Mounjaro's label starts at 2.5 mg once weekly and permits increases of 2.5 mg after at least four weeks on the current dose, to a maximum of 15 mg in adults and 10 mg in patients aged 10 and over. What separates this chart from the weight-management version of the same molecule is the trigger: the label increases the dose when additional glycaemic control is needed, not on a fixed run-up to a target.
That is why the numbers attached to each Mounjaro dose are HbA1c reductions rather than weight percentages. In SURPASS-1, tirzepatide monotherapy lowered HbA1c by 1.87, 1.89 and 2.07 percentage points at 5 mg, 10 mg and 15 mg over 40 weeks, against a 0.04 point rise on placebo (PMID 34186022). Here is the full ladder, what each rung produced across the SURPASS programme, and the label rules that go with it.
- Six strengths, 2.5 mg to 15 mg, in 2.5 mg steps no closer together than four weeks. The fastest route to 15 mg is week 21.
- The label frames each increase as a response to glycaemic control, so plenty of people stay on a middle dose indefinitely.
- HbA1c was the primary endpoint in every SURPASS trial. Weight was a secondary outcome.
- A missed dose has a four-day window, and the injection day can move as long as two doses stay 72 hours apart.
- The current label also covers cardiovascular risk reduction in adults at high risk, and paediatric use from age 10 with a 10 mg ceiling.
The Mounjaro dosage chart
The week column below is the earliest each strength can begin if every step is taken at the minimum four weeks. It is a floor, not a plan.
| Dose | Role on the diabetes label | Earliest week it can start | Published SURPASS data |
|---|---|---|---|
| 2.5 mg | Starting dose for the first four weeks | Week 1 | No efficacy endpoint measured |
| 5 mg | First dose with trial data | Week 5 | Yes, in all four trials below |
| 7.5 mg | Increment between 5 mg and 10 mg | Week 9 | Not a randomised arm |
| 10 mg | Mid dose, and the paediatric maximum | Week 13 | Yes, in all four trials below |
| 12.5 mg | Increment between 10 mg and 15 mg | Week 17 | Not a randomised arm |
| 15 mg | Adult maximum | Week 21 | Yes, in all four trials below |
Half the chart has never been studied as a destination. The SURPASS trials randomised people to 5 mg, 10 mg or 15 mg and titrated them there in 2.5 mg steps, so 2.5 mg, 7.5 mg and 12.5 mg exist to make the climb gentler rather than because anyone measured an outcome at them.
On this label, glucose moves the dose
The single most consequential sentence in the Mounjaro dosing section is the condition on every increase: the dose goes up if additional glycaemic control is needed. That is a different logic from a weight-management ladder, where the escalation is aimed at a maintenance dose the trials measured.
In practice it means a Mounjaro dose history is a record of how someone's HbA1c responded, not a countdown. Someone whose glucose is at target on 5 mg has no labelled reason to move to 7.5 mg. Someone whose HbA1c is still high at 10 mg has one. Reading the chart as a ladder everyone is expected to climb misreads what the label is describing.
What each dose produced across the SURPASS programme
Four phase 3 trials covering monotherapy, an active GLP-1 comparator, insulin comparison and insulin add-on. Every one used HbA1c change as its primary endpoint, and the background therapy differed in each, which is why the between-trial spread is wider than the between-dose spread.
| Trial | Design | Duration | Baseline HbA1c | HbA1c change at 5 / 10 / 15 mg | Comparator |
|---|---|---|---|---|---|
| SURPASS-1 (PMID 34186022) | Monotherapy vs placebo, 478 adults naive to injectables | 40 weeks | 7.9% | -1.87 / -1.89 / -2.07 points | Placebo +0.04 |
| SURPASS-2 (PMID 34170647) | Open-label vs semaglutide 1 mg, 1879 adults | 40 weeks | 8.28% | -2.01 / -2.24 / -2.30 points | Semaglutide 1 mg -1.86 |
| SURPASS-3 (PMID 34370970) | Vs titrated insulin degludec, on metformin with or without an SGLT2 inhibitor, 1437 adults | 52 weeks | 8.17% | -1.93 / -2.20 / -2.37 points | Insulin degludec -1.34 |
| SURPASS-5 (PMID 35133415) | Added to titrated insulin glargine vs placebo, 475 adults | 40 weeks | 8.31% | -2.11 / -2.40 / -2.34 points | Placebo -0.86 |
Two patterns are worth pulling out. The step from 5 mg to 15 mg bought between 0.20 and 0.44 HbA1c points depending on the trial, which is a modest return on tripling the dose. And in SURPASS-5 the 15 mg arm did not beat the 10 mg arm on HbA1c at all, while its premature discontinuation rate was 18% against 12%. More dose is not uniformly more glycaemic effect.
Weight, as the secondary outcome it was
Every SURPASS trial measured weight, and the figures are large, but they were secondary endpoints in a glycaemic trial population rather than the primary result.
| Trial | Weight change on tirzepatide | Comparator arm |
|---|---|---|
| SURPASS-1 | -7.0 kg to -9.5 kg across the three doses, from BMI 31.9 | Placebo |
| SURPASS-2 | 1.9 kg, 3.6 kg and 5.5 kg more than semaglutide 1 mg | Semaglutide 1 mg, from mean 93.7 kg |
| SURPASS-3 | -7.5 kg to -12.9 kg across the three doses, from 94.3 kg | Insulin degludec +2.3 kg |
| SURPASS-5 | -5.4 kg, -7.5 kg and -8.8 kg | Placebo +1.6 kg |
None of these is the 20.9% figure that circulates for tirzepatide. That came from SURMOUNT-1, a 72-week obesity trial in people without diabetes, and it belongs to a different programme, a different population and a different label. The comparison is set out in the tirzepatide dosage chart, which covers the weight-management side of the same molecule, and a GLP-1 weight loss calculator converts those percentages into pounds from a given starting weight.
Why the steps are four weeks apart
The escalation interval is a tolerability decision, and the SURPASS safety tables show what it is managing. In SURPASS-1, the monotherapy trial, nausea was reported by 12% to 18% of tirzepatide participants against 6% on placebo, diarrhoea by 12% to 14% against 8%, and vomiting by 2% to 6% against 2%, all described as mild to moderate and transient. No clinically significant or severe hypoglycaemia was reported on tirzepatide, which reflects the glucose-dependent way these receptors amplify insulin release.
Dose is what moves those rates. SURPASS-5 is the clearest illustration: premature discontinuation of treatment ran at 10% on 5 mg, 12% on 10 mg and 18% on 15 mg, against 3% on placebo, in a trial where 15 mg produced no HbA1c advantage over 10 mg. A four-week gap between increments exists so each step is tested for tolerance before the next one, which is part of why the top of the chart is reached by fewer people than the chart implies. The mechanism behind both the effect and the nausea is in how tirzepatide works.
Put the weight figures against your own starting point
The SURPASS numbers are kilograms from trial baselines. See what the published tirzepatide percentages mean from your weight.
Two devices, two sets of numbers
This is where a dosage chart and a pharmacy label stop matching, and it is the most common source of confusion about Mounjaro dosing.
The single-dose pens and vials all hold 0.5 mL, whatever the strength. A 2.5 mg pen and a 15 mg pen are the same volume, with the concentration doing the work. The multi-dose KwikPen and multi-dose vials hold four doses each, at concentrations chosen so one dose comes out of a 2.4 mL container.
| Dose delivered | Single-dose pen or vial | Multi-dose KwikPen or vial | Concentration in the multi-dose format |
|---|---|---|---|
| 2.5 mg | 2.5 mg/0.5 mL | 10 mg/2.4 mL | 4.17 mg/mL |
| 5 mg | 5 mg/0.5 mL | 20 mg/2.4 mL | 8.33 mg/mL |
| 7.5 mg | 7.5 mg/0.5 mL | 30 mg/2.4 mL | 12.5 mg/mL |
| 10 mg | 10 mg/0.5 mL | 40 mg/2.4 mL | 16.7 mg/mL |
| 12.5 mg | 12.5 mg/0.5 mL | 50 mg/2.4 mL | 20.8 mg/mL |
| 15 mg | 15 mg/0.5 mL | 60 mg/2.4 mL | 25 mg/mL |
Neither device is drawn up with an insulin syringe and neither is measured in units, so a unit figure copied from a compounded vial has no bearing on either column. Why that arithmetic does not transfer is covered in our mg to units explainer.
The timing rules on the label
Three of them, and they are more permissive than the semaglutide equivalents.
- A missed dose has four days. The label says a missed dose can be administered as soon as possible within 4 days, or 96 hours. Past that it is skipped and the schedule resumes on the usual day. Wegovy's window is two days, so the rules are not interchangeable between GLP-1 products.
- The injection day can move. The day of weekly administration can be changed as long as at least 3 days, or 72 hours, separate two doses.
- Timing within the day does not matter. The label allows any time of day, with or without meals.
The label also covers where the injection goes: the abdomen or thigh, or the back of the upper arm if someone else administers it, rotating sites with each dose. When it is given alongside insulin the two are separate injections, never mixed, and may go in the same body region provided they are not adjacent.
What the current label added
Two things sit on the Mounjaro label that are not on a standard titration chart.
Cardiovascular risk reduction. The label carries an indication to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes at high risk for them. The trial behind it, SURPASS-CVOT, randomised 13,299 patients with type 2 diabetes and atherosclerotic cardiovascular disease to tirzepatide up to 15 mg or dulaglutide 1.5 mg (PMID 41406444). The primary composite of cardiovascular death, myocardial infarction or stroke occurred in 12.2% of the tirzepatide group and 13.1% of the dulaglutide group, hazard ratio 0.92. That met the prespecified noninferiority criterion and missed superiority. The comparator was itself a drug shown to reduce these events, so the result reads as not worse than an effective agent rather than better than one.
Paediatric dosing. The label covers patients aged 10 and over with type 2 diabetes, and their maximum is 10 mg once weekly rather than 15 mg. A chart drawn for adults does not describe that group.
FAQ
What is the Mounjaro dosage chart?
The label starts at 2.5 mg once weekly for four weeks, then permits increases in 2.5 mg increments after at least four weeks on the current dose, through 5 mg, 7.5 mg, 10 mg and 12.5 mg to a maximum of 15 mg once weekly in adults. In paediatric patients aged 10 and over the maximum is 10 mg. Unlike a weight-management ladder, the increases are described as a response to whether more glycaemic control is needed.
How long can you stay on 2.5 mg of Mounjaro?
The label describes 2.5 mg as a starting dose intended for the first four weeks rather than a maintenance dose, and no SURPASS trial measured an outcome at 2.5 mg. The lowest dose with published efficacy data is 5 mg. How long any individual stays on a step is a prescriber decision.
What does the label say about a missed Mounjaro dose?
It gives a four-day window: a missed dose can be administered as soon as possible within 4 days, or 96 hours, of the missed dose, and if more than four days have passed the missed dose is skipped and the next one taken on the regularly scheduled day. Separately, the day of the week can be changed provided at least 3 days, or 72 hours, separate two doses.
How much HbA1c reduction does each Mounjaro dose give?
Across the four SURPASS trials covered here, mean HbA1c reductions ran from 1.87 to 2.11 percentage points at 5 mg, 1.89 to 2.40 at 10 mg, and 2.07 to 2.37 at 15 mg, from baselines between 7.9% and 8.31%. The spread between trials is wider than the spread between doses, because the background therapy and the comparator differed in each one.
Is Mounjaro the same dose as Zepbound?
Yes. Both are tirzepatide at the same six strengths, both start at 2.5 mg and both stop at 15 mg. The licensed indication differs, which changes what the dose is being adjusted for rather than what the doses are.
Does Mounjaro reduce cardiovascular risk?
The label now carries an indication to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes at high risk. In SURPASS-CVOT, the primary composite of cardiovascular death, myocardial infarction or stroke occurred in 12.2% of the tirzepatide group and 13.1% of the dulaglutide group. That met the trial's noninferiority criterion but not its superiority criterion, so the finding is that tirzepatide was not worse than an agent already shown to reduce these events.
Sources
- MOUNJARO (tirzepatide) injection, prescribing information. Eli Lilly and Company. Sections 1, 2 and 16.
- Rosenstock J, Wysham C, Frías JP, et al. Efficacy and safety of a novel dual GIP and GLP-1 receptor agonist tirzepatide in patients with type 2 diabetes (SURPASS-1): a double-blind, randomised, phase 3 trial. Lancet. 2021;398(10295):143-155. PMID: 34186022
- Frías JP, Davies MJ, Rosenstock J, et al. Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes (SURPASS-2). N Engl J Med. 2021;385(6):503-515. PMID: 34170647
- Ludvik B, Giorgino F, Jódar E, et al. Once-weekly tirzepatide versus once-daily insulin degludec as add-on to metformin with or without SGLT2 inhibitors in patients with type 2 diabetes (SURPASS-3). Lancet. 2021;398(10300):583-598. PMID: 34370970
- Dahl D, Onishi Y, Norwood P, et al. Effect of Subcutaneous Tirzepatide vs Placebo Added to Titrated Insulin Glargine on Glycemic Control in Patients With Type 2 Diabetes: The SURPASS-5 Randomized Clinical Trial. JAMA. 2022;327(6):534-545. PMID: 35133415
- Nicholls SJ, Pavo I, Bhatt DL, et al. Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes (SURPASS-CVOT). N Engl J Med. 2025;393(24):2409-2420. PMID: 41406444
- Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide Once Weekly for the Treatment of Obesity (SURMOUNT-1). N Engl J Med. 2022;387(3):205-216. PMID: 35658024
This article is for information only and is not medical advice. Dosing, suitability and any change to treatment are decisions for your prescriber.