Tirzepatide

What it is

A dual GLP-1 and GIP receptor agonist, FDA-approved for type 2 diabetes and obesity at standard doses. In our protocols it's used at a fraction of the obesity dose for metabolic and inflammatory benefit — not aggressive weight loss.

How it works

Start at 0.5 mg once weekly and titrate by 0.5 mg every four weeks to a maximum of 1.5 mg/week. At this microdose, the goal is improved insulin sensitivity, gastric motility, and inflammatory markers without the appetite-suppression intensity of obesity dosing.

Supports

• Insulin sensitivity
• Inflammation
• Metabolic health
• Weight stability

Cautions

• Off-label at this dose — informed consent required.
• Not for personal or family history of medullary thyroid carcinoma or MEN2.
• Pause before procedures requiring sedation due to slowed gastric emptying.

Mechanism

Single peptide acting as agonist at both GLP-1R and GIP-R. The dual action distinguishes it from GLP-1-only agents and is thought to underlie its superior glycemic and weight-loss profile at standard dosing.

Evidence

Phase III SURPASS and SURMOUNT trial programs at standard doses (5–15 mg/wk). Microdose use is supported by emerging clinical experience and pharmacokinetic modeling rather than dedicated RCTs.

Contraindications

Medullary thyroid carcinoma / MEN2

Personal or family history is an absolute contraindication — class warning.

Pancreatitis history

Use with caution; some risk of acute pancreatitis.

Pre-procedural sedation

Slowed gastric emptying increases aspiration risk; pause before scheduled anesthesia.