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Zepbound ® (tirzepatide) injection
2.5 mg/ 5 mg/ 7.5 mg/ 10 mg/ 12.5 mg/ 15 mg
This information is provided in response to your request. Resources may contain information about doses, uses, formulations and populations different from product labeling. See Prescribing Information above, if applicable.
What should a patient do if they miss a dose of Zepbound® (tirzepatide)?
If a dose is missed, it should be administered as soon as possible within 4 days (96 hours) after the missed dose.
See important safety information, including boxed warning, in the attached prescribing information.
Missed Dose
If a dose is missed, when the next dose is administered depends on the following schedule (Instructions for a Missed Dose of Tirzepatide and Example for a Missed Dose of Tirzepatide).1
If a dose of tirzepatide is missed and it is… |
Then… |
And... |
4 days (96 hours) or less after the missed dose |
it should be administered as soon as possible |
patients can resume their regular once-weekly dosing schedule. |
more than 4 days (96 hours) after the missed dose |
the missed dose should be skipped |
Changing Day of Weekly Dose
The day of weekly administration can be changed, if necessary, as long as the time between the two doses is at least 3 days (72 hours).1
Missed Dose During Dose Escalation
In the SURMOUNT study protocol, if participants temporarily interrupted tirzepatide therapy and the number of consecutive missed doses was
- 1 to 2 doses, the treatment was restarted at the same dose if the drug was well tolerated prior to discontinuation, or
- 3 doses or more, the treatment was restarted at 5 mg regardless of the dose received before the interruption and subsequently escalated as required by protocol.2-6
Pharmacokinetics
Steady-state plasma tirzepatide concentrations were achieved following 4 weeks of once-weekly injections.1
In Simulation of the Impact of a Missed Dose on Tirzepatide Concentration Over Time, it can be seen that when the next dose is taken on the regularly planned day, there is a transient, approximately 15% increase in concentration due to the subsequent dose. When the missed dose is administered 5 days or more after planned dosing day, the subsequent dose can lead to approximately 20% or greater increases in exposure.7
Figure 2 description: Simulation of steady-state tirzepatide pharmacokinetics was performed with the tirzepatide population pharmacokinetic model. Solid black lines denote the simulation median, gray triangles denote once-weekly tirzepatide dosing interval, red triangles denote tirzepatide dosing time beyond 1 week after a dose. The y-axis is tirzepatide concentration relative to the maximum concentration of the pharmacokinetic profile. The shaded area denotes the interval between minimum and maximum concentration of the steady state pharmacokinetic profile. There is more variance in relative concentration when tirzepatide doses are delayed beyond the recommended dosing of every week.
Enclosed Prescribing Information
References
The published references below are available by contacting 1-800-LillyRx (1-800-545-5979).
1Zepbound [package insert]. Indianapolis, IN: Eli Lilly and Company; 2024.
2Jastreboff AM, Aronne LJ, Ahmad NN, et al; SURMOUNT-1 Investigators. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-216. https://doi.org/10.1056/NEJMoa2206038
3Garvey WT, Frias JP, Jastreboff AM, et al; SURMOUNT-2 investigators. Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2023;402(10402):613-626. https://doi.org/10.1016/S0140-6736(23)01200-X
4Wadden TA, Chao AM, Machineni S, et al. Tirzepatide after intensive lifestyle intervention in adults with overweight or obesity: the SURMOUNT-3 phase 3 trial. Nat Med. 2023;29(11):2909-2918. https://doi.org/10.1038/s41591-023-02597-w
5A study of tirzepatide (LY3298176) in participants with obesity or overweight for the maintenance of weight loss (SURMOUNT-4). ClinicalTrials.gov identifier: NCT04660643. Updated May 24, 2023. Accessed July 27, 2023. https://clinicaltrials.gov/study/NCT04660643
6A study of tirzepatide (LY3298176) in participants with obesity or overweight with weight related comorbidities (SURMOUNT-5). ClinicalTrials.gov identifier: NCT05822830. Updated May 28, 2024. Accessed July 12, 2024. https://clinicaltrials.gov/study/NCT05822830
7Data on file, Eli Lilly and Company and/or one of its subsidiaries.
Date of Last Review: November 02, 2024