HealthRX.com · Printable medication review sheet
Mounjaro medication review for an older adult
Fill this in with the person taking Mounjaro, or with their caregiver, before a prescriber visit or pharmacy review: the treatment goal, every medicine and supplement, recent changes in weight, strength, appetite and falls, and the questions to ask. It keeps the label's dosing, kidney, low-blood-sugar and oral-medicine cautions on the same sheet.
Goal and current treatment
Write the goal in the person's own words. The point of the review is whether the benefit still outweighs the burden.
What Mounjaro is meant to achieveglucose control, weight, heart or kidney risk, or a mix
How benefit will be recognisedA1C, glucose readings, symptoms
Current weekly dose (mg) and weeks on it
Who gives the injectionself, partner, caregiver, nurse
Who can notice confusion, low blood sugar or missed dosesname and phone
Every medicine, supplement and over-the-counter product
Flag insulin or a sulfonylurea (low blood sugar), diuretics and blood-pressure tablets (fluids and dizziness), and tablets where small absorption changes matter, such as warfarin.
| Name and strength | When taken | What it is for | Flag to discuss |
|---|---|---|---|
Changes since starting Mounjaro or the last dose increase
- Weight loss that was not wanted, or faster than expected
- Less strength: slower walking, harder stairs, trouble rising from a chair
- A fall or a near-fall
- Eating less because of nausea or feeling full early
- Constipation that is new or worse
- Vomiting or diarrhea, or trouble keeping fluids down
- Low blood sugar readings or symptoms
- Dizziness when standing up
- Missed or doubled doses, or trouble using the pen or vial
What the Mounjaro label says
- There is no separate dose for older adults. Treatment starts at 2.5 mg once weekly and moves to 5 mg after 4 weeks; any further 2.5 mg increase needs at least 4 weeks on the current dose and a need for more glucose control.[1]
- No dose change is recommended for kidney impairment, but kidney function should be checked when vomiting, diarrhea or nausea could be causing fluid loss, especially when starting or increasing the dose.[1]
- With insulin or a sulfonylurea, low blood sugar is more likely; lowering the dose of those medicines may reduce the risk.[1]
- Mounjaro slows stomach emptying and can change how tablets are absorbed; medicines with a narrow safety margin, such as warfarin, need monitoring.[1]
- Mounjaro is not recommended for people with severe gastroparesis.[1]
- In a SURPASS analysis of adults 65 or older with BMI under 30, 16.8% stopped tirzepatide because of an adverse event, against 8.5% of all tirzepatide-treated participants.[2]
Contact the prescriber promptly or get urgent help
- Severe stomach pain that does not go away, sometimes spreading to the back, with or without vomiting (possible pancreatitis).[1]
- Vomiting, diarrhea or nausea that stops the person drinking enough: fluid loss can cause kidney problems.[1]
- Signs of low blood sugar such as dizziness, sweating, confusion or drowsiness, blurred vision, slurred speech, shakiness or a fast heartbeat.[1]
- Swelling of the face, lips, tongue or throat, or trouble breathing or swallowing (possible serious allergic reaction).[1]
Questions for the prescriber or pharmacist
- Is the weight change intended, and should we hold the dose rather than increase it?
- Should my insulin or sulfonylurea dose change, and which glucose reading should prompt a call?
- Which of my tablets need extra monitoring while Mounjaro slows stomach emptying?
- With my kidney function, which symptoms mean I need a kidney blood test?
- What protein intake and strength activity suit my kidneys, balance and appetite?
- Which symptoms, weight trend or change in function should make me call before the next dose?
- Does the benefit still fit my priorities, or is it time to simplify my diabetes medicines?
Plan agreed at this review
Next dose (mg) and date
Other medicine changes made
Weight, glucose or function change that should trigger a call
Date of next review
Who to call with problems
Sources for the facts on this sheet
- A-S Medication Solutions (repackaged Eli Lilly and Company labeling), via DailyMed. Mounjaro (tirzepatide) injection, for subcutaneous use: prescribing information and Medication Guide. Effective 2026-07-29. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=78aad975-4971-49fa-b4b0-6aa39f76d2e7
- Rasouli N, Wilding JPH, Kwan AYM, et al. Tirzepatide for Older Adults with Type 2 Diabetes and Without Obesity: A Post Hoc Analysis of the SURPASS Clinical Trials. Diabetes Ther 2025. PMID 40016573. https://pubmed.ncbi.nlm.nih.gov/40016573/
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.