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Recommended starting dose: Discontinue other basal insulin and/or GLP-1 agonist before initiating Xultophy Patients nave to basal insulin or a GLP-1 agonist: starting dose is 10 units once daily Patients currently on basal insulin or a GLP-1 agonist: starting dose is 16 units once daily Maintenance: titrate dose up or down by 2 units once or twice weekly, depending on blood sugar goals Missed doses: resume dosing at the next scheduled dose

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[8] [10] These medications are typically administered via subcutaneous injection (except oral semaglutide), with dosing frequencies ranging from twice daily to once weekly depending on the specific formulation

Diabetes Care 32 , 8490 (2009)

While there are no head-to-head trials specifically designed to compare tirzepatide plus metformin versus tirzepatide alone for weight loss, the available evidence suggests the combination is safe and effective, with metformin providing additional metabolic benefits without diminishing tirzepatide's weight loss effects