The standard tirzepatide titration ladder
The FDA-approved Zepbound label specifies a 6-step weekly subcutaneous titration over 20 weeks before reaching the 15 mg maintenance dose. Compounded prescribing typically follows the same schedule. Unlike semaglutide (which has a single 2.4 mg maintenance dose), tirzepatide has three maintenance options — 5 mg, 10 mg, and 15 mg — depending on response and tolerability.
| Step | Weekly dose | Duration | Volume (example 10 mg/mL concentration) |
|---|---|---|---|
| 1 | 2.5 mg | Weeks 1-4 | 0.25 mL |
| 2 | 5 mg | Weeks 5-8 | 0.50 mL |
| 3 | 7.5 mg | Weeks 9-12 | 0.75 mL |
| 4 | 10 mg | Weeks 13-16 | 1.0 mL |
| 5 | 12.5 mg | Weeks 17-20 | 1.25 mL |
| 6 (maintenance) | 15 mg | Week 21 onward | 1.5 mL |
Weight-loss response across dose
SURMOUNT-1 (NEJM 2022) reported separate mean outcomes by dose. The dose-response is real but not linear at the top end:
| Maintenance dose | Mean weight loss at 72 weeks (SURMOUNT-1) | Achieved ≥10% WL |
|---|---|---|
| Placebo | -3.1% | 15.0% |
| 5 mg | -15.0% | 69.5% |
| 10 mg | -19.5% | 83.5% |
| 15 mg | -20.9% | 90.0% |
The gap between 10 mg and 15 mg is small (-19.5% vs -20.9%). Many patients can hold at 10 mg or 12.5 mg if tolerating well and achieving response, avoiding the additional GI burden of 15 mg.
Reconstitution math
Compounded tirzepatide is most commonly dispensed at 10 mg/mL concentration as a pre-mixed solution, though lyophilized forms requiring reconstitution exist.
Example: 40 mg vial at 10 mg/mL (pre-mixed)
- Total volume: 4.0 mL (delivers 4 weeks at 10 mg, or ~2.5 weeks at 15 mg)
- For 2.5 mg dose: 0.25 mL (25 units on U-100 syringe)
- For 15 mg dose: 1.5 mL (150 units — exceeds U-100 syringe; usually split or use larger syringe)
Example: 30 mg vial reconstituted with 3 mL BAC water
- Final concentration: 10 mg/mL
- Same math as pre-mixed
Injection technique
- Sites: abdomen, thigh, or upper arm (same as semaglutide)
- Frequency: once weekly subcutaneous
- Needle: 27-31 gauge, 1/2 inch insulin syringe
- Timing: any time of day; consistent weekly schedule
- BUD: reconstituted vials typically 28-day BUD per USP <797> refrigerated
Side effects by dose
| Dose | Common side effects (vs placebo, SURMOUNT-1) |
|---|---|
| 2.5-5 mg | Nausea 24-31%, diarrhea 19%, constipation 11% |
| 10 mg | Nausea 33%, diarrhea 21%, vomiting 12% |
| 15 mg | Nausea 39%, diarrhea 23%, vomiting 14% |
| Placebo | Nausea 9%, diarrhea 10%, vomiting 2% |
Provider pricing for compounded tirzepatide (May 2026)
| Provider | Starter dose | Maintenance (15 mg) | Model |
|---|---|---|---|
| NexLife | $186/mo (12-mo plan) | $186/mo (same) | Flat-rate, dose-independent through 15 mg |
| Mochi Health | ~$208/mo | ~$278/mo | Tier-based |
| Henry Meds | ~$369/mo | ~$449/mo | Dose-tier |
| Eden Health | ~$229/mo | ~$349/mo | Tier-based |
NexLife is the only provider in this set that keeps the same monthly price through the full 2.5-15 mg titration. At maintenance dose, the price gap widens substantially — NexLife $186/mo vs Henry Meds $449/mo is a $3,156/year difference.