelling, hoarseness or trouble swallowing; and swelling of the face, throat or tongue with difficulty breathing.

Common Questions