[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-563448-105":53,"doc-detail-563448-en":124},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":117,"head_meta":119,"extra_data":121,"updated_unix":123},105,"en","bob-icb-tirzepatide-mounjaro-initiation-guide","BOB ICB Tirzepatide (Mounjaro) Initiation Guide","","BOB ICB Tirzepatide (Mounjaro) Initiation Guide provides prescribing and titration support for adults with type 2 diabetes in secondary or primary care, aligned with the Mounjaro SmPC. It explains the dual GIP/GLP-1 mechanism, expected effects on weight, insulin sensitivity and glycaemic control, and summarizes clinical evidence from SURPASS 1–5 while noting no confirmed cardiovascular benefit. It specifies initiation indications, BMI threshold rules, and a BOB formulary position, followed by dosage administration guidance including starting dose, stepwise titration, maintenance, missed-dose instructions, scheduling changes, and storage.",{"@graph":63,"@context":116},[64,80,95],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/bob-icb-tirzepatide-mounjaro-initiation-guide/563448/",4,{"url":78,"name":59,"@type":81,"author":82,"headline":59,"publisher":85,"fileFormat":88,"inLanguage":57,"description":61,"dateModified":89,"datePublished":89,"encodingFormat":88,"isAccessibleForFree":90,"interactionStatistic":91},"DigitalDocument",{"name":83,"@type":84},"Ezra","Person",{"url":68,"name":86,"@type":87},"DocShare","Organization","application/pdf","2026-10-12",true,{"@type":92,"interactionType":93,"userInteractionCount":4},"InteractionCounter",{"@type":94},"ViewAction",{"@type":96,"mainEntity":97},"FAQPage",[98,104,108,112],{"name":99,"@type":100,"acceptedAnswer":101},"What is the purpose of this initiation guide for Mounjaro (tirzepatide)?","Question",{"text":102,"@type":103},"It supports prescribing and titration of Mounjaro for adults with type 2 diabetes in secondary or primary care, using the SmPC as the basis for dosing and safety information.","Answer",{"name":105,"@type":100,"acceptedAnswer":106},"How does the guide describe the action and expected effects of Mounjaro?",{"text":107,"@type":103},"Mounjaro is a long-acting dual GIP and GLP-1 receptor agonist and is described as lowering body weight and body fat mass while improving insulin sensitivity and glycaemic control.",{"name":109,"@type":100,"acceptedAnswer":110},"When can Mounjaro be initiated, and what BMI rules are included?",{"text":111,"@type":103},"It is intended for adults whose type 2 diabetes is insufficiently controlled on diet and exercise, with specific conditions including triple therapy being ineffective, not tolerated or contraindicated, plus BMI thresholds (including lower thresholds for certain family backgrounds).",{"name":113,"@type":100,"acceptedAnswer":114},"What does the guide specify for starting dose and titration schedule?",{"text":115,"@type":103},"Starting is 2.5 mg subcutaneous once weekly for 4 weeks (not a maintenance dose), then increase to 5 mg once weekly for at least 4 weeks if tolerated, with further 2.5 mg increments after a minimum of 4 weeks if targets are not achieved.","https://schema.org",{"og:url":78,"og:type":118,"og:title":59,"og:site_name":86,"og:description":61},"article",{"robots":120,"canonical":78},"index,follow",{"doc_id":122,"site_id":56},563448,1791835503,{"code":4,"msg":5,"data":125},{"doc_id":122,"user_id":126,"nickname":83,"user_avatar":127,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":128,"file_id":129,"file_url":130,"file_type":131,"file_size":132,"view_count":4,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":133,"language":134,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":135,"faqs":136,"seo_title":137,"seo_description":61,"update_tm":123,"read_time":76},1099514068035,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","BOB ICB Tirzepatide  \n(Mounjaro) Initiation Guide.  \n\n| Title: | BOB ICB Tirzepatide (Mounjaro) Initiation Guide. |\n| --- | --- |\n| Status: | Final |\n| Version No: | 1.2 |\n| Date Approved by BOB APC: | May 2024 |\n| Next Review: | May 2027 |\n| Authors: | Gill Dunn (Diabetes Specialist Nurse Integrated Diabetes Delivery Network (IDDN) Clinical Lead.\u003Cbr>Reviewed by the Integrated Diabetes Delivery Network (IDDN |\n| Change History: | V1 .2 – update to co-prescribing with insulin July 24\u003Cbr>V1 .1 – flowchart updated\u003Cbr>V1 .0 – approved March 2024 |\n\nMOUNJARO/TIRZEPATIDE GIP/GLP-1 AGONISTS FOR ADULTS WITH TYPE 2 DIABETES INITIATION IN SECONDARY OR PRIMARY CARE  \nThis guidance aims to support the prescribing and titration of Mounjaro/tirzepatide in conjunction with information in the Summary of Product Characteristics (SmPC) accessed via SmPC  \nFor the purposes of prescribing safety this guidance will refer to the BRAND name Mounjaro.  \nRefer below to Table 1 (Contraindications and Precautions) and Table 2 (Dosage and Administration) .  \nBackground for use  \nMounjaro is a long-acting dual GIP and GLP-1 receptor agonist. Both receptors are present on the pancreatic α and β endocrine cells, heart, vasculature, immune cells (leukocytes), gut and kidney. GIP receptors are also present on adipocytes.  \nMounjaro lowers body weight and body fat mass and improves insulin sensitivity and glycaemic control.  \nClinical efficacy and safety  \nThe safety and efficacy of Mounjaro was evaluated in five global randomised, controlled, phase 3 studies (SURPASS 1-5) assessing glycaemic control as the primary objective. The studies involved 6 263 treated patients with type 2 diabetes (4 199 treated with Mounjaro) . The secondary objectives included body weight, fasting serum glucose (FSG) and proportion of patients reaching target HbA1c.  \nMounjaro SmPC-SURPASS 1-5  \nMounjaro does NOT have the evidence of cardiovascular (CV) benefit (superiority for CV endpoints) these studies are ongoing.  \nIndications for initiation  \nTreatment of adults with type 2 diabetes insufficiently controlled as an adjunct to diet and exercise in accordance with NICE NG28  \nMounjaro is recommended for treating type 2 diabetes alongside diet and exercise in adults when it isinsufficiently controlled only if:  \n• triple therapy with metformin and 2 other oral antidiabetic drugs is ineffective, not tolerated or contraindicated, and  \n• they have a body mass index (BMI) of 35 kg/m2 or more, and specific psychological or other medical problems associated with obesity, or  \n• they have a BMI of less than 35 kg/m2 and:  \n− insulin therapy would have significant occupational implications, or  \n− weight loss would benefit other significant obesity-related complications.  \nUse lower BMI thresholds (usually reduced by 2.5 kg/m2) for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family backgrounds.  \nBOB formulary position  \nGreen Restricted: Suitable for initiation and ongoing prescribing within primary care, following the  \nformulary status information:-  \n•  Buckinghamshire Formulary Formulary ([bucksformulary.nhs.uk](bucksformulary.nhs.uk))  \n•  Oxfordshire Clinical Commissioning Group Formulary ([oxfordshireformulary.nhs.uk](oxfordshireformulary.nhs.uk))  \n•  Berkshire West NHS Formulary ([westberksformulary.nhs.uk](westberksformulary.nhs.uk))  \nAs there is no published evidence of CV benefit, consider Mounjaro when other first line choices for CV benefit are not suitable or long-term availability is an issue. See table below.  \n\n| 1st line – those with CV benefit\u003Cbr>Ozempic (semaglutide)/Victoza (liraglutde)/Trulicity (dulaglutide) |\n| --- |\n| 2nd line – those with no CV benefit\u003Cbr>Once weekly – Monjouro (tirzepatide)/Bydureon (exenatide) |\n| Other\u003Cbr>Rybelsus (semaglutide)– for those who need an oral Rx (note-no CV benefit) |\n\nTable 2: Dosage and administration  \nBy subcutaneous injection in thigh or abdomen by pre-filled pen. See ","cbCaieq3MO1ZxZyX","https://ap.wps.com/l/cbCaieq3MO1ZxZyX","pdf",446555,9,"English","# Indications for initiation\n## BOB formulary position\n# Background for use\n# Clinical efficacy and safety\n# Dosage and administration\n## Starting dose and titration\n## Maintenance dose, missed dose, and scheduling\n## Storage","[{\"question\":\"What is the purpose of this initiation guide for Mounjaro (tirzepatide)?\",\"answer\":\"It supports prescribing and titration of Mounjaro for adults with type 2 diabetes in secondary or primary care, using the SmPC as the basis for dosing and safety information.\"},{\"question\":\"How does the guide describe the action and expected effects of Mounjaro?\",\"answer\":\"Mounjaro is a long-acting dual GIP and GLP-1 receptor agonist and is described as lowering body weight and body fat mass while improving insulin sensitivity and glycaemic control.\"},{\"question\":\"When can Mounjaro be initiated, and what BMI rules are included?\",\"answer\":\"It is intended for adults whose type 2 diabetes is insufficiently controlled on diet and exercise, with specific conditions including triple therapy being ineffective, not tolerated or contraindicated, plus BMI thresholds (including lower thresholds for certain family backgrounds).\"},{\"question\":\"What does the guide specify for starting dose and titration schedule?\",\"answer\":\"Starting is 2.5 mg subcutaneous once weekly for 4 weeks (not a maintenance dose), then increase to 5 mg once weekly for at least 4 weeks if tolerated, with further 2.5 mg increments after a minimum of 4 weeks if targets are not achieved.\"}]","BOB ICB Tirzepatide (Mounjaro) Initiation Guide | PDF"]