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Tirzepatide for Weight Loss

written by Linda Anegawa MD, FACP Written by Linda Anegawa MD, FACP
Linda Anegawa MD, FACP

Linda Anegawa MD, FACP

Dr. Anegawa graduated from the Univ. of Pennsylvania School of Medicine and completed residency at Stanford. She has over 20 years of practice experience and specializes in Internal Medicine and Obesity Medicine.

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May 17, 2022 Read Time - 4 minutes

What is Tirzepatide?

Tirzepatide is a novel drug to treat Type 2 Diabetes which has also been found to result in significant weight loss. It is manufactured by the drug company Eli Lilly and it has been approved by the FDA for treatment of Type 2 Diabetes, with the trade name Mounjaro.  

How Does Tirzepatide Work?

Tirzepatide is what is known as a “dual glucose-dependent insulinotropic polypeptide-GLP-1 receptor agonist.” This long and complicated name means it can do two things:

1. Stimulate GLP-1 receptors in the body to both help control blood glucose and reduce hunger, promoting weight loss.

2. Promote release of glucose-dependent insulinotropic polypeptide which helps modulate levels of a hormone called glucagon and improve insulin sensitivity of adipose (fat) tissue.

What Have Been Results on Tirzepatide?

A study published in 2021 called SURPASS-2 on over 1800 participants found that Tirzepatide + Metformin was superior to Semaglutide + Metformin on reduction in Hemoglobin A1C in individuals with Type 2 Diabetes.  As a secondary endpoint, 5.5% more weight loss was noted in the Tirzepatide group compared to the Semaglutide group.

The most recent clinical trial awaiting publication, called SURMOUNT-1, reports that the average weight loss among over 2500 trial participants was 16% at 72 weeks. Adults who were randomly assigned to receive tirzepatide had average weight losses of 16% with 5 mg of the drug, 21.4% with 10 mg, and 22.5% with 15 mg, compared with only 2.4% weight loss with participants who took a placebo. Of the tirzepatide group, 89% achieved a weight loss of at least 5% compared with 28% in the placebo group as well. The average BMI of trial participants starting off was 38, and was reduced to an average of 30, with many subjects getting into the normal range.  

The SURMOUNT-1 trial is still ongoing, and additional key outcome measures under study include progression to type 2 diabetes among patients with prediabetes.  It is anticipated that the trial will be continued for a total of an additional 104 weeks.

How Does Tirzepatide Compare to Similar Weight Loss Medications, or Weight Loss Surgery?

Keep in mind that currently Tirzepatide is not technically FDA-approved for weight loss, but for Type 2 Diabetes.  But based on the results of SURMOUNT-1, if Tirzepatide was approved for weight loss, it would easily become the most effective drug available. Given that it has two different mechanisms of action, it appears to have a greater effect on weight and blood sugar than GLP-1 agonist drugs alone such as Semaglutide or Liraglutide, which are both currently FDA approved for sugar and weight control under different trade names.

Given that over half the patients on the 10 mg dose and 63% of those on the 15 mg dose lost more than 20% of their body weight, this number takes many past the weight loss achieved long term with surgical interventions such as the lap-band, and is within the typical ranges achieved long term with procedures such as the sleeve gastrectomy.

What Are the Anticipated Side Effects of Tirzepatide?

The safety and tolerability profile for Tirzepatide is felt to be similar to other related drugs such as Semaglutide and Liraglutide, and would include nausea, diarrhea, constipation, and vomiting.  Additional study is ongoing and looking closely for other unanticipated adverse effects.  As of yet, there is no long term safety data on this drug.

Can I Get Tirzepatide Yet?

While Tirzepatide has been FDA approved, it is not yet available by prescription. Production and distribution of Tirzepatide to pharmacies will be occurring after June 2022.  

Tirzepatide, also known as Mounjaro, is expected to be available in the following doses:  2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, or 15 mg per 0.5 ml in single-dose injection pens.  The medication is designed to be injected weekly into the skin.  

Who Cannot Use Tirzepatide?

Like all weight loss medications, Tirzepatide can’t be used by anyone who is pregnant, plans to become pregnant within the next 3 months, or is breastfeeding. Tirzepatide also should not be used if you have ever had pancreatitis, medullary thyroid carcinoma, or if there is a family history of medullary thyroid carcinoma or something called the MEN2 syndrome.

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How Can I Learn More About Whether Tirzepatide is Right For Me?

Speak with a PlushCare Physician to discuss your concerns.  Even though Tirzepatide isn’t yet widely available, a PlushCare doctor can start the evaluation process which would include a discussion of your past medical history, current medication, and ordering of baseline tests and studies to determine if you will qualify.


Note: Tirzepatide is not currently available by prescription yet.


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Sources:

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The New England Journal of Medicine. Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes. N Engl J Med 2021; 385:503-515. Accessed on April 29, 2022 at https://www.nejm.org/doi/full/10.1056/NEJMoa2107519

American College of Cardiology. A Study of Tirzepatide (LY3298176) Versus Semaglutide Once Weekly as Add-on Therapy to Metformin in Participants With Type 2 Diabetes – SURPASS-2. Accessed on April 29, 2022 at https://www.acc.org/latest-in-cardiology/clinical-trials/2021/06/27/19/02/surpass-2

U.S. Food & Drug Administration. FDA Approves Novel, Dual-Targeted Treatment for Type 2 Diabetes. Accessed on May 16, 2022 at https://www.fda.gov/news-events/press-announcements/fda-approves-novel-dual-targeted-treatment-type-2-diabetes

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