HealthRX.com · Printable question sheet
Starting Mounjaro: BMI, medicine list and dose-step sheet
Take this to the visit where tirzepatide is started or a dose is raised. It records the numbers a plan or prescriber may ask for, lists the other medicines worth flagging for slowed stomach emptying or low blood sugar, and keeps what the label and the East Asian SURPASS trials report on one page.
My numbers
Height and weight
BMIask which cutoff your plan uses
Waist circumference
Latest HbA1c and date
Conditions on recordtype 2 diabetes, high blood pressure, sleep apnea, fatty liver
Other medicines to tell the prescriber about
Mounjaro slows stomach emptying, which can change how pills are absorbed; a sulfonylurea or insulin adds to the risk of low blood sugar.
- Birth control pills
- Warfarin
- Levothyroxine
- Clopidogrel
- An SSRI or other antidepressant
- A proton pump inhibitor such as omeprazole
- A sulfonylurea such as gliclazide, glimepiride or glipizide
- Insulin
What the label and the East Asian trials report
- The label: age, sex, race, ethnicity and body weight have no clinically relevant effect on tirzepatide levels.[1]
- The label: in its adult diabetes trials, effectiveness was not affected by race, ethnicity, region or starting BMI.[1]
- Everyone starts at 2.5 mg once a week.[1]
- Birth control pills: switch to a non-oral method, or add a barrier method, for 4 weeks after starting and for 4 weeks after each dose increase.[1]
- SURPASS J-mono: HbA1c fell by 2.4 to 2.8 points with tirzepatide 5 to 15 mg, against 1.3 with dulaglutide 0.75 mg, at week 52.[2]
- SURPASS-AP-Combo post hoc analysis, tirzepatide groups: low blood sugar (70 mg/dL or below, or severe) occurred in 37.8% to 43.1% of those also taking a sulfonylurea, against 6.6% to 13.2% of those on metformin alone.[3]
Dose steps
| Date | Dose | Weight | Waist | Days with nausea | Eating and drinking normally? | Notes |
|---|---|---|---|---|---|---|
Questions to ask
- Is my BMI recorded in a way my plan will accept, and does it use an Asian-specific cutoff?
- Which of my other medicines need closer checks while the dose goes up?
- If I take a sulfonylurea, should its dose come down when tirzepatide starts?
- If nausea stops me eating well, do we hold this dose longer before the next step?
- Is genotype testing useful for any of my other medicines, separate from tirzepatide?
Sources for the facts on this sheet
- Eli Lilly and Company, via DailyMed. Mounjaro (tirzepatide) injection, for subcutaneous use: prescribing information and Medication Guide. Effective 2026-08-27. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d2d7da5d-ad07-4228-955f-cf7e355c8cc0
- Inagaki N, Takeuchi M, Oura T, et al. Efficacy and safety of tirzepatide monotherapy compared with dulaglutide in Japanese patients with type 2 diabetes (SURPASS J-mono): a double-blind, multicentre, randomised, phase 3 trial. Lancet Diabetes Endocrinol 2022. PMID 35914543. https://pubmed.ncbi.nlm.nih.gov/35914543/
- Bi Y, Lu S, Tang J, et al. Efficacy and Safety of Tirzepatide in Patients with Type 2 Diabetes: Analysis of SURPASS-AP-Combo by Different Subgroups. Diabetes Ther 2024. PMID 38494574. https://pubmed.ncbi.nlm.nih.gov/38494574/
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.