Who Is Tirzepatide Right For? A Guide to Patient Selection

Conversations about weight loss drugs often center around Wegovy and Ozempic, but a newer drug, tirzepatide, is attracting attention too. Tirzepatide has been commercially available since 2022 as the brand name Mounjaro and Zepbound as well as compounded medications.

While all three versions can be safe and effective, knowing which one is right for you or if you’re a good candidate for tirzepatide in the first place is important.

Here’s what you need to know about tirzepatide, including how its different forms impact weight management, sleep apnea, and blood sugar control.

What is Tirzepatide?

Tirzepatide is a medication that may be used for weight management, moderate to severe sleep apnea, and type 2 diabetes. It comes under the brand name Mounjaro and Zepbound or as a compound medication from a licensed pharmacy.

Tirzepatide triggers the same effects as two naturally occurring hormones:

• Glucose-dependent insulinotropic polypeptide (GIP): released earlier in a meal to help the body more effectively break down sugar from food.
• Glucagon-like peptide-1 (GLP-1): released later in a meal to regulate blood sugar and appetite. It also promotes feeling full for longer after a meal.

Tirzepatide offers potential benefits, such as improved blood sugar control for those with type 2 diabetes and weight management. Some studies suggest tirzepatide may be better at promoting weight loss because it mimics two hormones instead of one.

	Mounjaro	Zepbound	Compounded Medication
FDA-approved uses	Improved glycemic control for adults with type 2 diabetes	Weight management and to treat moderate or severe sleep apnea in individuals with obesity	Not FDA-approved
Medication type and frequency	Weekly injection	Weekly injection	Weekly injection or daily oral tablets
Average weight loss	Up to 25 pounds	Up to 48 pounds	Depends on manufacturer
Monthly list price (before insurance or discounts)	$1,079.77	$1,086.37	Can be as low as $299 a month

FDA Approved Uses

Tirzepatide can be found under two brand names: Mounjaro and Zepbound. Mounjaro is FDA-approved for blood sugar control in adults with type 2 diabetes but is also sometimes used off-label for weight loss. Off-label uses are not FDA approved, meaning there isn’t a guarantee of their effectiveness or safety for an off-label purpose.

Zepbound is FDA-approved for weight loss in individuals with a BMI of 30 or higher or a BMI of 27 or higher with at least one weight-related condition, such as heart disease, sleep apnea, or type 2 diabetes.

There’s also compounded tirzepatide. Compounded medications are created in licensed labs with the same active ingredient (in this case tirzepatide) as brand name drugs. They are not FDA-approved, meaning the amount or quality of the active and inactive ingredients isn’t guaranteed, but they are legal to purchase.

For tirzepatide specifically, compounded versions may also be available as dissolving tablets instead of an injection, which could be a good option for anyone who is needle-adverse.

Weight Loss Efficacy

Tirzepatide’s promise for weight loss started in its earliest clinical trials. In the SURMOUNT-1 trial, for example, individuals taking a 5mg weekly dose experienced 15.0% weight loss over 72 weeks.

Those taking a 10mg dose experienced a 19.5% reduction, while participants on a 15mg dose saw a 20.9% reduction.

The SURMOUNT-4 trial boasted even more impressive results, with an overall mean weight reduction of 25.3% in 88 weeks.

Yet these trials took place in clinical settings, meaning trial participants had regular support and follow-up appointments with medical professionals. This may not reflect most people’s experience on tirzepatide.

In real-world settings, more factors influence how much weight someone loses. Diet, exercise, and other lifestyle habits sway how well this medication works, as does the exact type of Tirzepatide.

Zepbound is the version of tirzepatide that’s indicated for weight loss and most commonly used in weight loss trials. The drug’s manufacturer reports one in three people on the 10mg or 15mg dose of Zepbound experienced a -25% change in weight in 72 weeks.

Side Effects of Each

As an FDA-approved drug, tirzepatide’s side effects are well-established. Common ones are:

• Abdominal pain
• Dizziness
• Sweating
• Confusion
• Headache
• Shakiness
• Fast heartbeat
• Mood changes
• Nausea
• Diarrhea
• Vomiting
• Decreased appetite
• Constipation
• Indigestion

Allergic reactions at the injection site and hair loss are also reported for Zepbound, but not Mounjaro.

Dosing and Administration

Tirzepatide usually comes as a weekly injection, though some compounded versions are available as tablets. Patients administer a weekly injection at home into the thigh, abdomen, or upper arm at any time of day, with or without a meal.

For both Mounjaro and Zepbound, titration is recommended, which is when you start on a lower dose and increase gradually. Both start at 2.5mg dose. If there are no severe side effects, someone can increase the dose to 5mg at the four week mark.

The maximum recommended dose for Mounjaro and Zepbound is 15mg a week, though not everyone requires this dose to see results. Work with a healthcare provider to figure out when it’s safe to increase the dosage and what is the best maximum dose for your needs.

Cost and Accessibility

Tirzepatide is available to the public in three forms. All have a different list price, which is the cost before insurance or any discounts.

Medication	Monthly Cost (no insurance or discounts)
Mounjaro	$1,079.77
Zepbound	$1,086.37
Compounded tirzepatide	As low as $299 a month

If using insurance, most plans cover FDA-approved medications, including Zepbound and Mounjaro. Usually, a medication must be prescribed for a use stated on the FDA label. A doctor will submit a request to the insurance provider, detailing the exact reason it’s medically necessary.

The insurance company then accepts or denies. If denied, there’s a 30 day window to submit an appeal.

When covered by insurance, Eli Lilly, the manufacturer of both drugs, states that out-of-pocket costs for the consumer could be as low as $25 a month for Zepbound or Mounjaro.

Eli Lilly also claims that those who are self-paying (i.e. paying without insurance) could get Zepbound for as low as $349 (for a 2.5mg dose) if they purchase directly through the manufacturer’s pharmacy. There isn’t a similar savings program for Mounjaro.

Patient Selection: Who Is a Better Candidate for Each?

When deciding which version of tirzepatide will best work for you, a good place to start is with each version's FDA-approved uses. As a quick refresher, that means Mounjaro is probably the best bet for managing blood sugar levels for individuals with type 2 diabetes.

It may also be prescribed off-label to help manage levels in those with prediabetes or as a weight loss drug, though off-label uses may or may not be covered by insurance.

For maximum weight loss, Zepbound wins out. This drug is FDA-approved for weight management in individuals who are obese or overweight with the presence of one weight-related comorbid condition, such as heart disease or hypertension.

It’s also approved for sleep apnea when symptoms are moderate to severe and someone also has obesity.

So, when are compounded medications the better option? Those who are using self-pay will often find them more affordable.

Compounded tirzepatide may also be suitable for the needle-adverse since it can come in an oral tablet, or if someone is allergic to one of the inactive ingredients in Mounjaro or Zepbound, since compounded medications can be custom-made.

	Mounjaro	Zepbound	Compounded medication
Ideal For	Blood sugar control	Weight loss and/or managing sleep apnea	Those who are paying for the medication out-of-pocket and needle adverse individuals
Not indicated for or best for	Weight loss and managing sleep apnea	Blood sugar control	Individuals with insurance plans that cover Zepbound or Mounjaro

Which Drug Comes Out on Top?

Tirzepatide is an option worth considering for blood sugar control, weight management, or sleep apnea. Just remember that it comes in three forms, all of which have different purposes. Mounjaro is the clear winner for blood sugar control, while Zepbound offers the most efficacy for weight loss and sleep apnea.

Compounded medications are a good choice for those who are self-paying. No matter which option you’re learning toward, consult a healthcare provider on which one is the best choice for your health.

At SkinnyRx, we offer compounded tirzepatide under the guidance of licensed medical providers to help ensure safety and personalized care. If you’re considering treatment, you can start by taking our quick assessment to see if it's a good fit for you.