Tirzepatide Weight Loss in Studies, From the First Month to 3 Years

By week 8 of SURMOUNT-1, the main trial of Zepbound (tirzepatide) in adults with obesity, or overweight plus a weight-related condition, and no diabetes, people still taking it had lost about 6% of their starting weight on average, roughly 12 pounds from 200 (our arithmetic).^{1, 2} They spent weeks 1 to 4 on the 2.5 mg starting dose and weeks 5 to 8 on 5 mg, and neither the Zepbound label nor the trial reports we checked give an average for the first month alone.^{2, 3}

Over the first 24 weeks, people who took their doses and responded, on 5, 10 or 15 mg, lost about 2.4% to 2.6% of their starting weight a month, roughly 5.5 to 6 pounds a month from 230 pounds, and under 1% a month after that (our arithmetic). That analysis left out about a quarter of the people on tirzepatide, so treat it as a best case.⁴

In U.S. health records of adults with overweight or obesity who started Mounjaro, Lilly's tirzepatide for type 2 diabetes, people still taking it had lost 5.9% on average at 3 months, 10.1% at 6 months and 15.3% at 12 months, or 5.3%, 8.2% and 11.4% counting those who had stopped (see everyday care).⁵ Averages like these run below the trials', and the authors of another large study say that is likely because people stop treatment or stay on lower doses.⁶

At week 72, about 16.5 months in, average loss in SURMOUNT-1 counting everyone assigned to the drug was 15.0% on 5 mg, 19.5% on 10 mg and 20.9% on 15 mg, and about 1 in 10 people on the two higher doses lost less than 5%.² In the participants who also had prediabetes, averages at week 176, just over 3 years in, were 12.3% to 19.7%, depending on dose.⁷ In SURMOUNT-4, weight went back up by 14.0% on average in the year after people switched to a placebo.⁸

If your own loss is running slower or faster than these averages, see what is usual and when to call your prescriber. Compounded tirzepatide, which a pharmacy mixes for an individual patient's prescription, was not tested in any of these studies (see why the numbers do not carry over).^{2, 5, 6, 9, 10} Tirzepatide can also cause serious side effects, and its label carries a boxed warning about thyroid tumors (see side effects along the same timeline).²

What the trials found over 3 years

Most numbers here come from SURMOUNT-1. It randomly assigned 2,539 adults to tirzepatide at 5, 10 or 15 mg once a week, or to a placebo, for 72 weeks. All had obesity (a body mass index, or BMI, of at least 30), or overweight (a BMI of 27 or more but under 30) plus at least one weight-related condition; none had type 2 diabetes. They averaged 104.8 kg, about 230 pounds, at the start, and everyone had counseling aimed at eating about 500 fewer calories a day and getting at least 150 minutes of activity a week.^{2, 11}

Eli Lilly, which makes Zepbound, funded the SURMOUNT trials.^{8, 11, 12, 13, 14} Lilly also funded, or employs authors of, the later analyses of their data cited here. Several of those analyses count only people who kept taking their doses, so their numbers run higher than averages for everyone who starts.^{1, 3, 4, 15, 16, 17, 18}

Zepbound's approval covers weight loss and long-term weight control in adults with obesity, and in adults with overweight who have a weight-related condition, alongside a lower-calorie diet and more physical activity; it is also approved for adults with obesity who have moderate to severe obstructive sleep apnea.² Using it for weight loss outside those uses is off-label, meaning not one of its approved uses, and the trial averages on this page come only from people who met those trials' entry rules.^{2, 11} If you fall outside those uses, these numbers say little about what you would lose, so talk it over with a doctor who knows your health history before you sign up with any online weight-loss service, PlexusDx or another; our page for people below these weight thresholds covers what to ask. If you are under 18, Zepbound is approved only for adults and PlexusDx's service is for adults only, so talk with your own doctor.²

Weeks 1 to 4: the starting dose

Everyone on tirzepatide began at 2.5 mg once a week. Zepbound's label calls 2.5 mg a dose for starting treatment, not one to stay on, and raises the dose in steps to lower the risk of stomach side effects. In SURMOUNT-1 the dose went up by 2.5 mg every 4 weeks until each group reached its assigned dose: 5 mg at week 4, 10 mg at week 12 and 15 mg at week 20.^{2, 3}

So people assigned to 10 or 15 mg spent roughly their first 3 to 5 months on lower doses on the way up (our arithmetic), and in everyday care doses often climb more slowly still.¹⁹ That is how the trial ran, not a schedule for you. Your prescriber chooses your doses, and your pharmacy label says how to take them.

The label shows these first weeks only as a graph, without numbers.² One small study, of 37 adults on tirzepatide, did measure them, but with faster dosing. It started people at 5 mg, twice the label's starting dose, and moved them to 10 mg at week 3; they had lost 3.7 kg (about 8 pounds) on average by week 3, which does not describe a first month on the labeled schedule.^{2, 20} Nausea, diarrhea and vomiting are most common during these step-up months (see side effects).²

Week 8, about 2 months in

By week 8, after 4 weeks at 2.5 mg and 4 weeks at 5 mg, 62% of SURMOUNT-1 participants on tirzepatide had lost at least 5% of their starting weight, the level typically needed to improve or prevent some complications of obesity. In SURMOUNT-2, which enrolled adults with type 2 diabetes, 41% had.^{1, 3}

In SURMOUNT-1, those past 5% had lost 7.9% on average, and the rest 3.1%. Together that works out to about 6%, or roughly 12 pounds from 200, a faster pace than the 72-week average even though everyone was still on the two lowest doses. More than a third had not yet reached 5% (our arithmetic). This analysis counted people only while they were taking the drug.¹

Week 12, about 3 months in

Among SURMOUNT-1 participants who took at least 75% of their doses, 82% had lost at least 5% by week 12. The other 18% were more often men and started heavier. Most of them caught up on that measure: 70% passed 5% by week 24 and 90% by week 72. They still finished lower on average, at 11.0%, against 22.5% for those who had reached 5% by week 12.³

Week 24, about 5.5 months in

By week 24, every group had been on its assigned dose for at least 4 weeks.³ One analysis followed the three-quarters of tirzepatide-treated participants who took at least 75% of their doses, stayed on their assigned dose and reached at least 5% loss. With all three doses pooled, their average loss at week 24 was 13.3% to 14.5%, depending on starting BMI, and this was the fastest stretch of the trial for them.⁴ In SURMOUNT-5, which used the highest dose each person could tolerate (10 or 15 mg), 44% of people on tirzepatide had lost at least 15% by week 24.¹⁶

Weeks 24 to 72: slower loss, then a plateau

In the same group, a further 4.6% to 9.7% came off over the next 48 weeks, more in people who started at a higher BMI.⁴ The analysis called it a plateau once weight changed by less than 5% over 12 weeks and every 12 weeks after, so weight could still drift down slowly. Half of each BMI group had reached a plateau by 24 to 36 weeks, and about 88% to 90% had by week 72. Higher doses, younger age and being female went with a later plateau, and people who plateaued later had lost more.⁴

Week 72, about 16.5 months in

Counting everyone randomly assigned, including people who stopped taking the drug, average loss at week 72 in SURMOUNT-1 was:^{2, 11}

• 15.0% on 5 mg
• 19.5% on 10 mg
• 20.9% on 15 mg
• 3.1% on placebo

Three other trials ran for 72 weeks with different groups of people:

• SURMOUNT-2 (adults with type 2 diabetes): 12.8% lost on 10 mg and 14.7% on 15 mg, against 3.2% on placebo; 79% to 83% of those on tirzepatide lost at least 5%.¹²
• SURMOUNT-3 (adults who first lost at least 5% in a 12-week intensive diet and exercise program, 6.9% on average): a further 18.4% lost on the highest dose each person could tolerate (10 or 15 mg), against a 2.5% gain on placebo.^{2, 13}
• SURMOUNT-5 (adults with obesity, without type 2 diabetes, who knew which drug they were taking): 20.2% lost on tirzepatide at 10 or 15 mg, against 13.7% on semaglutide at 1.7 or 2.4 mg.¹⁴

How far apart individual results landed is shown further down.

Week 176, just over 3 years in

SURMOUNT-1 kept its 1,032 participants who also had prediabetes on their assigned dose for 176 weeks. At that point, average loss was 12.3% on 5 mg, 18.7% on 10 mg and 19.7% on 15 mg, against 1.3% on placebo.⁷ This is a subgroup, and the published summary does not say how people who stopped were counted.

After stopping: SURMOUNT-4

SURMOUNT-4's participants, all without diabetes, had obesity, or overweight along with a weight-related condition. All took Zepbound (tirzepatide) for 36 weeks, stepping up over as long as 20 weeks to the highest dose they tolerated, 10 or 15 mg (15 mg for 93% of those who went on to the next phase), and those who finished that phase had lost 20.9% on average. Then half were switched to a placebo for 52 weeks, with neither they nor the trial staff knowing who got which.^{2, 8}

• Those who stayed on tirzepatide lost a further 5.5%. Those switched to placebo saw their weight rise by 14.0%.
• 89.5% of those who stayed on it kept at least 80% of the weight they had lost, against 16.6% of those on placebo.
• From the start of the trial to week 88, total loss was 25.3% with continued tirzepatide and 9.9% with placebo.⁸

How much came back varied widely. Among 308 people switched to placebo after losing at least 10%, about 18% regained less than a quarter of the weight they had lost, 25% a quarter to half, 33% half to three-quarters and 24% three-quarters or more (our arithmetic).¹⁵ Zepbound is approved to reduce weight and keep it off long term, so if you are thinking about stopping or pausing, make a plan with your prescriber first.^{2, 21} For what staying on it costs, see the cost of a year of Zepbound.

Why a single monthly number misleads

Spread evenly over 72 weeks, SURMOUNT-1's averages on Zepbound would come to about 0.9% of starting weight a month on 5 mg and 1.3% on 15 mg, roughly 2 to 3 pounds a month from 230 pounds (our arithmetic).² Real months were uneven, for four reasons.

The pace changes. Among SURMOUNT-1 participants who took their doses and responded, loss averaged about 2.4% to 2.6% of starting weight a month through week 24 and under 1% a month over weeks 24 to 72: from 230 pounds, a best case of roughly 5.5 to 6 pounds a month at first and 1 to 2 pounds a month later (our arithmetic).⁴ Health records show the same slowing: people still taking Mounjaro lost about 2% a month in the first 3 months, about 1.4% a month in months 3 to 6 and under 1% a month in months 6 to 12 (our arithmetic).⁵

Pounds depend on where you start. The trials report percentages, and the same percentage is more pounds for a heavier person.

To compare yourself with these checkpoints, divide the pounds you have lost by your starting weight and multiply by 100: 12 pounds from 240 is 5%.

Results spread widely. Across the SURMOUNT trials, individual results ran from under 5% to over 30%, and why people differ this much is not known.⁴ This is how many reached each level by week 72:

The 10 mg group fell between those two columns, with 50.1% losing at least 20% and 11.1% losing less than 5%. On placebo, 34.5% lost at least 5%, 3.1% lost at least 20% and 65.5% lost less than 5%. Each "less than 5%" figure is 100 minus the "at least 5%" figure (our arithmetic).²

These figures count everyone randomly assigned; for about 1 in 10 people in each tirzepatide group, the week-72 weight was missing and was estimated statistically.² Across controlled trials of these drugs in people without diabetes, about 10% lose less than 5%, and records from routine care suggest the share may be higher there.²²

Who is counted changes the average. The label's figures include the 14% to 16% in each tirzepatide group who stopped taking it.² Counting only time on the drug gives bigger numbers: in SURMOUNT-3, the same trial came to 18.4% counting everyone and 21.1% counting only time before people stopped.¹³

Everyday care: lower averages, and why

Outside trials, people stop more often, many stay on lower doses, and weight is recorded only when they see a clinician. Three large U.S. record studies show what that does to the numbers.^{5, 6, 19}

The first used Truveta, a database of health records from a group of U.S. health systems. It compared adults with overweight or obesity who started Mounjaro with closely matched people who started Ozempic (semaglutide), 18,386 people in all.⁵

About half had type 2 diabetes, and those without it lost more. In the tirzepatide group, 55.9% stopped taking it during the study. Among people still taking it, 81.8% lost at least 5% within a year, 62.1% at least 10% and 42.3% at least 15%.⁵

Mounjaro is approved only for people with type 2 diabetes: to improve blood sugar control, alongside diet and exercise, in adults and in children 10 or older, and to reduce major cardiovascular events (heart attack, stroke or cardiovascular death) for adults at high risk of them. Taking it for weight alone is off-label.²³

Cleveland Clinic records (Ohio and Florida) followed 1,772 adults without type 2 diabetes who started tirzepatide in 2022 or 2023, as Zepbound or as Mounjaro used off-label. Counting people who stopped, they had lost 12.4% on average at 1 year, and 78.9% were on doses below 10 mg. Those still taking tirzepatide at 1 year had lost 15.3%, or 18.0% if they were on a high dose (10 mg or more).⁶

Across both drugs in the study, weight loss at 1 year was 3.6% for people who stopped within 3 months, 6.8% for those who stopped between 3 and 12 months, and 11.9% for those who kept going.⁶

Optum insurance claims (pharmacy billing records), analyzed by Eli Lilly employees, covered 20,998 adults without type 2 diabetes whose first pharmacy claim for tirzepatide came between May 2022 and September 2023. Tirzepatide was then approved only for type 2 diabetes, so the authors note this use was off-label. Of the 3,459 who were eligible for obesity medicines (a BMI of 30 or more, or 27 or more with a weight-related condition) and had 6 months of coverage after starting, 55.4% were still taking it at 6 months, and doses rose more slowly than in the trials: by the sixth fill, 74.2% were on less than 10 mg. Among 239 of them who were new to GLP-1 drugs, stayed on it at least 6 months and had weights on record, average loss at 6 months was 11.9%, and 85.8% had lost at least 5%.¹⁹

Limits. People who see no loss may be more likely to stop, which flatters any "still taking it" figure. Weight is recorded only at visits, the Truveta data did not measure doses, the Optum average rests on 239 people, and one health system or an uneven mix of states may not reflect the whole country. Drug shortages during those years may also have caused some temporary stops.^{5, 6, 19}

Why some people lose more than others

These patterns come from the studies above. They describe groups, not what will happen to you.

• Dose. Higher doses brought more loss on average and a bigger share reaching 20% (table above), but also more vomiting (13% on 15 mg against 8% on 5 mg) and diarrhea (23% against 19%).² Which dose you take is for your prescriber to decide.
• Type 2 diabetes. People with type 2 diabetes lost less. At the same doses, SURMOUNT-2's averages were about 6 to 7 percentage points below SURMOUNT-1's, though the two trials enrolled different people, and the Truveta records found the same pattern.^{5, 11, 12}
• Staying on treatment. In the Cleveland Clinic records, staying on treatment, a high dose, tirzepatide rather than semaglutide, and being female were each linked to reaching 10% loss at 1 year.⁶
• Sex and age. In SURMOUNT-1, women were more likely than men to pass 5% by week 8, and slow starters were more often men. Women and younger people also tended to keep losing longer before a plateau.^{1, 3, 4}
• Early response. People who passed 5% by week 8 or week 12 tended to lose more by week 72, and a 2026 review calls early response the most practical predictor available.^{1, 3, 22} Most slow starters still reached 5% later (see week 12). Early response describes how people did on the same dose schedule; it is not something to force by eating less or raising a dose faster.
• Starting weight. A heavier person loses more pounds for the same percentage, and people with a higher BMI lost more after week 24.⁴
• The program around the drug. Everyone in the four weight-loss trials on Zepbound's label had diet and activity counseling.² In SURMOUNT-3, people who first lost at least 5% in an intensive 12-week program, then took tirzepatide, lost 24.3% in total. The 17.5% who did not reach 5% in the program were left out, so the authors say the result may be higher than in a less selected group.^{2, 13}

Some things did not predict results:

• Any single starting trait. The 2026 review found that no single baseline characteristic reliably predicts response.²²
• Genetic tests. The same review says genetic findings so far are unconfirmed and not a basis for testing individuals, and that such markers need more study before use in care.²² So no genetic test, including the genetic tests PlexusDx offers, has been shown to tell you in advance how much you will lose on tirzepatide.
• Feeling sick. Across SURMOUNT-1 to -4, weight loss was similar whether or not people had nausea, vomiting or diarrhea, and those stomach symptoms, including indigestion, accounted for at most about 3% of the weight lost. You do not need to feel sick for it to work.¹⁷

If you are losing slower or faster than these averages

Ups and downs of 1% to 2% of body weight are normal fluctuation, so judge the trend over several weeks.⁴ The usual pattern is quicker loss in the first months, then slower loss and a plateau: as weight falls, hunger hormones rise, fullness hormones fall and the body uses less energy.⁴ The researchers who timed tirzepatide plateaus note that a plateau is often mistaken for the end of a treatment's benefit, yet in SURMOUNT-4, stopping the drug led to substantial regain.^{4, 8} The trials set no target number of pounds a month.²

If loss is slower

A slow start is common. By week 8, more than a third of SURMOUNT-1 participants had not reached 5%, and the doses kept rising until week 20.^{1, 3} Of those still under 5% at week 12, 70% passed it by week 24 and 90% by week 72, though they finished lower on average (see week 12).³

If you have lost little, these are worth raising with your prescriber (the patterns behind the first three are in why some people lose more):

• whether you have been able to take every dose as prescribed;
• whether you have diet and activity support like the counseling in the trials;
• conditions that go with smaller losses, such as type 2 diabetes;
• how and when your response will be judged: Zepbound's label asks prescribers to weigh response and tolerability when choosing the long-term dose.²

Some obesity guidelines from 2015 suggest stopping a weight-loss drug that has not produced 5% loss within 12 weeks. The authors of the slow-starter analysis, which Lilly sponsored, say it is reasonable to continue tirzepatide for longer than 12 weeks, because its dose steps can take up to 20 weeks.³ More recent recommendations for VA clinicians, from June 2026, look for about 5% loss once someone has spent 3 months on the highest dose they tolerate, and say to stop the drug if that loss is not reached or not kept.²¹ Which approach fits you is a decision for you and your prescriber.

Tell your prescriber at your next visit if your weight is climbing while you are still taking every dose, or if you have lost little several months after reaching the dose you are meant to stay on. Bring a record of your weight, and do not change, skip or speed up doses, or cut back hard on food, on your own.

If loss is faster

Faster is not automatically better. In an analysis of SURMOUNT-5, people on tirzepatide or semaglutide who lost 15% or more by week 24 were more likely to reach each weight-loss level by week 72 and finished treatment as often as others, but reported more stomach and gallbladder or liver side effects, a raw difference the authors did not call significant. They lost fast on the trial's own dose plan, so the finding gives no support for raising a dose faster.^{14, 16}

Eating far less to speed things up is not what the trials tested: counseling during treatment aimed at about 500 fewer calories a day, and SURMOUNT-3's stricter phase, about 1,200 calories a day (women) or 1,500 (men), came before the drug and was run by dietitians.² In a body-scan substudy of SURMOUNT-1, about a quarter of the weight lost was lean mass (muscle and other non-fat tissue), the same split as on placebo.¹⁸ A 2025 advisory from four obesity and nutrition societies says lean-mass loss depends partly on how hard calories are cut, how fast weight comes off and whether you do strength training; it ties large, fast loss (14% or more within 3 to 4 months) to bone loss, and eating under about 1,200 calories a day (women) or 1,800 (men) to vitamin and mineral shortfalls.²⁴ Our page on protein and strength training on tirzepatide covers what helps.

If you are losing fast, tell your prescriber, and know the warning signs of gallbladder problems and dehydration (see side effects). If the weight is coming off because you cannot keep food or fluids down, call your provider right away.²

Do not raise your dose on your own. FDA has received reports of side effects that may be related to taking compounded semaglutide or tirzepatide above the label's doses or stepping up faster than its schedule, and others that may be related to mistakes measuring compounded semaglutide injections, some of them serious enough for a hospital stay.²⁵ If you use a compounded injection, have your pharmacy show you how to measure each dose; our page on pens and vials explains how mix-ups happen.

Side effects along the same timeline

Side effects tend to keep the same calendar as the weight loss: stomach trouble while the dose climbs, gallbladder problems as the weight comes off, and a few serious risks at any point.² Two signs, at any stage, mean stopping the medicine and getting care at once:²

• Severe belly pain that will not go away, which may reach through to your back, with or without nausea or vomiting. This can be pancreatitis: stop the medicine and phone your provider right away.
• A swollen face, lips, tongue or throat, a hard time breathing or swallowing, a racing heartbeat, a severe rash or itching, or feeling faint or dizzy. This may be a serious allergic reaction, so stop the medicine and get medical care immediately.

The rest of this section keeps to that calendar. It follows Zepbound's prescribing information and Medication Guide, which cover the FDA-approved drug and list more risks than this section does; raise any of them with your prescriber.

There is no FDA label for compounded tirzepatide, because it is not FDA-approved.²⁵ According to FDA, many of the side effects people report with compounded semaglutide and tirzepatide resemble those of the approved drugs, and they are likely underreported, because federal law does not require ordinary state-licensed compounding pharmacies to report them to FDA.²⁵ If you use a compounded product, ask whoever prescribes it to walk you through these warnings and who should not take tirzepatide.

Before the first dose. In rats, tirzepatide caused thyroid C-cell tumors, which is why Zepbound carries a boxed warning; whether it does the same in humans, including medullary thyroid carcinoma (MTC), one kind of thyroid cancer, is unknown. Under the label, three groups must not use it: people with a personal or family history of MTC, people with multiple endocrine neoplasia syndrome type 2 (MEN 2), and people who have had a serious allergic reaction to any ingredient in the product, tirzepatide included.² If your thyroid has been removed, our page on GLP-1s after a thyroidectomy goes through what the labels say for each reason.

Zepbound is also not recommended for severe gastroparesis, a stomach that empties far too slowly.² Hoarseness that lasts, a neck lump or swelling, trouble swallowing or shortness of breath may point to a thyroid tumor; report any of them to your provider.²

Zepbound may harm an unborn baby, and its label says to stop taking it once a pregnancy is recognized, because losing weight brings no benefit during pregnancy; if you plan to become pregnant, tell your prescriber.² Mounjaro's label, written for type 2 diabetes, says animal studies suggest it may harm an unborn baby, and that it should be used during pregnancy only if its potential benefit justifies the potential risk, so someone on Mounjaro who becomes pregnant should call the prescriber promptly to decide what to do.²³ Zepbound may pass into breast milk, so if you are breastfeeding, talk with your provider about how to feed your baby.²

Tirzepatide can make birth-control pills work less well. Zepbound's label advises a non-pill method, or a barrier method on top of the pill, in the first 4 weeks of treatment and again for 4 weeks after each dose increase.² Do not take it with any other tirzepatide product or another GLP-1 medicine, compounded semaglutide or tirzepatide included.² Because it slows how fast the stomach empties, it can change how well pills are absorbed, so give your prescriber a full list of your medicines, especially any, like warfarin, where a small change in the blood level matters.²

While the dose is climbing. Most nausea, vomiting and diarrhea came during the step-up months and faded with time; in SURMOUNT-1 and -2, nausea affected 25% to 29% of people on tirzepatide, against 8% on placebo, and constipation 11% to 17%, against 5%.² Most of those who quit because of side effects did so in the first few months, and overall 4.8% to 6.7% quit for that reason, against 3.4% on placebo.² Tiredness was reported by 5% to 7%, against 3% on placebo.²

Fluid lost through vomiting or diarrhea can harm the kidneys, sometimes so badly that dialysis is needed, so keep drinking fluids, call your provider right away if nausea, vomiting or diarrhea does not go away, and tell your provider about any stomach problem that is severe or lasting.² Blood pressure can drop too: low blood pressure was reported in 1.6% of people on Zepbound against 0.1% on placebo, more often in those taking blood pressure medicine and alongside stomach side effects and dehydration.² If you take medicine for blood pressure or diabetes, ask the clinician who prescribes it whether the dose should change as you start and as you lose weight, and report dizziness or light-headedness.²

As the weight comes off. Gallbladder problems happen more often with tirzepatide than with placebo, and the label links both gallbladder problems and hair loss to the weight loss itself. Gallbladder inflammation was reported in 0.7% of people on tirzepatide, against 0.2% on placebo, and hair loss in 4% to 5%, against 1%, more often in women.² Call your provider right away for fever, yellowing of the skin or eyes, clay-colored stools or pain high in the stomach, which can signal a gallbladder problem.² Our page on eating, vitamins and hair shedding on tirzepatide covers what the evidence says, and losing weight fast has cautions of its own.

At any point. The label also warns of:²

• inflammation of the pancreas (pancreatitis), which has sometimes been severe and even fatal;
• serious allergic reactions;
• low blood sugar, most likely when tirzepatide is combined with insulin or a sulfonylurea (a diabetes drug that prompts the body to release insulin), though the label links it to adults without type 2 diabetes too;
• diabetic eye disease getting worse in people with type 2 diabetes.

Low blood sugar can show up as shakiness, sweating, hunger, confusion, dizziness or a fast heartbeat; tell your provider about these and, with type 2 diabetes, about changes in your eyesight.² In rare cases, people on GLP-1 drugs have breathed food or liquid from the stomach into the lungs during deep sedation or anesthesia; before any planned surgery or procedure, tell every clinician who treats you, your dentist included, that you take it.²

If you inject too much, get help right away from your provider, Poison Help (1-800-222-1222) or the nearest emergency room.² Side effects can be reported to FDA through MedWatch, by you or your prescriber.²⁵

Compounded tirzepatide has no timeline of its own

The trials on this page tested Zepbound, and the Truveta and Cleveland Clinic records followed people taking Mounjaro or Zepbound.^{2, 5, 6} None of them included compounded tirzepatide, and a search of PubMed, the National Library of Medicine's index of medical research, found no published clinical trial of it as of October 3, 2026.¹⁰

FDA has not approved any compounded drug and does not review whether compounded drugs work, are safe or are made well before patients receive them. FDA's recommendation is that compounded drugs be used only if an FDA-approved drug cannot meet the patient's medical needs.^{9, 25} FDA also tells companies not to call a compounded drug generic or the same as an approved one, or to claim it is proven to give the same results, so the numbers above are not a forecast for any compounded product.^{26, 27}

An American College of Clinical Pharmacy group says data showing good results with compounded semaglutide and tirzepatide are limited and come from small groups of patients.²⁸ The largest outcome report we found that included compounded tirzepatide came from a telehealth company's own staff. It counted only patients who completed at least a year, about 9 in 10 of them on compounded tirzepatide, used weights that patients reported and providers checked, and was not a randomized trial, so it cannot show how compounded tirzepatide compares with the trial results above.²⁹ Before trusting any provider's outcome claims, see how to vet a compounded provider.

Zepbound and Mounjaro, the only FDA-approved tirzepatide products, are both injections.^{2, 23} No trial on this page tested a tirzepatide tablet or drop, or ongoing doses below the label's, a practice sometimes called microdosing that is off-label.² A review published in 2026 of 33 compounded semaglutide or tirzepatide products listed on compounding websites in early 2025 found that all 17 single-ingredient products were sold as under-the-tongue products or tablets that dissolve in the mouth, and called their popularity concerning given the lack of evidence for safety and efficacy.³⁰

The same goes for PlexusDx's own offer: no compounded tirzepatide prescribed through PlexusDx has been tested in a trial like the ones above.¹⁰ As of October 19, 2026, PlexusDx's Terms of Service say a product's formulation and any added ingredients may differ between pharmacies and between fills. PlexusDx offers compounded tirzepatide in two forms: a weekly injection, and a daily tablet whose directions say to let it dissolve under the tongue (PlexusDx calls it an ODT). Its injections all pair tirzepatide with vitamin B12 or glycine; Californians choose between the two in the intake, and for everyone else the dispensing pharmacy decides, without the checkout screen saying which. Lone Star requires the add-in to be justified by the individual patient's clinical needs. What the tablets contain besides tirzepatide is not public. No tirzepatide tablet is FDA-approved. In the Microdose plan, the injection, again with B12, goes up in steps from 0.5 mg to 1.5 mg of tirzepatide weekly. An allergy you report is sent to the physician to weigh in deciding on treatment; mention any reaction to B12 or glycine, since the intake's allergy checklist leaves both out. The 2026 review's concern applies directly to PlexusDx's daily tirzepatide tablet and to the tablet form of Microdose GLP-1, since dissolving products like these lack evidence of safety and efficacy.³⁰ The same review found little justification for adding nutrients to injectable semaglutide or tirzepatide, which bears on PlexusDx's injections with added vitamin B12 or glycine.³⁰

PlexusDx also offers Microdose GLP-1, a low-dose plan with tirzepatide and semaglutide versions. For tirzepatide, that is off-label: on Zepbound's label, 2.5 mg a week is a starting dose only, and ongoing treatment means 5, 10 or 15 mg weekly.² Because ingredients can vary, check the pharmacy label on every fill and tell your prescriber about any allergy. Side effects and who should not take tirzepatide are covered above.

The results above belong to Zepbound, the medicine these trials tested. Lone Star Virtual Health provides the clinicians who treat people enrolled through PlexusDx, and they decide whether to prescribe and at what dose. Lone Star says its physicians must record, case by case, why compounded tirzepatide serves a patient better than Zepbound and explain that reasoning, along with the absence of FDA approval, to the patient. It cites no typical reason, and added B12, B6 or glycine can support one only when the patient's clinical situation calls for it.

PlexusDx does not sell or ship brand-name medications. If you would prefer a brand-name, FDA-approved medication, your provider may write a prescription you can fill at the pharmacy of your choice. If you later move from compounded tirzepatide to Zepbound, our page on making that switch covers what changes.

Sources

1. Tirzepatide Efficacy and Tolerability According to Early Weight Response: A Post Hoc Analysis of the SURMOUNT-1 and SURMOUNT-2 Trials, Kokkinos A, et al., Diabetes, Obesity and Metabolism, 2026 (full text on PubMed Central), accessed October 3, 2026.
2. ZEPBOUND (tirzepatide) injection: prescribing information and Medication Guide (revised August 2026), Eli Lilly and Company, via DailyMed, National Library of Medicine, accessed October 3, 2026.
3. Weight reduction over time in tirzepatide-treated participants by early weight loss response: Post hoc analysis in SURMOUNT-1, Ard J, et al., Diabetes, Obesity and Metabolism, 2025 (full text on PubMed Central), accessed October 3, 2026.
4. Time to weight plateau with tirzepatide treatment in the SURMOUNT-1 and SURMOUNT-4 clinical trials, Horn DB, et al., Clinical Obesity, 2025 (full text on PubMed Central), accessed October 3, 2026.
5. Semaglutide vs Tirzepatide for Weight Loss in Adults With Overweight or Obesity, Rodriguez PJ, et al., JAMA Internal Medicine, 2024 (full text on PubMed Central), accessed October 3, 2026.
6. Changes in weight and glycemic control following obesity treatment with semaglutide or tirzepatide by discontinuation status, Gasoyan H, et al., Obesity, 2025 (full text on PubMed Central), accessed October 3, 2026.
7. Tirzepatide for Obesity Treatment and Diabetes Prevention, Jastreboff AM, et al., New England Journal of Medicine, 2025 (SURMOUNT-1 three-year results; abstract on PubMed), accessed October 3, 2026.
8. Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial, Aronne LJ, et al., JAMA, 2024 (on PubMed Central), accessed October 3, 2026.
9. Human Drug Compounding, U.S. Food and Drug Administration, content current as of June 15, 2026, accessed October 3, 2026.
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11. Tirzepatide Once Weekly for the Treatment of Obesity, Jastreboff AM, et al., New England Journal of Medicine, 2022 (SURMOUNT-1; abstract on PubMed), accessed October 3, 2026.
12. Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial, Garvey WT, et al., The Lancet, 2023 (abstract on PubMed), accessed October 3, 2026.
13. Tirzepatide after intensive lifestyle intervention in adults with overweight or obesity: the SURMOUNT-3 phase 3 trial, Wadden TA, et al., Nature Medicine, 2023 (full text on PubMed Central), accessed October 3, 2026.
14. Tirzepatide as Compared with Semaglutide for the Treatment of Obesity, Aronne LJ, et al., New England Journal of Medicine, 2025 (SURMOUNT-5; abstract on PubMed), accessed October 3, 2026.
15. Cardiometabolic Parameter Change by Weight Regain on Tirzepatide Withdrawal in Adults With Obesity: A Post Hoc Analysis of the SURMOUNT-4 Trial, Horn DB, et al., JAMA Internal Medicine, 2026 (abstract on PubMed), accessed October 3, 2026.
16. Relationship of early rapid weight loss to efficacy and safety of tirzepatide and semaglutide for obesity: SURMOUNT-5 post hoc analysis, Aronne LJ, et al., The American Journal of Medicine, 2026 (abstract on PubMed), accessed October 3, 2026.
17. Gastrointestinal tolerability and weight reduction associated with tirzepatide in adults with obesity or overweight with and without type 2 diabetes in the SURMOUNT-1 to -4 trials, Rubino DM, et al., Diabetes, Obesity and Metabolism, 2025 (abstract on PubMed), accessed October 3, 2026.
18. Body composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study of adults with obesity or overweight, Look M, et al., Diabetes, Obesity and Metabolism, 2025 (abstract on PubMed), accessed October 3, 2026.
19. Real-world use and effectiveness of tirzepatide among individuals without type 2 diabetes: Results from the Optum Market Clarity database, Hankosky ER, et al., Diabetes, Obesity and Metabolism, 2025 (full text on PubMed Central), accessed October 3, 2026.
20. Tirzepatide on ingestive behavior in adults with overweight or obesity: a randomized 6-week phase 1 trial, Martin CK, et al., Nature Medicine, 2025 (full text on PubMed Central), accessed October 3, 2026.
21. Weight Management Medications for Chronic Use: Clinical Recommendations for Treatment Selection, VA Pharmacy Benefits Management Services and National Formulary Committee, U.S. Department of Veterans Affairs, June 2026, accessed October 3, 2026.
22. Responders Vs. Non-Responders or How to Predict the Response to GLP-1 or GLP-1/GIP Receptor Agonist Therapy, Kuryłowicz A, Czupryniak L, Diabetes, Obesity and Metabolism, 2026 (abstract on PubMed), accessed October 3, 2026.
23. MOUNJARO (tirzepatide) injection: prescribing information (revised August 2026), Eli Lilly and Company, via DailyMed, National Library of Medicine, accessed October 3, 2026.
24. Nutritional priorities to support GLP-1 therapy for obesity: A joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society, Mozaffarian D, et al., Obesity, 2025 (full text on PubMed Central), accessed October 3, 2026.
25. FDA's Concerns with Unapproved GLP-1 Drugs Used for Weight Loss, U.S. Food and Drug Administration, content current as of October 1, 2026, accessed October 3, 2026.
26. FDA to Telehealth Companies: What to Know When Promoting Compounded Drugs, U.S. Food and Drug Administration, content current as of June 15, 2026, accessed October 3, 2026.
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28. Compounded incretins in clinical practice: An opinion of the endocrine and metabolism practice and research network of the American College of Clinical Pharmacy, Courtney LA, et al., Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2025 (abstract on PubMed), accessed October 3, 2026.
29. Weight reduction and treatment adherence with tirzepatide using the Individualized Virtual Integrative Medicine (IVIM) protocol, Duncan J, et al., Obesity Pillars, 2026 (published online November 29, 2025; full text on PubMed Central), accessed October 3, 2026.
30. Compounded Semaglutide and Tirzepatide Products Use Unique Formulations but Efficacy and Safety Largely Unknown, Belcourt J, Sapowadia A, White CM, The Annals of Pharmacotherapy, 2026 (abstract on PubMed), accessed October 3, 2026.

How we made this page

The work on this page is lining up the same checkpoints, weeks 8, 12, 24, 72 and 176, across more than a dozen trial reports and later analyses, next to three U.S. health-record studies. AI tools pulled each figure with its dose, population and type of average from the Zepbound label (the August 2026 revision on DailyMed), the SURMOUNT-1 to -5 reports, the 3-year SURMOUNT-1 report and the later analyses, and drafted the page from them. The same tools searched PubMed for trials of compounded tirzepatide and read FDA's pages on compounded drugs, the VA's June 2026 recommendations and a 2025 nutrition advisory. We could not open the full text of three New England Journal of Medicine papers (SURMOUNT-1, SURMOUNT-5 and the 3-year report), so their figures come from the published abstracts and the label.

The pound figures and monthly paces were computed by a script from the published percentages, and the page marks them as our arithmetic. A second automated pass compared each statement with its source and checked that every figure keeps its dose, population and type of average, the mistake this topic invites most; it is a comparison with the papers, not a clinical review. The title and search description were checked against the same sources. Nothing from the older PlexusDx post at this address carried over: not its monthly pound estimates, its genetic-test claims or its program pitch.

PlexusDx sells compounded GLP-1 treatment, so we have a financial interest in this topic. Its statements about its own products and clinicians are current as of October 19, 2026, and it has no outcome data of its own on this page.

Jay Hastings reviewed and approved the final version on October 19, 2026. Dr. Asad K. Niazi, MD, MPH, reviewed the medical content on October 17, 2026. He is co-founder and CEO of Lone Star Virtual Health, the company that provides PlexusDx's prescribing clinicians, so he has a business relationship with PlexusDx. Read our editorial policy.