HealthRX.com · Printable titration log
Mounjaro dose-step log for an older adult
A one-page record to bring to each visit while the Mounjaro dose is being raised: the dose and how long it was held, weight, fluid losses, the lowest glucose readings, and any change to sulfonylurea or insulin doses. It keeps the label's dose rules and warning signs beside the log.
Starting point
Date of first Mounjaro injection
Other diabetes medicines and dosessay if any is a sulfonylurea (glipizide, glimepiride, glyburide) or insulin
Most recent kidney test (eGFR) and date
Weight on the first day
Who gives the injectionself, family member, carer, nurse
Each dose step
One line per visit or per dose change. Bring your glucose meter or readings.
| Date | Mounjaro dose | Weeks on this dose | Weight | Days with vomiting or diarrhea | Lowest glucose reading | Sulfonylurea or insulin dose now | Dizzy on standing? |
|---|---|---|---|---|---|---|---|
Dose rules in the Mounjaro label
- Start at 2.5 mg once a week. If more glucose control is needed, the dose goes up by 2.5 mg, after at least 4 weeks on the current dose.[1]
- No dose change is recommended for kidney impairment.[1]
- Lowering a sulfonylurea or insulin dose may reduce the risk of low blood sugar; the size of any reduction is your prescriber's decision.[1]
- Missed dose: inject within 4 days (96 hours). After more than 4 days, skip it and take the next dose on the usual day.[1]
- The KwikPen is not recommended for self-injection by people who are visually impaired.[1]
Call the prescriber promptly
- Nausea, vomiting or diarrhea that keeps going, or signs of kidney trouble.[1]
- Severe stomach pain that will not go away, sometimes spreading to the back, with or without vomiting.[1]
- Signs of low blood sugar such as dizziness, sweating, confusion, drowsiness, blurred vision, slurred speech or shakiness, especially with a sulfonylurea or insulin.[1]
For the next visit
- Is this dose doing enough, or is there a reason to stay here longer?
- Should my sulfonylurea or insulin be lowered before the next step up?
- Do I need a kidney blood test after this change?
- Is my weight coming off faster than you want for my age and strength?
- Who can give the injection if my hands or eyesight make it hard?
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
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.