How do I know how many milligrams or units of Semaglutide or Tirzepatide to take?

This is a question I get every day as part of my weight loss practice.  There are two very important things to keep in mind when discussing Semaglutide and Tirzepatide dosing.  First, how many milligrams (mg) of the medication do I take.  Second,  how do I figure out this dose in milliliters (mL) or units on a syringe.

What is your Semaglutide or Tirzepatide dose in milligrams?

Both Semaglutide and Tirzepatide are dosed in milligrams (mg).  You should be starting on the lowest dose and titrating up depending on 3 factors:

1. How many weeks have you been at your current dose? It is recommended that you stay at each dose for a minimum of 4 weeks before increasing the dose.  This allows your body to acclimate to the medicine and prevents any unwanted side effects that can occur by increasing the dose too quickly.
2. Are you having any side effects at your current dose?  If you are having side effects at your current dose it is not recommended that you increase your dosage until these side effects have resolved.  Doing so will likely make any side effects you may be experiencing worse.
3. Are you losing weight at your current dose?  I recommend a consistent weight loss of 1.5 lbs to 2 lbs per week as a target weight loss goal.  If a patient is losing this much weight consistently, I do not recommend increasing the dosage.  I only recommend a dosage increase if you fall below this threshold or your weight loss plateau’s.

How do I convert my dose in milligrams to milliliters or units on a syringe?

Every medication has a concentration that is expressed in mg/mL.  To put it simply this reflects how many milligrams of Tirzepatide or Semaglutide is in 1 mL of the liquid medication.  Every 1 mL of liquid is equal to 100 units on a syringe.

By knowing both the concentration of the medication in mg/mL and how many mg of medication you wish to inject you can calculate how many units of medication to draw up in the syringe for the appropriate dose.

The calculation is as follows:

Your Desired dose in mg / Concentration of the medication in mg/mL = # mLs of medication to administer

An example for the starting dose of Semaglutide would be:

0.25 mg / 5 mg per mL = 0.05 mL of medication.

To get this number in units on your syringe you can simply take the medication dosage in mL and multiply it by 100.  1 mL of medication equals 100 units on the syringe.

So 0.25 mg of Semaglutide is 5 units on the syringe for a bottle with a concentration of 5 mg/mL

How do I figure out my dose of Tirzepatide or Semaglutide in mg based on how many units I am taking weekly?

This is another common question I get from patients that are new to my practice.  I have a lot of patients that join my practice that were previously being given the medication by another provider or med spa.  It is a common occurrence that patients are being told how many units of the medication they are being given but they are uncertain what this equates to in milligrams (mg).  To calculate this you will need both the number of units you are taking and the concentration of medication you are being provided..

The calculation is as follows:

(Dose in units / 100) x ( Concentration of the medication in mg/mL) = Dose in mg

An example for one of my patients taking 44 units of Tirzepatide with a concentration of 17 mg/mL would be:

(44 units / 100) x (17 mg/mL) = 7.5 mg. 

So 44 units of Tirzepatide drawn up on a syringe is equal to 7.5 mg of the medication.

 

Tirzepatide and Semaglutide Dosing for Good Hearts Health Patients:

The following are dosing guidelines I use for my patients based on the concentrations of Semaglutide and Tirzepatide that we currently prescribe.

For Semaglutide: The initial dose of the medication is 0.25 mg weekly. This is 5 units (0.05mL) on the insulin syringe provided.

Fore Tirzepatide: The initial dose of the medication is 2.5 mg weekly. This is 15 units (0.15 mL) on the insulin syringe provided.

 

Semaglutide 5 mg/mL Dosing Schedule:

0.25 mg or 5 units weekly for the first 2-4 weeks.

0.5mg or 10 units weekly for 4 weeks

1 mg or 20 units weekly for 4 weeks

1.7 mg or 34 units weekly for 4 weeks

2.4 mg or 48 units weekly for 4 weeks

Tirzepatide 17 mg/mL Dosing Schedule:

2.5 mg or 15 units weekly for 2-4 weeks

5 mg or 30 units weekly for 4 weeks

7.5 mg or 45 units weekly for 4 weeks

10 mg or 60 units weekly for 4 weeks

12.5 mg of 74 units weekly for 4 weeks

15 mg or 88 units weekly for 4 weeks

Please remember, the goal is to take the lowest effective dose of the medication. If you are tolerating the medication well and losing weight you do not need to increase the dose of the medication.  My recommendation is to continue taking your current dose as long as you are seeing consistent weight loss in the 1.5lb to 2 lb per week range.  If you plateau at any point after 4 weeks on your current dose you have the option to increase your dose.

 

One of my mentors used to tell me, “Life is complicated, but medicine makes sense!”  I hope you found this review on Semaglutide and Tirzepatide dosing helpful.  Thanks for taking time to read it and I look forward to helping you on your weight loss journey.

 

This Post was Prepared by:

Dr. Mario Quiros

Good Hearts Health

Diplomate of the American Board of Obesity Medicine

 

 

For more Info regarding Semaglutide and Tirzepatide click below:

Semaglutide Clinical Trials

Tirzepatide Clinical Trials

 

 

What type of exercise should I be doing while on GLP-1 Therapy?

One of the most frequent questions I get from patients starting GLP-1 Therapy with Tirzepatide (Mounjaro/Zepbound) or Semaglutide (Ozempic/Wegovy) is, “What type of exercise should I be doing while on GLP-1 medication?”

First, lets understand the main types of exercise.  Exercise can get broken down into Aerobic exercise, Anaerobic (Strength and Resistance) excercise, Flexibility exercise, and balance exercise.

What is Aerobic Exercise?

Aerobic exercises include things like walking, jogging, hiking, swimming, cycling and typically involve exercises that use oxygen to increase your heart rate and breathing.  Aerobic exercise is beneficial in improving your cardiovascular fitness, lowering your blood pressure, and boosts your energy levels.  These types of exercises are very effective for burning calories and are associated with more weight loss then anaerobic exercise.  Aerobic exercises use oxygen to produce energy and are typically lower in intensity and longer in duration than anaerobic exercise.

What is Anaerobic Exercise?

Anaerobic exercises include things like weightlifting, sprinting, jumping, HIIT training, and plyometrics and use energy stored in muscles as opposed to oxygen.  Benefits of anaerobic exercise include increasing muscle mass, helping the body use insulin more efficiently (something GLP-1’s like Semaglutide and Tirzepatide also assist with), decreases the risk of osteoporosis, prevents cardiac aging, lowers cardiovascular risk, and may help to increase your metabolism and resting metabolic rate.

What Exercise is Best for Weight Loss and Weight Maintenence?

While exercise is important for weight loss and even more important for weight maintenence, the effects of exercise alone on weight loss are neglible compared to diet.  The most important component of weight loss is running a caloric deficit over a perior of time.  An average caloric deificit of 500 – 750 calories per day is recommended for most successful diets.   A healthy weight loss goal that I aim for in my patients is a consistent weight loss of 1.5 – 2 lb per week.

GLP-1 medications like Tirzepatide and Semaglutide are very effective at suppressing your appetite, limiting portion sizes, and allowing you to consistently run a caloric deficit.  This is what makes them such great weight loss medications! This consistent caloric deficit combined with other ways they optimize your metabolism allows your body to burn through existing fat reserves as a source of energy and thus lose weight.

What exercise does Dr. Quiros recommend for his patients on GLP-1 Therapy?

I recommend a training regimen focusing primarily on Strength and Resistance training while taking GLP-1 medications.  I recommend 30-45 minutes per day, 3-4 days per week as a starting point.  If you enjoy aerobic exercise you can continue to do it as part of your wellness routine, but it should be secondary to strength and resistance training for patients taking Semaglutide or Tirzepatide for weight loss.  I recommend this for the following reasons:

1.  Optimize Body Composition: 

The caloric deficit produced by taking semaglutide or tirzepatide is more than enough to achieve significant weight gain.  The concern is not if you will lose weight but rather how you lose the weight.  By focusing on strength and resistance training you will be signaling to your body to hold on to your existing muscle mass and ideally build additional muscle.  This will mitigate the loss of muscle mass that can occur when you are running a caloric deficit and amplify the rate that you burn through fat a source of energy in a caloric restricted state. 

2.  Increase you metabolism:

If you run a caloric deficit over a prolonged period of time your metabolism may slow down.  This is a result of your body becoming more efficient as a response to running a prolonged caloric deficit.  This is also one of the reasons patients can see their weight loss plateau.  By performing anaerobic strength and resistance exercises regularly and building muscle mass you will increase your metabolism and ensure that your resting metabolic rate does not decrease as you continue to lose weight.

3.  Mitigate Osteoporosis:

One of the side effects described in the clinical trials for Semaglutide and Tirzepatide was osteoporosis.  This is particularly concerning in women over 65 and post-menopausal patients.  Some loss of bone density is natural with weight loss as your bones are not subject to the same weight loading and stress forces, but too much can be pathological. Anaerobic exercise, particularly resistance training, can be highly effective in decreasing the risk of osteoporosis by increasing bone density and strength due to the mechanical stress it places on bones, which stimulates bone formation and helps prevent bone loss. Essentially, when you engage in resistance training, your body responds by building stronger bones to handle the added stress.

 

This post was prepared by:

Dr. Mario I. Quiros

Good Hearts Health Owner and Founder

Dipolomate of the American Board of Obesity Medicine

 

More useful Info on benefits of Aerobic vs. Anaerobic Exercise:

https://www.shape.com/fitness/tips/aerobic-vs-anaerobic-exercise

https://www.healthline.com/health/fitness-exercise/aerobic-vs-anaerobic#Why-anaerobic-exercise-is-better-for-fat-loss