ADVERSE REACTIONS SECTION.

6 ADVERSE REACTIONS. The following serious adverse reactions are described below or elsewhere in the prescribing information:Risk of Thyroid C-cell Tumors [see Warnings and Precautions (5.1)] Pancreatitis [see Warnings and Precautions (5.2)] Hypoglycemia with Concomitant Use of Insulin Secretagogues or Insulin [see Warnings and Precautions (5.3)] Hypersensitivity [see Warnings and Precautions (5.4)] Acute Kidney Injury [see Warnings and Precautions (5.5)] Severe Gastrointestinal Disease [see Warnings and Precautions (5.6)] Diabetic Retinopathy Complications [see Warnings and Precautions (5.7)] Acute Gallbladder Disease [see Warnings and Precautions (5.8)] Risk of Thyroid C-cell Tumors [see Warnings and Precautions (5.1)] Pancreatitis [see Warnings and Precautions (5.2)] Hypoglycemia with Concomitant Use of Insulin Secretagogues or Insulin [see Warnings and Precautions (5.3)] Hypersensitivity [see Warnings and Precautions (5.4)] Acute Kidney Injury [see Warnings and Precautions (5.5)] Severe Gastrointestinal Disease [see Warnings and Precautions (5.6)] Diabetic Retinopathy Complications [see Warnings and Precautions (5.7)] Acute Gallbladder Disease [see Warnings and Precautions (5.8)] The most common adverse reactions, reported in >=5% of patients treated with MOUNJARO are: nausea, diarrhea, decreased appetite, vomiting, constipation, dyspepsia, and abdominal pain. (6.1)To report SUSPECTED ADVERSE REACTIONS, contact Eli Lilly and Company at 1-800-LillyRx (1-800-545-5979) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.. 6.1 Clinical Trials Experience. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.. Pool of Two Placebo-Controlled Clinical TrialsThe data in Table are derived from placebo-controlled trials [1 monotherapy trial (SURPASS-1) and trial in combination with basal insulin with or without metformin (SURPASS-5)] in adult patients with type diabetes mellitus [see Clinical Studies (14.2, 14.4)]. These data reflect exposure of 718 patients to MOUNJARO and mean duration of exposure to MOUNJARO of 36.6 weeks. The mean age of patients was 58 years, 4% were 75 years or older and 54% were male. The population was 57% White, 27% Asian, 13% American Indian or Alaska Native, and 3% Black or African American; 25% identified as Hispanic or Latino ethnicity. At baseline, patients had type diabetes mellitus for an average of 9.1 years with mean HbA1c of 8.1%. As assessed by baseline fundoscopic examination, 13% of the population had retinopathy. At baseline, eGFR was >=90 mL/min/1.73 m2 in 53%, 60 to 90 mL/min/1.73 m2 in 39%, 45 to 60 mL/min/1.73 m2 in 7%, and 30 to 45 mL/min/1.73 m2 in 1% of patients.. Pool of Seven Controlled Clinical TrialsAdverse reactions were also evaluated in larger pool of adult patients with type diabetes mellitus participating in seven controlled clinical trials which included two placebo-controlled trials (SURPASS-1 and -5), three trials of MOUNJARO in combination with metformin, sulfonylureas, and/or SGLT2 Inhibitors (SURPASS-2, -3, -4) [see Clinical Studies (14.3)] and two additional trials conducted in Japan. In this pool, total of 5119 adult patients with type diabetes mellitus were treated with MOUNJARO for mean duration of 48.1 weeks. The mean age of patients was 58 years, 4% were 75 years or older and 58% were male. The population was 65% White, 24% Asian, 7% American Indian or Alaska Native, and 3% Black or African American; 38% identified as Hispanic or Latino ethnicity. At baseline, patients had type diabetes mellitus for an average of 9.1 years with mean HbA1c of 8.3%. As assessed by baseline fundoscopic examination, 15% of the population had retinopathy. At baseline, eGFR was >=90 mL/min/1.73 m2 in 52%, 60 to 90 mL/min/1.73 m2 in 40%, 45 to 60 mL/min/1.73 m2 in 6%, and 30 to 45 mL/min/1.73 m2 in 1% of patients.. Common Adverse ReactionsTable shows common adverse reactions, not including hypoglycemia, associated with the use of MOUNJARO in the pool of placebo-controlled trials. These adverse reactions occurred more commonly on MOUNJARO than on placebo and occurred in at least 5% of patients treated with MOUNJARO.Table 1: Adverse Reactions in Pool of Placebo-Controlled Trials Reported in >=5% of MOUNJARO-treated Adult Patients with Type Diabetes MellitusNote: Percentages reflect the number of patients who reported at least occurrence of the adverse reaction.Adverse ReactionPlacebo(N=235)%MOUNJARO mg(N=237)%MOUNJARO 10 mg(N=240)%MOUNJARO 15 mg(N=241)%Nausea4121518Diarrhea9121317Decreased Appetite151011Vomiting2559Constipation1667Dyspepsia3885Abdominal Pain4655In the pool of seven clinical trials, the types and frequency of common adverse reactions, not including hypoglycemia, were similar to those listed in Table 1.. Gastrointestinal Adverse ReactionsIn the pool of placebo-controlled trials, gastrointestinal adverse reactions occurred more frequently among patients receiving MOUNJARO than placebo (placebo 20.4%, MOUNJARO mg 37.1%, MOUNJARO 10 mg 39.6%, MOUNJARO 15 mg 43.6%). More patients receiving MOUNJARO mg (3.0%), MOUNJARO 10 mg (5.4%), and MOUNJARO 15 mg (6.6%) discontinued treatment due to gastrointestinal adverse reactions than patients receiving placebo (0.4%). The majority of reports of nausea, vomiting, and/or diarrhea occurred during dose escalation and decreased over time.The following gastrointestinal adverse reactions were reported more frequently in MOUNJARO-treated patients than placebo-treated patients (frequencies listed, respectively, as: placebo; mg; 10 mg; 15 mg): eructation (0.4%, 3.0%, 2.5%, 3.3%), flatulence (0%, 1.3%, 2.5%, 2.9%), gastroesophageal reflux disease (0.4%, 1.7%, 2.5%, 1.7%), abdominal distension (0.4%, 0.4%, 2.9%, 0.8%).. Other Adverse Reactions. HypoglycemiaTable summarizes the incidence of hypoglycemic events in the placebo-controlled trials.Table 2: Hypoglycemia Adverse Reactions in Placebo-Controlled Trials in Adult Patients with Type Diabetes Mellitus Reflects the study treatment period. Data include events occurring during weeks of treatment-free safety follow up. Events after introduction of new glucose-lowering treatment are excluded. Episodes requiring the assistance of another person to actively administer carbohydrate, glucagon, or other resuscitative actions.Placebo %MOUNJARO mg%MOUNJARO 10 mg%MOUNJARO 15 mg%Monotherapy (40 weeks)N=115N=121N=119N=120 Blood glucose <54 mg/dL1000 Severe hypoglycemia0000Add-on to Basal Insulin with or without Metformin (40 weeks)N=120N=116N=119N=120 Blood glucose <54 mg/dL13161914 Severe hypoglycemia0021Hypoglycemia was more frequent when MOUNJARO was used in combination with sulfonylurea [see Clinical Studies (14)]. In clinical trial up to 104 weeks of treatment, when administered with sulfonylurea, hypoglycemia (glucose level <54 mg/dL) occurred in 13.8%, 9.9%, and 12.8%, and severe hypoglycemia occurred in 0.5%, 0%, and 0.6% of patients treated with MOUNJARO mg, 10 mg, and 15 mg, respectively.. Heart Rate IncreaseIn the pool of placebo-controlled trials, treatment with MOUNJARO resulted in mean increase in heart rate of to beats per minute compared to mean increase of beat per minute in placebo-treated patients. Episodes of sinus tachycardia, associated with concomitant increase from baseline in heart rate of >=15 beats per minute, also were reported in 4.3%, 4.6%, 5.9% and 10% of subjects treated with placebo, MOUNJARO mg, 10 mg, and 15 mg, respectively. For patients enrolled in Japan, these episodes were reported in 7% (3/43), 7.1% (3/42), 9.3% (4/43), and 23% (10/43) of patients treated with placebo, MOUNJARO mg, 10 mg, and 15 mg, respectively. The clinical relevance of heart rate increases is uncertain.. Hypersensitivity ReactionsHypersensitivity reactions have been reported with MOUNJARO in the pool of placebo-controlled trials, sometimes severe (e.g., urticaria and eczema); hypersensitivity reactions were reported in 3.2% of MOUNJARO-treated patients compared to 1.7% of placebo-treated patients.In the pool of seven clinical trials, hypersensitivity reactions occurred in 106/2,570 (4.1%) of MOUNJARO-treated patients with anti-tirzepatide antibodies and in 73/2,455 (3.0%) of MOUNJARO-treated patients who did not develop anti-tirzepatide antibodies [see Clinical Pharmacology (12.6)]. Injection Site ReactionsIn the pool of placebo-controlled trials, injection site reactions were reported in 3.2% of MOUNJARO-treated patients compared to 0.4% of placebo-treated patients.In the pool of seven clinical trials, injection site reactions occurred in 119/2,570 (4.6%) of MOUNJARO-treated patients with anti-tirzepatide antibodies and in 18/2,455 (0.7%) of MOUNJARO-treated patients who did not develop anti-tirzepatide antibodies [see Clinical Pharmacology (12.6)]. Acute Gallbladder DiseaseIn the pool of placebo-controlled clinical trials, acute gallbladder disease (cholelithiasis, biliary colic and cholecystectomy) was reported by 0.6% of MOUNJARO-treated patients and 0% of placebo-treated patients.. Laboratory Abnormalities. Amylase and Lipase IncreaseIn the pool of placebo-controlled clinical trials, treatment with MOUNJARO resulted in mean increases from baseline in serum pancreatic amylase concentrations of 33% to 38% and serum lipase concentrations of 31% to 42%. Placebo-treated patients had mean increase from baseline in pancreatic amylase of 4% and no changes were observed in lipase. The clinical significance of elevations in lipase or amylase with MOUNJARO is unknown in the absence of other signs and symptoms of pancreatitis.

BOXED WARNING SECTION.

WARNING: RISK OF THYROID C-CELL TUMORS. In both male and female rats, tirzepatide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. It is unknown whether MOUNJARO causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of tirzepatide-induced rodent thyroid C-cell tumors has not been determined[see Warnings and Precautions (5.1) and Nonclinical Toxicology (13.1)].MOUNJARO is contraindicated in patients with personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type (MEN 2)[see Contraindications (4)]. Counsel patients regarding the potential risk for MTC with the use of MOUNJARO and inform them of symptoms of thyroid tumors (e.g., mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with MOUNJARO[see Contraindications (4) and Warnings and Precautions (5.1)].. In both male and female rats, tirzepatide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. It is unknown whether MOUNJARO causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of tirzepatide-induced rodent thyroid C-cell tumors has not been determined[see Warnings and Precautions (5.1) and Nonclinical Toxicology (13.1)].. MOUNJARO is contraindicated in patients with personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type (MEN 2)[see Contraindications (4)]. Counsel patients regarding the potential risk for MTC with the use of MOUNJARO and inform them of symptoms of thyroid tumors (e.g., mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with MOUNJARO[see Contraindications (4) and Warnings and Precautions (5.1)].. WARNING: RISK OF THYROID C-CELL TUMORSSee full prescribing information for complete boxed warning.Tirzepatide causes thyroid C-cell tumors in rats. It is unknown whether MOUNJARO causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as the human relevance of tirzepatide-induced rodent thyroid C-cell tumors has not been determined (5.1, 13.1).MOUNJARO is contraindicated in patients with personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type (MEN 2). Counsel patients regarding the potential risk of MTC and symptoms of thyroid tumors (4, 5.1).. Tirzepatide causes thyroid C-cell tumors in rats. It is unknown whether MOUNJARO causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as the human relevance of tirzepatide-induced rodent thyroid C-cell tumors has not been determined (5.1, 13.1).. MOUNJARO is contraindicated in patients with personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type (MEN 2). Counsel patients regarding the potential risk of MTC and symptoms of thyroid tumors (4, 5.1).

CLINICAL PHARMACOLOGY SECTION.

12 CLINICAL PHARMACOLOGY. 12.1 Mechanism of Action. Tirzepatide is GIP receptor and GLP-1 receptor agonist. It is 39-amino-acid modified peptide with C20 fatty diacid moiety that enables albumin binding and prolongs the half-life. Tirzepatide selectively binds to and activates both the GIP and GLP-1 receptors, the targets for native GIP and GLP-1.Tirzepatide enhances first- and second-phase insulin secretion, and reduces glucagon levels, both in glucose-dependent manner.. 12.2 Pharmacodynamics. Tirzepatide lowers fasting and postprandial glucose concentration, decreases food intake, and reduces body weight in patients with type diabetes mellitus.. First and Second-Phase Insulin SecretionTirzepatide enhances the first- and second-phase insulin secretion. (Figure 1) Figure 1: Mean insulin concentration at 0-120 minutes during hyperglycemic clamp at baseline and Week 28. Figure 1. Insulin SensitivityTirzepatide increases insulin sensitivity, as demonstrated in hyperinsulinemic euglycemic clamp study after 28 weeks of treatment.. Glucagon SecretionTirzepatide reduces fasting and postprandial glucagon concentrations. Tirzepatide 15 mg reduced fasting glucagon concentration by 28% and glucagon AUC after mixed meal by 43%, compared with no change for placebo after 28 weeks of treatment.. Gastric EmptyingTirzepatide delays gastric emptying. The delay is largest after the first dose and this effect diminishes over time. Tirzepatide slows post-meal glucose absorption, reducing postprandial glucose.. 12.3 Pharmacokinetics. The pharmacokinetics of tirzepatide is similar between healthy subjects and patients with type diabetes mellitus. Steady-state plasma tirzepatide concentrations were achieved following weeks of once weekly administration. Tirzepatide exposure increases in dose-proportional manner.. AbsorptionFollowing subcutaneous administration, the time to maximum plasma concentration of tirzepatide ranges from to 72 hours. The mean absolute bioavailability of tirzepatide following subcutaneous administration is 80%. Similar exposure was achieved with subcutaneous administration of tirzepatide in the abdomen, thigh, or upper arm.. DistributionThe mean apparent steady-state volume of distribution of tirzepatide following subcutaneous administration in patients with type diabetes mellitus is approximately 10.3 L. Tirzepatide is highly bound to plasma albumin (99%).. EliminationThe apparent population mean clearance of tirzepatide is 0.061 L/h with an elimination half-life of approximately days, enabling once-weekly dosing.. MetabolismTirzepatide is metabolized by proteolytic cleavage of the peptide backbone, beta-oxidation of the C20 fatty diacid moiety and amide hydrolysis.. ExcretionThe primary excretion routes of tirzepatide metabolites are via urine and feces. Intact tirzepatide is not observed in urine or feces.. Specific PopulationsThe intrinsic factors of age, gender, race, ethnicity, or body weight do not have clinically relevant effect on the PK of tirzepatide.. Patients with Renal ImpairmentRenal impairment does not impact the pharmacokinetics of tirzepatide. The pharmacokinetics of tirzepatide after single mg dose was evaluated in patients with different degrees of renal impairment (mild, moderate, severe, ESRD) compared with subjects with normal renal function. This was also shown for patients with both type diabetes mellitus and renal impairment based on data from clinical studies [see Use in Specific Populations (8.6)].. Patients with Hepatic ImpairmentHepatic impairment does not impact the pharmacokinetics of tirzepatide. The pharmacokinetics of tirzepatide after single mg dose was evaluated in patients with different degrees of hepatic impairment (mild, moderate, severe) compared with subjects with normal hepatic function [see Use in Specific Populations (8.7)].. Drug Interactions Studies. Potential for Tirzepatide to Influence the Pharmacokinetics of Other DrugsIn vitro studies have shown low potential for tirzepatide to inhibit or induce CYP enzymes, and to inhibit drug transporters.MOUNJARO delays gastric emptying, and thereby has the potential to impact the absorption of concomitantly administered oral medications [see Drug Interactions (7.2)].The impact of tirzepatide on gastric emptying was greatest after single dose of mg and diminished after subsequent doses.Following first dose of tirzepatide mg, acetaminophen maximum concentration (Cmax) was reduced by 50%, and the median peak plasma concentration (tmax) occurred hour later. After coadministration at week 4, there was no meaningful impact on acetaminophen Cmax and tmax. Overall acetaminophen exposure (AUC0-24hr) was not influenced.Following administration of combined oral contraceptive (0.035 mg ethinyl estradiol and 0.25 mg norgestimate) in the presence of single dose of tirzepatide mg, mean Cmax of ethinyl estradiol, norgestimate, and norelgestromin was reduced by 59%,66%, and 55%, while mean AUC was reduced by 20%, 21%, and 23%, respectively. delay in tmax of 2.5 to 4.5 hours was observed.. 12.6 Immunogenicity. The observed incidence of anti-drug antibodies is highly dependent on the sensitivity and specificity of the assay. Differences in assay methods preclude meaningful comparisons of the incidence of anti-drug antibodies in the trials described below with the incidence of anti-drug antibodies in other trials, including those of tirzepatide or of GLP-1 receptor agonist products.During the 40- to 104-week treatment periods with ADA sampling conducted up to 44 to 108 weeks in seven clinical trials in adults with type diabetes mellitus [see Clinical Studies (14)], 51% (2,570/5,025) of MOUNJARO-treated patients developed anti-tirzepatide antibodies. In these trials, anti-tirzepatide antibody formation in 34% and 14% of MOUNJARO-treated patients showed cross-reactivity to native GIP or native GLP-1, respectively.Of the 2,570 MOUNJARO-treated patients who developed anti-tirzepatide antibodies during the treatment periods in these seven trials, 2% and 2% developed neutralizing antibodies against tirzepatide activity on the GIP or GLP-1 receptors, respectively, and 0.9% and 0.4% developed neutralizing antibodies against native GIP or GLP-1, respectively.There was no identified clinically significant effect of anti-tirzepatide antibodies on pharmacokinetics or effectiveness of MOUNJARO. More MOUNJARO-treated patients who developed anti-tirzepatide antibodies experienced hypersensitivity reactions or injection site reactions than those who did not develop these antibodies [see Adverse Reactions (6.1)].

CLINICAL STUDIES SECTION.

14 CLINICAL STUDIES. 14.1 Overview of Clinical Studies. The effectiveness of MOUNJARO as an adjunct to diet and exercise to improve glycemic control in adults with type diabetes mellitus was established in five trials. In these trials, MOUNJARO was studied as monotherapy (SURPASS-1); as an add-on to metformin, sulfonylureas, and/or sodium-glucose co-transporter inhibitors (SGLT2 inhibitors) (SURPASS-2, -3, and -4); and in combination with basal insulin with or without metformin (SURPASS-5). In these trials, MOUNJARO (5 mg, 10 mg, and 15 mg given subcutaneously once weekly) was compared with placebo, semaglutide mg, insulin degludec, and/or insulin glargine.In adult patients with type diabetes mellitus, treatment with MOUNJARO produced statistically significant reduction from baseline in HbA1c compared to placebo. The effectiveness of MOUNJARO was not impacted by age, gender, race, ethnicity, region, or by baseline BMI, HbA1c, diabetes duration, or renal function.. 14.2 Monotherapy Use of MOUNJARO in Adult Patients with Type Diabetes Mellitus. SURPASS-1 (NCT03954834) was 40-week double-blind trial that randomized 478 adult patients with type diabetes mellitus with inadequate glycemic control with diet and exercise to MOUNJARO mg, MOUNJARO 10 mg, MOUNJARO 15 mg, or placebo once weekly.Patients had mean age of 54 years, and 52% were men. The mean duration of type diabetes mellitus was 4.7 years, and the mean BMI was 32 kg/m2. Overall, 36% were White, 35% were Asian, 25% were American Indians/Alaska Natives, and 5% were Black or African American; 43% identified as Hispanic or Latino ethnicity.Monotherapy with MOUNJARO mg, 10 mg and 15 mg once weekly for 40 weeks resulted in statistically significant reduction in HbA1c compared with placebo (see Table 3).Table 3: Results at Week 40 in Trial of MOUNJARO as Monotherapy in Adult Patients with Type Diabetes Mellitus with Inadequate Glycemic Control with Diet and Exercisea The modified intent-to-treat population consists of all randomly assigned participants who were exposed to at least dose of study drug. Patients who discontinued study treatment because they did not meet study enrollment criteria were excluded. During the trial, rescue medication (additional antihyperglycemic medication) was initiated by 25%, 2%, 3%, and 2% of patients randomized to placebo, MOUNJARO mg, 10 mg, and 15 mg, respectively. At Week 40 the HbA1c data were missing for 12%, 6%, 7%, and 14% of patients randomized to placebo, MOUNJARO mg, 10 mg, and 15 mg, respectively. Missing Week 40 data were imputed using placebo-based multiple imputation.b Least-squares mean from ANCOVA adjusted for baseline value and other stratification factors.c p<0.001 (two-sided) for superiority vs. placebo, adjusted for multiplicity.d Analyzed using logistic regression adjusted for baseline value and other stratification factors.PlaceboMOUNJARO5 mgMOUNJARO10 mgMOUNJARO15 mgModified Intent-to-Treat (mITT) Population (N)a 113121121120HbA1c (%) Baseline (mean)8.18.07.97.9 Change at Week 40b -0.1-1.8-1.7-1.7 Difference from placebob (95% CI)---1.7c (-2.0, -1.4)-1.6c (-1.9, -1.3)-1.6c (-1.9, -1.3)Patients (%) achieving HbA1c <7%d 2382c 85c 78c Fasting Serum Glucose (mg/dL) Baseline (mean)155154153154 Change at Week 40b 4-40-40-39 Difference from placebob (95% CI)---43c (-55, -32)-43c (-55, -32)-42c (-54, -30)Body Weight (kg) Baseline (mean)84.587.086.285.5 Change at Week 40b -1.0-6.3-7.0-7.8 Difference from placebob (95% CI)---5.3c (-6.8, -3.9)-6.0c (-7.4, -4.6)-6.8c (-8.3, -5.4). 14.3 MOUNJARO Use in Combination with Metformin, Sulfonylureas, and/or SGLT2 Inhibitors in Adult Patients with Type Diabetes Mellitus. Add-on to metforminSURPASS-2 (NCT03987919) was 40-week open-label trial (double-blind with respect to MOUNJARO dose assignment) that randomized 1879 adult patients with type diabetes mellitus with inadequate glycemic control on stable doses of metformin alone to the addition of MOUNJARO mg, MOUNJARO 10 mg, or MOUNJARO 15 mg once weekly or subcutaneous semaglutide mg once weekly.Patients had mean age of 57 years and 47% were men. The mean duration of type diabetes mellitus was 8.6 years, and the mean BMI was 34 kg/m2. Overall, 83% were White, 4% were Black or African American, and 1% were Asian; 70% identified as Hispanic or Latino ethnicity.Treatment with MOUNJARO 10 mg and 15 mg once weekly for 40 weeks resulted in statistically significant reduction in HbA1c compared with semaglutide mg once weekly (see Table and Figure 2).Table 4: Results at Week 40 in Trial of MOUNJARO versus Semaglutide mg in Adult Patients with Type Diabetes Mellitus Added to Metformina The modified intent-to-treat population consists of all randomly assigned participants who were exposed to at least dose of study drug. Patients who discontinued study treatment because they did not meet study enrollment criteria were excluded. During the trial, rescue medication (additional antihyperglycemic medication) was initiated by 3%, 2%, 1%, and 1% of patients randomized to semaglutide mg, MOUNJARO mg, 10 mg, and 15 mg, respectively. At Week 40 the HbA1c endpoint was missing for 5%, 4%, 5%, and 5% of patients randomized to semaglutide mg, MOUNJARO mg, 10 mg, and 15 mg, respectively. Missing Week 40 data were imputed using multiple imputation with retrieved dropout.b Least-squares mean from ANCOVA adjusted for baseline value and other stratification factors.c p<0.05 (two-sided) for superiority vs. semaglutide, adjusted for multiplicity.d p<0.001 (two-sided) for superiority vs. semaglutide, adjusted for multiplicity.e Analyzed using logistic regression adjusted for baseline value and other stratification factors.f p<0.01 (two-sided) for superiority vs. semaglutide, adjusted for multiplicity.Semaglutide mgMOUNJARO5 mgMOUNJARO10 mgMOUNJARO15 mgModified Intent-to-Treat (mITT) Population (N)a 468470469469HbA1c (%) Baseline (mean)8.38.38.38.3 Change at Week 40b -1.9-2.0-2.2-2.3 Difference from semaglutideb (95% CI)---0.2c (-0.3, -0.0)-0.4d (-0.5, -0.3)-0.5d (-0.6, -0.3)Patients (%) achieving HbA1c <7%e 798286f 86f Fasting Serum Glucose (mg/dL) Baseline (mean)171174174172 Change at Week 40b -49-55-59-60Body Weight (kg) Baseline (mean)93.792.594.893.8 Change at Week 40b -5.7-7.6-9.3-11.2 Difference from semaglutideb (95% CI)---1.9c (-2.8, -1.0)-3.6d (-4.5, -2.7)-5.5d (-6.4, -4.6)Figure 2. Mean HbA1c (%) Over Time Baseline to Week 40Number of patientsMOUNJARO 5mg470451470MOUNJARO 10mg469445469MOUNJARO 15mg469447469Semaglutide 1mg468443468Note: Displayed results are from modified Intent-to-Treat Full Analysis Set. (1) Observed mean value from Week to Week 40, and (2) least-squares mean +- standard error at Week 40 multiple imputation (MI).. Figure 2. Add-on to metformin with or without SGLT2 inhibitorSURPASS-3 (NCT03882970) was 52-week open-label trial that randomized 1444 adult patients with type diabetes mellitus with inadequate glycemic control on stable doses of metformin with or without SGLT2 inhibitor to the addition of MOUNJARO mg, MOUNJARO 10 mg, MOUNJARO 15 mg once weekly, or insulin degludec 100 units/mL once daily. In this trial, 32% of patients were on SGLT2 inhibitor. Insulin degludec was initiated at 10 units once daily and adjusted weekly throughout the trial using treat-to-target algorithm based on self-measured fasting blood glucose values. At Week 52, 26% of patients randomized to insulin degludec achieved the fasting serum glucose target of <90 mg/dL, and the mean daily insulin degludec dose was 49 (0.5 per kilogram).Patients had mean age of 57 years, and 56% were men. The mean duration of type diabetes mellitus was 8.4 years, and the mean baseline BMI was 34 kg/m2. Overall, 91% were White, 3% were Black or African American, and 5% were Asian; 29% identified as Hispanic or Latino ethnicity.Treatment with MOUNJARO 10 mg and 15 mg once weekly for 52 weeks resulted in statistically significant reduction in HbA1c compared with daily insulin degludec (see Table 5).Table 5: Results at Week 52 in Trial of MOUNJARO versus Insulin Degludec in Adult Patients with Type Diabetes Mellitus Added to Metformin with or without SGLT2 Inhibitora The modified intent-to-treat population consists of all randomly assigned participants who were exposed to at least dose of study drug. Patients who discontinued study treatment because they did not meet study enrollment criteria were excluded. During the trial, rescue medication (additional antihyperglycemic medication) was initiated by 1%,1%, 1%, and 2% of patients randomized to insulin degludec, MOUNJARO mg, 10 mg, and 15 mg, respectively. At Week 52 the HbA1c endpoint was missing for 9%, 6%, 10%, and 5% of patients randomized to insulin degludec, MOUNJARO mg, 10 mg, and 15 mg, respectively. Missing Week 52 data were imputed using multiple imputation with retrieved dropout.b Least-squares mean from ANCOVA adjusted for baseline value and other stratification factors.c p<0.001 (two-sided) for superiority vs. insulin degludec, adjusted for multiplicity.d Analyzed using logistic regression adjusted for baseline value and other stratification factors.Insulin DegludecMOUNJARO5 mgMOUNJARO10 mgMOUNJARO15 mgModified Intent-to-Treat (mITT)a Population (N)359358360358HbA1c (%) Baseline (mean)8.18.28.28.2 Change at Week 52b -1.3-1.9-2.0-2.1 Difference from insulin degludecb (95% CI)---0.6c (-0.7, -0.5)-0.8c (-0.9, -0.6)-0.9c (-1.0, -0.7)Patients (%) achieving HbA1c <7%d 5879c 82c 83c Fasting Serum Glucose (mg/dL) Baseline (mean)167172170168 Change at Week 52b -51-47-50-54Body Weight (kg) Baseline (mean)94.094.493.894.9 Change at Week 52b 1.9-7.0-9.6-11.3 Difference from insulin degludecb (95% CI)---8.9c (-10.0, -7.8)-11.5c (-12.6, -10.4)-13.2c (-14.3, -12.1). Add-on to 1-3 oral anti-hyperglycemic agents (metformin, sulfonylurea or SGLT-2 inhibitor)SURPASS-4 (NCT03730662) was 104-week open-label trial (52-week primary endpoint) that randomized 2002 adult patients with type diabetes mellitus with increased cardiovascular risk to MOUNJARO mg, MOUNJARO 10 mg, MOUNJARO 15 mg once weekly, or insulin glargine 100 units/mL once daily (1:1:1:3 ratio) on background of metformin (95%) and/or sulfonylureas (54%) and/or SGLT2 inhibitors (25%).Patients had mean age of 64 years, and 63% were men. The mean duration of type diabetes mellitus was 11.8 years, and the mean baseline BMI was 33 kg/m2. Overall, 82% were White, 4% were Black or African American, and 4% were Asian; 48% identified as Hispanic or Latino ethnicity. Across all treatment groups, 87% had history of cardiovascular disease. At baseline, eGFR was >=90 mL/min/1.73 m2 in 43%, 60 to 90 mL/min/1.73 m2 in 40%, 45 to 60 mL/min/1.73 m2 in 10%, and 30 to 45 mL/min/1.73 m2 in 6% of patients.Insulin glargine was initiated at 10 once daily and adjusted weekly throughout the trial using treat-to-target algorithm based on self-measured fasting blood glucose values. At Week 52, 30% of patients randomized to insulin glargine achieved the fasting serum glucose target of <100 mg/dL, and the mean daily insulin glargine dose was 44 (0.5 per kilogram).Treatment with MOUNJARO 10 mg and 15 mg once weekly for 52 weeks resulted in statistically significant reduction in HbA1c compared with insulin glargine once daily (see Table 6).Table 6: Results at Week 52 in Trial of MOUNJARO versus Insulin Glargine in Adult Patients with Type Diabetes Mellitus Added to Metformin and/or Sulfonylurea and/or SGLT2 Inhibitora The modified intent-to-treat population consists of all randomly assigned participants who were exposed to at least dose of study drug. Patients who discontinued study treatment because they did not meet study enrollment criteria were excluded. During the trial, rescue medication (additional antihyperglycemic medication) was initiated by 1%, 0%, 0%, and 1% of patients randomized to insulin glargine, MOUNJARO mg, 10 mg, and 15 mg, respectively. At Week 52 the HbA1c endpoint was missing for 9%, 9%, 6%, and 4% of patients randomized to insulin glargine, MOUNJARO mg, 10 mg, and 15 mg, respectively. Missing Week 52 data were imputed using multiple imputation with retrieved dropout.b Least-squares mean from ANCOVA adjusted for baseline value and other stratification factors.c p<0.001 (two-sided) for superiority vs. insulin glargine, adjusted for multiplicity.d Analyzed using logistic regression adjusted for baseline value and other stratification factors.Insulin GlargineMOUNJARO5 mgMOUNJARO10 mgMOUNJARO15 mgModified Intent-to-Treat (mITT) Population (N)a 998328326337HbA1c (%) Baseline (mean)8.58.58.68.5 Change at Week 52b -1.4-2.1-2.3-2.4 Difference from insulin glargineb (95% CI)---0.7c (-0.9, -0.6)-0.9c (-1.1, -0.8)-1.0c (-1.2, -0.9)Patients (%) achieving HbA1c <7%d 4975c 83c 85c Fasting Serum Glucose (mg/dL) Baseline (mean)168172176174 Change at Week 52b -49-44-50-55Body Weight (kg) Baseline (mean)90.290.390.690.0 Change at Week 52b 1.7-6.4-8.9-10.6 Difference from insulin glargineb (95% CI)---8.1c (-8.9, -7.3)-10.6c (-11.4, -9.8)-12.2c (-13.0, -11.5). 14.4 MOUNJARO Use in Combination with Basal Insulin with or without Metformin in Adult Patients with Type Diabetes Mellitus. SURPASS-5 (NCT04039503) was 40-week double-blind trial that randomized 475 patients with type diabetes mellitus with inadequate glycemic control on insulin glargine 100 units/mL, with or without metformin, to MOUNJARO mg, MOUNJARO 10 mg, MOUNJARO 15 mg once weekly, or placebo. The dose of background insulin glargine was adjusted using treat-to-target algorithm based on self-measured fasting blood glucose values, targeting <100 mg/dL.Patients had mean age of 61 years, and 56% were men. The mean duration of type diabetes mellitus was 13.3 years, and the mean baseline BMI was 33 kg/m2. Overall, 80% were White, 1% were Black or African American, and 18% were Asian; 5% identified as Hispanic or Latino ethnicity.The mean dose of insulin glargine at baseline was 34, 32, 35, and 33 units/day for patients receiving MOUNJARO mg, 10 mg, 15 mg, and placebo, respectively. At randomization, the initial insulin glargine dose in patients with HbA1c <=8.0% was reduced by 20%. At week 40, mean dose of insulin glargine was 38, 36, 29, and 59 units/day for patients receiving MOUNJARO mg, 10 mg, 15 mg, and placebo, respectively.Treatment with MOUNJARO mg once weekly, 10 mg once weekly and 15 mg once weekly for 40 weeks resulted in statistically significant reduction in HbA1c compared with placebo (see Table 7).Table 7: Results at Week 40 in Trial of MOUNJARO Added to Basal Insulin with or without Metformin in Adult Patients with Type Diabetes Mellitusa The modified intent-to-treat population consists of all randomly assigned participants who were exposed to at least dose of study drug. Patients who discontinued study treatment because they did not meet study enrollment criteria were excluded. During the trial, rescue medication (additional antihyperglycemic medication) was initiated by 4%, 1%, 0%, and 1% of patients randomized to placebo, MOUNJARO mg, 10 mg, and 15 mg, respectively. At Week 40 the HbA1c endpoint was missing for 2%, 6%, 3%, and 7% of patients randomized to placebo, MOUNJARO mg, 10 mg, and 15 mg, respectively. Missing Week 40 data were imputed using placebo-based multiple imputation.b Least-squares mean from ANCOVA adjusted for baseline value and other stratification factors.c p<0.001 (two-sided) for superiority vs. placebo, adjusted for multiplicity.d Analyzed using logistic regression adjusted for baseline value and other stratification factors.PlaceboMOUNJARO5 mgMOUNJARO10 mgMOUNJARO15 mgModified Intent-to-Treat (mITT) Population (N)a 119116118118HbA1c (%) Baseline (mean)8.48.38.48.2 Change at Week 40b -0.9-2.1-2.4-2.3 Difference from placebob (95% CI)---1.2c (-1.5, -1.0)-1.5c (-1.8, -1.3)-1.5c (-1.7, -1.2)Patients (%) achieving HbA1c <7%d 3587c 90c 85c Fasting Serum Glucose (mg/dL) Baseline (mean)164163163160 Change at Week 40b -39-58-64-63 Difference from placebob (95% CI)---19c (-27, -11)-25c (-32, -17)-23c (-31, -16)Body Weight (kg) Baseline (mean)94.295.894.696.0 Change at Week 40b 1.6-5.4-7.5-8.8 Difference from placebob (95% CI)---7.1c (-8.7, -5.4)-9.1c (-10.7, -7.5)-10.5c (-12.1, -8.8).

CLINICAL TRIALS EXPERIENCE SECTION.

6.1 Clinical Trials Experience. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.. Pool of Two Placebo-Controlled Clinical TrialsThe data in Table are derived from placebo-controlled trials [1 monotherapy trial (SURPASS-1) and trial in combination with basal insulin with or without metformin (SURPASS-5)] in adult patients with type diabetes mellitus [see Clinical Studies (14.2, 14.4)]. These data reflect exposure of 718 patients to MOUNJARO and mean duration of exposure to MOUNJARO of 36.6 weeks. The mean age of patients was 58 years, 4% were 75 years or older and 54% were male. The population was 57% White, 27% Asian, 13% American Indian or Alaska Native, and 3% Black or African American; 25% identified as Hispanic or Latino ethnicity. At baseline, patients had type diabetes mellitus for an average of 9.1 years with mean HbA1c of 8.1%. As assessed by baseline fundoscopic examination, 13% of the population had retinopathy. At baseline, eGFR was >=90 mL/min/1.73 m2 in 53%, 60 to 90 mL/min/1.73 m2 in 39%, 45 to 60 mL/min/1.73 m2 in 7%, and 30 to 45 mL/min/1.73 m2 in 1% of patients.. Pool of Seven Controlled Clinical TrialsAdverse reactions were also evaluated in larger pool of adult patients with type diabetes mellitus participating in seven controlled clinical trials which included two placebo-controlled trials (SURPASS-1 and -5), three trials of MOUNJARO in combination with metformin, sulfonylureas, and/or SGLT2 Inhibitors (SURPASS-2, -3, -4) [see Clinical Studies (14.3)] and two additional trials conducted in Japan. In this pool, total of 5119 adult patients with type diabetes mellitus were treated with MOUNJARO for mean duration of 48.1 weeks. The mean age of patients was 58 years, 4% were 75 years or older and 58% were male. The population was 65% White, 24% Asian, 7% American Indian or Alaska Native, and 3% Black or African American; 38% identified as Hispanic or Latino ethnicity. At baseline, patients had type diabetes mellitus for an average of 9.1 years with mean HbA1c of 8.3%. As assessed by baseline fundoscopic examination, 15% of the population had retinopathy. At baseline, eGFR was >=90 mL/min/1.73 m2 in 52%, 60 to 90 mL/min/1.73 m2 in 40%, 45 to 60 mL/min/1.73 m2 in 6%, and 30 to 45 mL/min/1.73 m2 in 1% of patients.. Common Adverse ReactionsTable shows common adverse reactions, not including hypoglycemia, associated with the use of MOUNJARO in the pool of placebo-controlled trials. These adverse reactions occurred more commonly on MOUNJARO than on placebo and occurred in at least 5% of patients treated with MOUNJARO.Table 1: Adverse Reactions in Pool of Placebo-Controlled Trials Reported in >=5% of MOUNJARO-treated Adult Patients with Type Diabetes MellitusNote: Percentages reflect the number of patients who reported at least occurrence of the adverse reaction.Adverse ReactionPlacebo(N=235)%MOUNJARO mg(N=237)%MOUNJARO 10 mg(N=240)%MOUNJARO 15 mg(N=241)%Nausea4121518Diarrhea9121317Decreased Appetite151011Vomiting2559Constipation1667Dyspepsia3885Abdominal Pain4655In the pool of seven clinical trials, the types and frequency of common adverse reactions, not including hypoglycemia, were similar to those listed in Table 1.. Gastrointestinal Adverse ReactionsIn the pool of placebo-controlled trials, gastrointestinal adverse reactions occurred more frequently among patients receiving MOUNJARO than placebo (placebo 20.4%, MOUNJARO mg 37.1%, MOUNJARO 10 mg 39.6%, MOUNJARO 15 mg 43.6%). More patients receiving MOUNJARO mg (3.0%), MOUNJARO 10 mg (5.4%), and MOUNJARO 15 mg (6.6%) discontinued treatment due to gastrointestinal adverse reactions than patients receiving placebo (0.4%). The majority of reports of nausea, vomiting, and/or diarrhea occurred during dose escalation and decreased over time.The following gastrointestinal adverse reactions were reported more frequently in MOUNJARO-treated patients than placebo-treated patients (frequencies listed, respectively, as: placebo; mg; 10 mg; 15 mg): eructation (0.4%, 3.0%, 2.5%, 3.3%), flatulence (0%, 1.3%, 2.5%, 2.9%), gastroesophageal reflux disease (0.4%, 1.7%, 2.5%, 1.7%), abdominal distension (0.4%, 0.4%, 2.9%, 0.8%).. Other Adverse Reactions. HypoglycemiaTable summarizes the incidence of hypoglycemic events in the placebo-controlled trials.Table 2: Hypoglycemia Adverse Reactions in Placebo-Controlled Trials in Adult Patients with Type Diabetes Mellitus Reflects the study treatment period. Data include events occurring during weeks of treatment-free safety follow up. Events after introduction of new glucose-lowering treatment are excluded. Episodes requiring the assistance of another person to actively administer carbohydrate, glucagon, or other resuscitative actions.Placebo %MOUNJARO mg%MOUNJARO 10 mg%MOUNJARO 15 mg%Monotherapy (40 weeks)N=115N=121N=119N=120 Blood glucose <54 mg/dL1000 Severe hypoglycemia0000Add-on to Basal Insulin with or without Metformin (40 weeks)N=120N=116N=119N=120 Blood glucose <54 mg/dL13161914 Severe hypoglycemia0021Hypoglycemia was more frequent when MOUNJARO was used in combination with sulfonylurea [see Clinical Studies (14)]. In clinical trial up to 104 weeks of treatment, when administered with sulfonylurea, hypoglycemia (glucose level <54 mg/dL) occurred in 13.8%, 9.9%, and 12.8%, and severe hypoglycemia occurred in 0.5%, 0%, and 0.6% of patients treated with MOUNJARO mg, 10 mg, and 15 mg, respectively.. Heart Rate IncreaseIn the pool of placebo-controlled trials, treatment with MOUNJARO resulted in mean increase in heart rate of to beats per minute compared to mean increase of beat per minute in placebo-treated patients. Episodes of sinus tachycardia, associated with concomitant increase from baseline in heart rate of >=15 beats per minute, also were reported in 4.3%, 4.6%, 5.9% and 10% of subjects treated with placebo, MOUNJARO mg, 10 mg, and 15 mg, respectively. For patients enrolled in Japan, these episodes were reported in 7% (3/43), 7.1% (3/42), 9.3% (4/43), and 23% (10/43) of patients treated with placebo, MOUNJARO mg, 10 mg, and 15 mg, respectively. The clinical relevance of heart rate increases is uncertain.. Hypersensitivity ReactionsHypersensitivity reactions have been reported with MOUNJARO in the pool of placebo-controlled trials, sometimes severe (e.g., urticaria and eczema); hypersensitivity reactions were reported in 3.2% of MOUNJARO-treated patients compared to 1.7% of placebo-treated patients.In the pool of seven clinical trials, hypersensitivity reactions occurred in 106/2,570 (4.1%) of MOUNJARO-treated patients with anti-tirzepatide antibodies and in 73/2,455 (3.0%) of MOUNJARO-treated patients who did not develop anti-tirzepatide antibodies [see Clinical Pharmacology (12.6)]. Injection Site ReactionsIn the pool of placebo-controlled trials, injection site reactions were reported in 3.2% of MOUNJARO-treated patients compared to 0.4% of placebo-treated patients.In the pool of seven clinical trials, injection site reactions occurred in 119/2,570 (4.6%) of MOUNJARO-treated patients with anti-tirzepatide antibodies and in 18/2,455 (0.7%) of MOUNJARO-treated patients who did not develop anti-tirzepatide antibodies [see Clinical Pharmacology (12.6)]. Acute Gallbladder DiseaseIn the pool of placebo-controlled clinical trials, acute gallbladder disease (cholelithiasis, biliary colic and cholecystectomy) was reported by 0.6% of MOUNJARO-treated patients and 0% of placebo-treated patients.. Laboratory Abnormalities. Amylase and Lipase IncreaseIn the pool of placebo-controlled clinical trials, treatment with MOUNJARO resulted in mean increases from baseline in serum pancreatic amylase concentrations of 33% to 38% and serum lipase concentrations of 31% to 42%. Placebo-treated patients had mean increase from baseline in pancreatic amylase of 4% and no changes were observed in lipase. The clinical significance of elevations in lipase or amylase with MOUNJARO is unknown in the absence of other signs and symptoms of pancreatitis.

DOSAGE & ADMINISTRATION SECTION.

2 DOSAGE AND ADMINISTRATION. The recommended starting dosage is 2.5 mg injected subcutaneously once weekly (2.1)After weeks, increase to mg injected subcutaneously once weekly (2.1)If additional glycemic control is needed, increase the dosage in 2.5 mg increments after at least weeks on the current dose.The maximum dosage is 15 mg subcutaneously once weekly (2.1).Administer once weekly at any time of day, with or without meals. (2.2)Inject subcutaneously in the abdomen, thigh, or upper arm. (2.2)Rotate injection sites with each dose.. The recommended starting dosage is 2.5 mg injected subcutaneously once weekly (2.1). After weeks, increase to mg injected subcutaneously once weekly (2.1). If additional glycemic control is needed, increase the dosage in 2.5 mg increments after at least weeks on the current dose.. The maximum dosage is 15 mg subcutaneously once weekly (2.1).. Administer once weekly at any time of day, with or without meals. (2.2). Inject subcutaneously in the abdomen, thigh, or upper arm. (2.2). Rotate injection sites with each dose.. 2.1 Dosage. The recommended starting dosage of MOUNJARO is 2.5 mg injected subcutaneously once weekly. The 2.5 mg dosage is for treatment initiation and is not intended for glycemic control.After weeks, increase the dosage to mg injected subcutaneously once weekly.If additional glycemic control is needed, increase the dosage in 2.5 mg increments after at least weeks on the current dose.The maximum dosage of MOUNJARO is 15 mg injected subcutaneously once weekly.If dose is missed, instruct patients to administer MOUNJARO as soon as possible within days (96 hours) after the missed dose. If more than days have passed, skip the missed dose and administer the next dose on the regularly scheduled day. In each case, patients can then resume their regular once weekly dosing schedule.The day of weekly administration can be changed, if necessary, as long as the time between the two doses is at least days (72 hours).. The recommended starting dosage of MOUNJARO is 2.5 mg injected subcutaneously once weekly. The 2.5 mg dosage is for treatment initiation and is not intended for glycemic control.. After weeks, increase the dosage to mg injected subcutaneously once weekly.. If additional glycemic control is needed, increase the dosage in 2.5 mg increments after at least weeks on the current dose.. The maximum dosage of MOUNJARO is 15 mg injected subcutaneously once weekly.. If dose is missed, instruct patients to administer MOUNJARO as soon as possible within days (96 hours) after the missed dose. If more than days have passed, skip the missed dose and administer the next dose on the regularly scheduled day. In each case, patients can then resume their regular once weekly dosing schedule.. The day of weekly administration can be changed, if necessary, as long as the time between the two doses is at least days (72 hours).. 2.2 Important Administration Instructions. Administer MOUNJARO once weekly, any time of day, with or without meals.Inject MOUNJARO subcutaneously in the abdomen, thigh, or upper arm.Rotate injection sites with each dose.Inspect MOUNJARO visually before use. It should appear clear and colorless to slightly yellow. Do not use MOUNJARO if particulate matter or discoloration is seen.When using MOUNJARO with insulin, administer as separate injections and never mix. It is acceptable to inject MOUNJARO and insulin in the same body region, but the injections should not be adjacent to each other.. Administer MOUNJARO once weekly, any time of day, with or without meals.. Inject MOUNJARO subcutaneously in the abdomen, thigh, or upper arm.. Rotate injection sites with each dose.. Inspect MOUNJARO visually before use. It should appear clear and colorless to slightly yellow. Do not use MOUNJARO if particulate matter or discoloration is seen.. When using MOUNJARO with insulin, administer as separate injections and never mix. It is acceptable to inject MOUNJARO and insulin in the same body region, but the injections should not be adjacent to each other.

INSTRUCTIONS FOR USE SECTION.

INSTRUCTIONS FOR USEMOUNJARO(TM) (mown-JAHR-OH)(tirzepatide)injection, for subcutaneous use2.5 mg/0.5 mL single-dose pen5 mg/0.5 mL single-dose pen7.5 mg/0.5 mL single-dose pen10 mg/0.5 mL single-dose pen12.5 mg/0.5 mL single-dose pen15 mg/0.5 mL single-dose penuse time each weekImportant information you need to know before injecting MOUNJARORead this Instructions for Use and the Medication Guide before using your MOUNJARO Pen and each time you get refill. There may be new information. This information does not take the place of talking to your healthcare provider about your medical condition or treatment.Talk to your healthcare provider about how to inject MOUNJARO the right way.MOUNJARO is single-dose prefilled pen.MOUNJARO is used time each week.Inject under the skin (subcutaneously) only.You or another person can inject into your stomach (abdomen) or thigh.Another person can inject into the back of your upper arm.Storage and handlingStore your Pen in the refrigerator between 36F to 46F (2C to 8C).You may store your Pen at room temperature up to 86F (30C) for up to 21 days.Do not freeze your Pen. If the Pen has been frozen, throw the Pen away and use new Pen.Store your Pen in the original carton to protect your Pen from light.The Pen has glass parts. Handle it carefully. If you drop the Pen on hard surface, do not use it. Use new Pen for your injection.Keep your MOUNJARO Pen and all medicines out of the reach of children.Guide to partsPreparing to inject MOUNJARORemove the Pen from the refrigerator.Leave the gray base cap on until you are ready to inject.Check the Pen label to make sure you have the right medicine and dose, and that it has not expired. Inspect the Pen to make sure that it is not damaged.Make sure the medicine:is not frozenis not cloudyis colorless to slightly yellowdoes not have particlesWash your hands.Step1Choose your injection siteYour healthcare provider can help you choose the injection site that is best for you. You or another person can inject the medicine in your stomach (abdomen) or thigh.Another person should give you the injection in the back of your upper arm.Change (rotate) your injection site each week.You may use the same area of your body but be sure to choose different injection site in that area.Step2Pull off the gray base capMake sure the Pen is locked. Do not unlock the Pen until you place the clear base on your skin and are ready to inject.Pull the gray base cap straight off and throw it away in your household trash. Do not put the gray base cap back on this could damage the needle. Do not touch the needle.Step3Place clear base on skin, then unlockPlace the clear base flat against your skin at the injection site.Unlock by turning the lock ring.Step4Press and hold up to 10 secondsPress and hold the purple injection button for up to 10 seconds. Listen for:o First click injection startedo Second click injection completedYou will know your injection is complete when the gray plunger is visible.After your injection, place the used Pen in sharps container.See Disposing of your used Pen. Disposing of your used PenPut your used Pen in an FDA-cleared sharps disposal container right away after use. Do not throw away (dispose of) Pens in your household trash.If you do not have an FDA-cleared sharps disposal container, you may use household container that is:-made of heavy-duty plastic,-can be closed with tight-fitting, puncture-resistant lid, without sharps being able to come out,-upright and stable during use,-leak-resistant, and-properly labeled to warn of hazardous waste inside the container. When your sharps disposal container is almost full, you will need to follow your community guidelines for the right way to dispose of your sharps disposal container. There may be state or local laws about how you should throw away used needles and syringes. For more information about safe sharps disposal, and for specific information about sharps disposal in the state that you live in, go to the FDAs website at: http://www.fda.gov/safesharpsdisposal.Do not recycle your used sharps disposal container.Commonly asked questionsWhat if see air bubbles in my PenAir bubbles are normal.What if my Pen is not at room temperatureIt is not necessary to warm the Pen to room temperature.What if unlock the Pen and press the purple injection button before pulling off the gray base capDo not remove the gray base cap. Throw away the Pen and get new Pen.What if there is drop of liquid on the tip of the needle when remove the gray base capA drop of liquid on the tip of the needle is normal. Do not touch the needle.Do need to hold the injection button down until the injection is completeThis is not necessary, but it may help you keep the Pen steady against your skin.I heard more than clicks during my injection--2 loud clicks and soft one. Did get my complete injectionSome people may hear soft click right before the second loud click. That is the normal operation of the Pen. Do not remove the Pen from your skin until you hear the second loud click.I am not sure if my Pen worked the right way.Check to see if you have received your dose. Your dose was delivered the right way if the gray plunger is visible. Also, see Step of the instructions.If you do not see the gray plunger, contact Lilly at 1-800-Lilly-Rx (1-800-545-5979) for further instructions. Until then, store your Pen safely to avoid an accidental needle stick. What if there is drop of liquid or blood on my skin after my injectionThis is normal. Press cotton ball or gauze over the injection site. Do not rub the injection site.Other informationo If you have vision problems, do not use your Pen without help from person trained to use the MOUNJARO Pen.Where to learn moreo If you have questions or problems with your MOUNJARO Pen, contact Lilly at 1-800-Lilly-Rx (1-800-545-5979) or call your healthcare provider.o For more information about the MOUNJARO Pen, visit our website at www.mounjaro.com.Scan this code to launch www.mounjaro.comMarketed by:Lilly USA, LLCIndianapolis, IN 46285, USAMOUNJARO is trademark of Eli Lilly and Company.Copyright (C) 2022, Eli Lilly and Company. All rights reserved.This Instructions for Use has been approved by the U.S. Food and Drug Administration. Approved: May 2022MOU-0001-IFU-20220513. MOUNJARO is single-dose prefilled pen.. MOUNJARO is used time each week.. Inject under the skin (subcutaneously) only.. You or another person can inject into your stomach (abdomen) or thigh.. Another person can inject into the back of your upper arm.. Store your Pen in the refrigerator between 36F to 46F (2C to 8C).. You may store your Pen at room temperature up to 86F (30C) for up to 21 days.. Do not freeze your Pen. If the Pen has been frozen, throw the Pen away and use new Pen.. Store your Pen in the original carton to protect your Pen from light.. The Pen has glass parts. Handle it carefully. If you drop the Pen on hard surface, do not use it. Use new Pen for your injection.. Keep your MOUNJARO Pen and all medicines out of the reach of children.. is not frozen. is not cloudy. is colorless to slightly yellow. does not have particles. Put your used Pen in an FDA-cleared sharps disposal container right away after use. Do not throw away (dispose of) Pens in your household trash.. If you do not have an FDA-cleared sharps disposal container, you may use household container that is:-made of heavy-duty plastic,-can be closed with tight-fitting, puncture-resistant lid, without sharps being able to come out,-upright and stable during use,-leak-resistant, and-properly labeled to warn of hazardous waste inside the container. -made of heavy-duty plastic,. -can be closed with tight-fitting, puncture-resistant lid, without sharps being able to come out,. -upright and stable during use,. -leak-resistant, and. -properly labeled to warn of hazardous waste inside the container.. When your sharps disposal container is almost full, you will need to follow your community guidelines for the right way to dispose of your sharps disposal container. There may be state or local laws about how you should throw away used needles and syringes. For more information about safe sharps disposal, and for specific information about sharps disposal in the state that you live in, go to the FDAs website at: http://www.fda.gov/safesharpsdisposal.. Do not recycle your used sharps disposal container.. Figure. Figure. Figure. Figure. Figure. Figure. Figure. Figure. Figure. Figure. Figure. Figure. Figure.

PATIENT COUNSELING INFORMATION.

17 PATIENT COUNSELING INFORMATION. Advise the patient to read the FDA-approved patient labeling (Medication Guide and Instructions for Use). Risk of Thyroid C-Cell TumorsInform patients that MOUNJARO causes thyroid C-cell tumors in rats and that the human relevance of this finding has not been determined. Counsel patients to report symptoms of thyroid tumors (e.g., lump in the neck, persistent hoarseness, dysphagia, or dyspnea) to their healthcare provider [see Boxed Warning and Warnings and Precautions (5.1)].. PancreatitisInform patients of the potential risk for pancreatitis. Instruct patients to discontinue MOUNJARO promptly and contact their healthcare provider if pancreatitis is suspected (severe abdominal pain that may radiate to the back, and which may or may not be accompanied by vomiting) [see Warnings and Precautions (5.2)].. Hypoglycemia with Concomitant Use of Insulin Secretagogues or InsulinInform patients that the risk of hypoglycemia is increased when MOUNJARO is used with an insulin secretagogue (such as sulfonylurea) or insulin. Educate patients on the signs and symptoms of hypoglycemia [see Warnings and Precautions (5.3)].. Hypersensitivity ReactionsInform patients that hypersensitivity reactions have been reported with use of MOUNJARO. Advise patients on the symptoms of hypersensitivity reactions and instruct them to stop taking MOUNJARO and seek medical advice promptly if such symptoms occur [see Warnings and Precautions (5.4)].. Acute Kidney InjuryAdvise patients treated with MOUNJARO of the potential risk of dehydration due to gastrointestinal adverse reactions and take precautions to avoid fluid depletion. Inform patients of the potential risk for worsening renal function and explain the associated signs and symptoms of renal impairment, as well as the possibility of dialysis as medical intervention if renal failure occurs [see Warnings and Precautions (5.5].. Severe Gastrointestinal Adverse ReactionsInform patients of the potential risk of severe gastrointestinal adverse reactions. Instruct patients to contact their healthcare provider if they have severe or persistent gastrointestinal symptoms [see Warnings and Precautions (5.6)]. Diabetic Retinopathy ComplicationsInform patients to contact their healthcare provider if changes in vision are experienced during treatment with MOUNJARO [see Warnings and Precautions (5.7].. Acute Gallbladder DiseaseInform patients of the risk of acute gallbladder disease. Instruct patients to contact their healthcare provider for appropriate clinical follow-up if gallbladder disease is suspected [see Warnings and Precautions (5.8)].. PregnancyAdvise pregnant woman of the potential risk to fetus. Advise women to inform their healthcare provider if they are pregnant or intend to become pregnant [see Use in Specific Populations (8.1)]. ContraceptionUse of MOUNJARO may reduce the efficacy of oral hormonal contraceptives. Advise patients using oral hormonal contraceptives to switch to non-oral contraceptive method, or add barrier method of contraception for weeks after initiation and for weeks after each dose escalation with MOUNJARO [see Drug Interactions (7.2), Use in Specific Populations (8.3), and Clinical Pharmacology (12.3)]. Missed DosesInform patients if dose is missed, it should be administered as soon as possible within days after the missed dose. If more than days have passed, the missed dose should be skipped and the next dose should be administered on the regularly scheduled day. In each case, inform patients to resume their regular once weekly dosing schedule [see Dosage and Administration (2.1)]. Marketed by: Lilly USA, LLC, Indianapolis, IN 46285, USA Copyright (C) 2022, Eli Lilly and Company. All rights reserved.MOU-0001-USPI-20220513.

PHARMACOKINETICS SECTION.

12.3 Pharmacokinetics. The pharmacokinetics of tirzepatide is similar between healthy subjects and patients with type diabetes mellitus. Steady-state plasma tirzepatide concentrations were achieved following weeks of once weekly administration. Tirzepatide exposure increases in dose-proportional manner.. AbsorptionFollowing subcutaneous administration, the time to maximum plasma concentration of tirzepatide ranges from to 72 hours. The mean absolute bioavailability of tirzepatide following subcutaneous administration is 80%. Similar exposure was achieved with subcutaneous administration of tirzepatide in the abdomen, thigh, or upper arm.. DistributionThe mean apparent steady-state volume of distribution of tirzepatide following subcutaneous administration in patients with type diabetes mellitus is approximately 10.3 L. Tirzepatide is highly bound to plasma albumin (99%).. EliminationThe apparent population mean clearance of tirzepatide is 0.061 L/h with an elimination half-life of approximately days, enabling once-weekly dosing.. MetabolismTirzepatide is metabolized by proteolytic cleavage of the peptide backbone, beta-oxidation of the C20 fatty diacid moiety and amide hydrolysis.. ExcretionThe primary excretion routes of tirzepatide metabolites are via urine and feces. Intact tirzepatide is not observed in urine or feces.. Specific PopulationsThe intrinsic factors of age, gender, race, ethnicity, or body weight do not have clinically relevant effect on the PK of tirzepatide.. Patients with Renal ImpairmentRenal impairment does not impact the pharmacokinetics of tirzepatide. The pharmacokinetics of tirzepatide after single mg dose was evaluated in patients with different degrees of renal impairment (mild, moderate, severe, ESRD) compared with subjects with normal renal function. This was also shown for patients with both type diabetes mellitus and renal impairment based on data from clinical studies [see Use in Specific Populations (8.6)].. Patients with Hepatic ImpairmentHepatic impairment does not impact the pharmacokinetics of tirzepatide. The pharmacokinetics of tirzepatide after single mg dose was evaluated in patients with different degrees of hepatic impairment (mild, moderate, severe) compared with subjects with normal hepatic function [see Use in Specific Populations (8.7)].. Drug Interactions Studies. Potential for Tirzepatide to Influence the Pharmacokinetics of Other DrugsIn vitro studies have shown low potential for tirzepatide to inhibit or induce CYP enzymes, and to inhibit drug transporters.MOUNJARO delays gastric emptying, and thereby has the potential to impact the absorption of concomitantly administered oral medications [see Drug Interactions (7.2)].The impact of tirzepatide on gastric emptying was greatest after single dose of mg and diminished after subsequent doses.Following first dose of tirzepatide mg, acetaminophen maximum concentration (Cmax) was reduced by 50%, and the median peak plasma concentration (tmax) occurred hour later. After coadministration at week 4, there was no meaningful impact on acetaminophen Cmax and tmax. Overall acetaminophen exposure (AUC0-24hr) was not influenced.Following administration of combined oral contraceptive (0.035 mg ethinyl estradiol and 0.25 mg norgestimate) in the presence of single dose of tirzepatide mg, mean Cmax of ethinyl estradiol, norgestimate, and norelgestromin was reduced by 59%,66%, and 55%, while mean AUC was reduced by 20%, 21%, and 23%, respectively. delay in tmax of 2.5 to 4.5 hours was observed.

PREGNANCY SECTION.

8.1 Pregnancy. Risk SummaryAvailable data with MOUNJARO use in pregnant women are insufficient to evaluate for drug-related risk of major birth defects, miscarriage, or other adverse maternal or fetal outcomes. There are risks to the mother and fetus associated with poorly controlled diabetes in pregnancy (see Clinical Considerations). Based on animal reproduction studies, there may be risks to the fetus from exposure to tirzepatide during pregnancy. MOUNJARO should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.In pregnant rats administered tirzepatide during organogenesis, fetal growth reductions and fetal abnormalities occurred at clinical exposure in maternal rats based on AUC. In rabbits administered tirzepatide during organogenesis, fetal growth reductions were observed at clinically relevant exposures based on AUC. These adverse embryo/fetal effects in animals coincided with pharmacological effects on maternal weight and food consumption (see Data).The estimated background risk of major birth defects is 6-10% in women with pre-gestational diabetes with an HbA1c >7% and has been reported to be as high as 20-25% in women with an HbA1c >10%. The estimated background risk of miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.. Clinical Considerations. Disease-Associated Maternal and/or Embryo/Fetal RiskPoorly controlled diabetes in pregnancy increases the maternal risk for diabetic ketoacidosis, pre-eclampsia, spontaneous abortions, preterm delivery and delivery complications. Poorly controlled diabetes increases the fetal risk for major birth defects, stillbirth, and macrosomia-related morbidity.. Data. Animal DataIn pregnant rats given twice weekly subcutaneous doses of 0.02, 0.1, and 0.5 mg/kg tirzepatide (0.03-, 0.07-, and 0.5-fold the MRHD of 15 mg once weekly based on AUC) during organogenesis, increased incidences of external, visceral, and skeletal malformations, increased incidences of visceral and skeletal developmental variations, and decreased fetal weights coincided with pharmacologically-mediated reductions in maternal body weights and food consumption at 0.5 mg/kg. In pregnant rabbits given once weekly subcutaneous doses of 0.01, 0.03, or 0.1 mg/kg tirzepatide (0.01-, 0.06-, and 0.2-fold the MRHD) during organogenesis, pharmacologically-mediated effects on the gastrointestinal system resulting in maternal mortality or abortion in few rabbits occurred at all dose levels. Reduced fetal weights associated with decreased maternal food consumption and body weights were observed at 0.1 mg/kg. In pre- and post-natal study in rats administered subcutaneous doses of 0.02, 0.10, or 0.25 mg/kg tirzepatide twice weekly from implantation through lactation, F1 pups from F0 maternal rats given 0.25 mg/kg tirzepatide had statistically significant lower mean body weight when compared to controls from post-natal day through post-natal day 126 for males and post-natal day 56 for females.

SPL MEDGUIDE SECTION.

This Medication Guide has been approved by the U.S. Food and Drug Administration Approved: May 2022Medication GuideMOUNJARO(TM) (mown-JAHR-OH)(tirzepatide)injection, for subcutaneous useWhat is the most important information should know about MOUNJAROMOUNJARO may cause serious side effects, including:Possible thyroid tumors, including cancer. Tell your healthcare provider if you get lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rats, MOUNJARO and medicines that work like MOUNJARO caused thyroid tumors, including thyroid cancer. It is not known if MOUNJARO will cause thyroid tumors, or type of thyroid cancer called medullary thyroid carcinoma (MTC) in people.Do not use MOUNJARO if you or any of your family have ever had type of thyroid cancer called medullary thyroid carcinoma (MTC), or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type (MEN 2).What is MOUNJAROMOUNJARO is an injectable prescription medicine that is used along with diet and exercise to improve blood sugar (glucose) in adults with type diabetes mellitus.It is not known if MOUNJARO can be used in people who have had pancreatitis.MOUNJARO is not for use in people with type diabetes.It is not known if MOUNJARO is safe and effective for use in children under 18 years of age.Do not use MOUNJARO if:you or any of your family have ever had type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type (MEN 2).you have had serious allergic reaction to tirzepatide or any of the ingredients in MOUNJARO. See the end of this Medication Guide for complete list of ingredients in MOUNJARO.Before using MOUNJARO, tell your healthcare provider about all of your medical conditions, including if you:have or have had problems with your pancreas or kidneys.have severe problems with your stomach, such as slowed emptying of your stomach (gastroparesis) or problems with digesting food.have history of diabetic retinopathy.are pregnant or plan to become pregnant. It is not known if MOUNJARO will harm your unborn baby. Tell your healthcare provider if you become pregnant while using MOUNJARO.Birth control pills by mouth may not work as well while using MOUNJARO. If you take birth control pills by mouth, your healthcare provider may recommend another type of birth control for weeks after you start MOUNJARO and for weeks after each increase in your dose of MOUNJARO. Talk to your healthcare provider about birth control methods that may be right for you while using MOUNJARO. are breastfeeding or plan to breastfeed. It is not known if MOUNJARO passes into your breast milk. Talk to your healthcare provider about the best way to feed your baby while using MOUNJARO.Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. MOUNJARO may affect the way some medicines work, and some medicines may affect the way MOUNJARO works.Before using MOUNJARO, tell your healthcare provider if you are taking other medicines to treat diabetes including insulin or sulfonylureas which could increase your risk of low blood sugar. Talk to your healthcare provider about low blood sugar and how to manage it.Know the medicines you take. Keep list of them to show your healthcare provider and pharmacist when you get new medicine.How should use MOUNJARORead the Instructions for Use that comes with MOUNJARO.Use MOUNJARO exactly as your healthcare provider tells you to.MOUNJARO is injected under the skin (subcutaneously) of your stomach (abdomen), thigh, or upper arm.Use MOUNJARO time each week, at any time of the day.You may change the day of the week you use MOUNJARO as long as the time between the doses is at least days (72 hours).If you miss dose of MOUNJARO, take the missed dose as soon as possible within days (96 hours) after the missed dose. If more than days have passed, skip the missed dose and take your next dose on the regularly scheduled day. Do not take doses of MOUNJARO within days of each other.MOUNJARO may be taken with or without food.Do not mix insulin and MOUNJARO together in the same injection.You may give an injection of MOUNJARO and insulin in the same body area (such as your stomach area), but not right next to each other.Change (rotate) your injection site with each weekly injection. Do not use the same site for each injection.If you take too much MOUNJARO, call your healthcare provider.What are the possible side effects of MOUNJAROMOUNJARO may cause serious side effects, including:See What is the most important information should know about MOUNJARO inflammation of your pancreas (pancreatitis). Stop using MOUNJARO and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back.low blood sugar (hypoglycemia). Your risk for getting low blood sugar may be higher if you use MOUNJARO with another medicine that can cause low blood sugar, such as sulfonylurea or insulin. Signs and symptoms of low blood sugar may include: dizziness or light-headednesssweatingconfusion or drowsinessheadacheblurred visionslurred speechshakinessfast heartbeatanxiety, irritability, or mood changeshungerweaknessfeeling jitteryserious allergic reactions. Stop using MOUNJARO and get medical help right away if you have any symptoms of serious allergic reaction including: swelling of your face, lips, tongue or throatproblems breathing or swallowingsevere rash or itchingfainting or feeling dizzyvery rapid heartbeatkidney problems (kidney failure). In people who have kidney problems, diarrhea, nausea, and vomiting may cause loss of fluids (dehydration) which may cause kidney problems to get worse. It is important for you to drink fluids to help reduce your chance of dehydration.severe stomach problems. Stomach problems, sometimes severe, have been reported in people who use MOUNJARO. Tell your healthcare provider if you have stomach problems that are severe or will not go away.changes in vision. Tell your healthcare provider if you have changes in vision during treatment with MOUNJARO.gallbladder problems. Gallbladder problems have happened in some people who use MOUNJARO. Tell your healthcare provider right away if you get symptoms of gallbladder problems which may include: pain in your upper stomach (abdomen)feveryellowing of skin or eyes (jaundice)clay-colored stoolsThe most common side effects of MOUNJARO include:nauseadiarrheadecreased appetitevomitingconstipationindigestionstomach (abdominal) painTalk to your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of MOUNJARO. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.How should store MOUNJAROStore MOUNJARO in the refrigerator between 360F to 460F (20C to 80C). Store MOUNJARO in the original carton until use to protect it from light.If needed, each single-dose pen can be stored at room temperature up to 860F (300C) for up to 21 days.Do not freeze MOUNJARO. Do not use MOUNJARO if frozen.Keep MOUNJARO and all medicines out of the reach of children.General information about the safe and effective use of MOUNJARO.Medicines are sometimes prescribed for purposes other than those listed in Medication Guide. Do not use MOUNJARO for condition for which it was not prescribed. Do not give MOUNJARO to other people, even if they have the same symptoms you have. It may harm them. You can ask your pharmacist or healthcare provider for information about MOUNJARO that is written for health professionals.What are the ingredients in MOUNJAROActive ingredient: tirzepatide Inactive ingredients: sodium chloride, sodium phosphate dibasic heptahydrate, and water for injection. Hydrochloric acid solution and/or sodium hydroxide solution may have been added to adjust the pH.MOUNJARO(TM) is trademark of Eli Lilly and Company.Marketed by: Lilly USA, LLC Indianapolis, IN 46285, USACopyright (C) 2022, Eli Lilly and Company. All rights reserved.For more information, go to www.MOUNJARO.com or call 1-800-545-5979.MOU-0001-MG-20220513. Possible thyroid tumors, including cancer. Tell your healthcare provider if you get lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rats, MOUNJARO and medicines that work like MOUNJARO caused thyroid tumors, including thyroid cancer. It is not known if MOUNJARO will cause thyroid tumors, or type of thyroid cancer called medullary thyroid carcinoma (MTC) in people.. Do not use MOUNJARO if you or any of your family have ever had type of thyroid cancer called medullary thyroid carcinoma (MTC), or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type (MEN 2).. MOUNJARO is an injectable prescription medicine that is used along with diet and exercise to improve blood sugar (glucose) in adults with type diabetes mellitus.. It is not known if MOUNJARO can be used in people who have had pancreatitis.. MOUNJARO is not for use in people with type diabetes.. It is not known if MOUNJARO is safe and effective for use in children under 18 years of age.. you or any of your family have ever had type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type (MEN 2).. you have had serious allergic reaction to tirzepatide or any of the ingredients in MOUNJARO. See the end of this Medication Guide for complete list of ingredients in MOUNJARO.. have or have had problems with your pancreas or kidneys.. have severe problems with your stomach, such as slowed emptying of your stomach (gastroparesis) or problems with digesting food.. have history of diabetic retinopathy.. are pregnant or plan to become pregnant. It is not known if MOUNJARO will harm your unborn baby. Tell your healthcare provider if you become pregnant while using MOUNJARO.Birth control pills by mouth may not work as well while using MOUNJARO. If you take birth control pills by mouth, your healthcare provider may recommend another type of birth control for weeks after you start MOUNJARO and for weeks after each increase in your dose of MOUNJARO. Talk to your healthcare provider about birth control methods that may be right for you while using MOUNJARO. Birth control pills by mouth may not work as well while using MOUNJARO. If you take birth control pills by mouth, your healthcare provider may recommend another type of birth control for weeks after you start MOUNJARO and for weeks after each increase in your dose of MOUNJARO. Talk to your healthcare provider about birth control methods that may be right for you while using MOUNJARO.. are breastfeeding or plan to breastfeed. It is not known if MOUNJARO passes into your breast milk. Talk to your healthcare provider about the best way to feed your baby while using MOUNJARO.. Read the Instructions for Use that comes with MOUNJARO.. Use MOUNJARO exactly as your healthcare provider tells you to.. MOUNJARO is injected under the skin (subcutaneously) of your stomach (abdomen), thigh, or upper arm.. Use MOUNJARO time each week, at any time of the day.. You may change the day of the week you use MOUNJARO as long as the time between the doses is at least days (72 hours).. If you miss dose of MOUNJARO, take the missed dose as soon as possible within days (96 hours) after the missed dose. If more than days have passed, skip the missed dose and take your next dose on the regularly scheduled day. Do not take doses of MOUNJARO within days of each other.. MOUNJARO may be taken with or without food.. Do not mix insulin and MOUNJARO together in the same injection.. You may give an injection of MOUNJARO and insulin in the same body area (such as your stomach area), but not right next to each other.. Change (rotate) your injection site with each weekly injection. Do not use the same site for each injection.. If you take too much MOUNJARO, call your healthcare provider.. See What is the most important information should know about MOUNJARO inflammation of your pancreas (pancreatitis). Stop using MOUNJARO and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back.. low blood sugar (hypoglycemia). Your risk for getting low blood sugar may be higher if you use MOUNJARO with another medicine that can cause low blood sugar, such as sulfonylurea or insulin. Signs and symptoms of low blood sugar may include: dizziness or light-headedness. sweating. confusion or drowsiness. headache. blurred vision. slurred speech. shakiness. fast heartbeat. anxiety, irritability, or mood changes. hunger. weakness. feeling jittery. serious allergic reactions. Stop using MOUNJARO and get medical help right away if you have any symptoms of serious allergic reaction including: swelling of your face, lips, tongue or throat. problems breathing or swallowing. severe rash or itching. fainting or feeling dizzy. very rapid heartbeat. kidney problems (kidney failure). In people who have kidney problems, diarrhea, nausea, and vomiting may cause loss of fluids (dehydration) which may cause kidney problems to get worse. It is important for you to drink fluids to help reduce your chance of dehydration.. severe stomach problems. Stomach problems, sometimes severe, have been reported in people who use MOUNJARO. Tell your healthcare provider if you have stomach problems that are severe or will not go away.. changes in vision. Tell your healthcare provider if you have changes in vision during treatment with MOUNJARO.. gallbladder problems. Gallbladder problems have happened in some people who use MOUNJARO. Tell your healthcare provider right away if you get symptoms of gallbladder problems which may include: pain in your upper stomach (abdomen). fever. yellowing of skin or eyes (jaundice). clay-colored stools. nausea. diarrhea. decreased appetite. vomiting. constipation. indigestion. stomach (abdominal) pain. Store MOUNJARO in the refrigerator between 360F to 460F (20C to 80C). Store MOUNJARO in the original carton until use to protect it from light.. If needed, each single-dose pen can be stored at room temperature up to 860F (300C) for up to 21 days.. Do not freeze MOUNJARO. Do not use MOUNJARO if frozen.

USE IN SPECIFIC POPULATIONS SECTION.

8 USE IN SPECIFIC POPULATIONS. Pregnancy: Based on animal study, may cause fetal harm. (8.1)Females of Reproductive Potential: Advise females using oral contraceptives to switch to non-oral contraceptive method, or add barrier method of contraception for weeks after initiation and for weeks after each dose escalation. (7.2, 8.3, 12.3). Pregnancy: Based on animal study, may cause fetal harm. (8.1). Females of Reproductive Potential: Advise females using oral contraceptives to switch to non-oral contraceptive method, or add barrier method of contraception for weeks after initiation and for weeks after each dose escalation. (7.2, 8.3, 12.3). 8.1 Pregnancy. Risk SummaryAvailable data with MOUNJARO use in pregnant women are insufficient to evaluate for drug-related risk of major birth defects, miscarriage, or other adverse maternal or fetal outcomes. There are risks to the mother and fetus associated with poorly controlled diabetes in pregnancy (see Clinical Considerations). Based on animal reproduction studies, there may be risks to the fetus from exposure to tirzepatide during pregnancy. MOUNJARO should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.In pregnant rats administered tirzepatide during organogenesis, fetal growth reductions and fetal abnormalities occurred at clinical exposure in maternal rats based on AUC. In rabbits administered tirzepatide during organogenesis, fetal growth reductions were observed at clinically relevant exposures based on AUC. These adverse embryo/fetal effects in animals coincided with pharmacological effects on maternal weight and food consumption (see Data).The estimated background risk of major birth defects is 6-10% in women with pre-gestational diabetes with an HbA1c >7% and has been reported to be as high as 20-25% in women with an HbA1c >10%. The estimated background risk of miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.. Clinical Considerations. Disease-Associated Maternal and/or Embryo/Fetal RiskPoorly controlled diabetes in pregnancy increases the maternal risk for diabetic ketoacidosis, pre-eclampsia, spontaneous abortions, preterm delivery and delivery complications. Poorly controlled diabetes increases the fetal risk for major birth defects, stillbirth, and macrosomia-related morbidity.. Data. Animal DataIn pregnant rats given twice weekly subcutaneous doses of 0.02, 0.1, and 0.5 mg/kg tirzepatide (0.03-, 0.07-, and 0.5-fold the MRHD of 15 mg once weekly based on AUC) during organogenesis, increased incidences of external, visceral, and skeletal malformations, increased incidences of visceral and skeletal developmental variations, and decreased fetal weights coincided with pharmacologically-mediated reductions in maternal body weights and food consumption at 0.5 mg/kg. In pregnant rabbits given once weekly subcutaneous doses of 0.01, 0.03, or 0.1 mg/kg tirzepatide (0.01-, 0.06-, and 0.2-fold the MRHD) during organogenesis, pharmacologically-mediated effects on the gastrointestinal system resulting in maternal mortality or abortion in few rabbits occurred at all dose levels. Reduced fetal weights associated with decreased maternal food consumption and body weights were observed at 0.1 mg/kg. In pre- and post-natal study in rats administered subcutaneous doses of 0.02, 0.10, or 0.25 mg/kg tirzepatide twice weekly from implantation through lactation, F1 pups from F0 maternal rats given 0.25 mg/kg tirzepatide had statistically significant lower mean body weight when compared to controls from post-natal day through post-natal day 126 for males and post-natal day 56 for females.. 8.2 Lactation. Risk SummaryThere are no data on the presence of tirzepatide in animal or human milk, the effects on the breastfed infant, or the effects on milk production. The developmental and health benefits of breastfeeding should be considered along with the mothers clinical need for MOUNJARO and any potential adverse effects on the breastfed infant from MOUNJARO or from the underlying maternal condition.. 8.3 Females and Males of Reproductive Potential. ContraceptionUse of MOUNJARO may reduce the efficacy of oral hormonal contraceptives due to delayed gastric emptying. This delay is largest after the first dose and diminishes over time. Advise patients using oral hormonal contraceptives to switch to non-oral contraceptive method, or add barrier method of contraception for weeks after initiation and for weeks after each dose escalation with MOUNJARO [see Drug Interactions (7.2) and Clinical Pharmacology (12.2, 12.3)]. 8.4 Pediatric Use. Safety and effectiveness of MOUNJARO have not been established in pediatric patients (younger than 18 years of age).. 8.5 Geriatric Use. In the pool of seven clinical trials, 1539 (30.1%) MOUNJARO-treated patients were 65 years of age or older, and 212 (4.1%) MOUNJARO-treated patients were 75 years of age or older at baseline.No overall differences in safety or efficacy were detected between these patients and younger patients, but greater sensitivity of some older individuals cannot be ruled out.. 8.6 Renal Impairment. No dosage adjustment of MOUNJARO is recommended for patients with renal impairment. In subjects with renal impairment including end-stage renal disease (ESRD), no change in tirzepatide pharmacokinetics (PK) was observed [see Clinical Pharmacology (12.3)]. Monitor renal function when initiating or escalating doses of MOUNJARO in patients with renal impairment reporting severe adverse gastrointestinal reactions [see Warnings and Precautions (5.5)]. 8.7 Hepatic Impairment. No dosage adjustment of MOUNJARO is recommended for patients with hepatic impairment. In clinical pharmacology study in subjects with varying degrees of hepatic impairment, no change in tirzepatide PK was observed [see Clinical Pharmacology (12.3)].

WARNINGS AND PRECAUTIONS SECTION.

5 WARNINGS AND PRECAUTIONS. Pancreatitis: Has been reported in clinical trials. Discontinue promptly if pancreatitis is suspected. (5.2)Hypoglycemia with Concomitant Use of Insulin Secretagogues or Insulin: Concomitant use with an insulin secretagogue or insulin may increase the risk of hypoglycemia, including severe hypoglycemia. Reducing dose of insulin secretagogue or insulin may be necessary. (5.3)Hypersensitivity Reactions: Hypersensitivity reactions have been reported. Discontinue MOUNJARO if suspected. (5.4)Acute Kidney Injury: Monitor renal function in patients with renal impairment reporting severe adverse gastrointestinal reactions. (5.5)Severe Gastrointestinal Disease: Use may be associated with gastrointestinal adverse reactions, sometimes severe. Has not been studied in patients with severe gastrointestinal disease and is not recommended in these patients. (5.6)Diabetic Retinopathy Complications in Patients with History of Diabetic Retinopathy: Has not been studied in patients with non-proliferative diabetic retinopathy requiring acute therapy, proliferative diabetic retinopathy, or diabetic macular edema. Monitor patients with history of diabetic retinopathy for progression. (5.7)Acute Gallbladder Disease: Has occurred in clinical trials. If cholelithiasis is suspected, gallbladder studies and clinical follow-up are indicated. (5.8). Pancreatitis: Has been reported in clinical trials. Discontinue promptly if pancreatitis is suspected. (5.2). Hypoglycemia with Concomitant Use of Insulin Secretagogues or Insulin: Concomitant use with an insulin secretagogue or insulin may increase the risk of hypoglycemia, including severe hypoglycemia. Reducing dose of insulin secretagogue or insulin may be necessary. (5.3). Hypersensitivity Reactions: Hypersensitivity reactions have been reported. Discontinue MOUNJARO if suspected. (5.4). Acute Kidney Injury: Monitor renal function in patients with renal impairment reporting severe adverse gastrointestinal reactions. (5.5). Severe Gastrointestinal Disease: Use may be associated with gastrointestinal adverse reactions, sometimes severe. Has not been studied in patients with severe gastrointestinal disease and is not recommended in these patients. (5.6). Diabetic Retinopathy Complications in Patients with History of Diabetic Retinopathy: Has not been studied in patients with non-proliferative diabetic retinopathy requiring acute therapy, proliferative diabetic retinopathy, or diabetic macular edema. Monitor patients with history of diabetic retinopathy for progression. (5.7). Acute Gallbladder Disease: Has occurred in clinical trials. If cholelithiasis is suspected, gallbladder studies and clinical follow-up are indicated. (5.8). 5.1 Risk of Thyroid C-Cell Tumors. In both sexes of rats, tirzepatide caused dose-dependent and treatment-duration-dependent increase in the incidence of thyroid C-cell tumors (adenomas and carcinomas) in 2-year study at clinically relevant plasma exposures [see Nonclinical Toxicology (13.1)]. It is unknown whether MOUNJARO causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of tirzepatide-induced rodent thyroid C-cell tumors has not been determined.MOUNJARO is contraindicated in patients with personal or family history of MTC or in patients with MEN 2. Counsel patients regarding the potential risk for MTC with the use of MOUNJARO and inform them of symptoms of thyroid tumors (e.g., mass in the neck, dysphagia, dyspnea, persistent hoarseness).Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with MOUNJARO. Such monitoring may increase the risk of unnecessary procedures, due to the low test specificity for serum calcitonin and high background incidence of thyroid disease. Significantly elevated serum calcitonin values may indicate MTC and patients with MTC usually have calcitonin values >50 ng/L. If serum calcitonin is measured and found to be elevated, the patient should be further evaluated. Patients with thyroid nodules noted on physical examination or neck imaging should also be further evaluated.. 5.2 Pancreatitis. Acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis, has been observed in patients treated with GLP-1 receptor agonists.In clinical studies, 14 events of acute pancreatitis were confirmed by adjudication in 13 MOUNJARO-treated patients (0.23 patients per 100 years of exposure) versus events in comparator-treated patients (0.11 patients per 100 years of exposure). MOUNJARO has not been studied in patients with prior history of pancreatitis. It is unknown if patients with history of pancreatitis are at higher risk for development of pancreatitis on MOUNJARO.After initiation of MOUNJARO, observe patients carefully for signs and symptoms of pancreatitis (including persistent severe abdominal pain, sometimes radiating to the back and which may or may not be accompanied by vomiting). If pancreatitis is suspected, discontinue MOUNJARO and initiate appropriate management.. 5.3 Hypoglycemia with Concomitant Use of Insulin Secretagogues or Insulin. Patients receiving MOUNJARO in combination with an insulin secretagogue (e.g., sulfonylurea) or insulin may have an increased risk of hypoglycemia, including severe hypoglycemia [see Adverse Reactions (6.1), Drug Interactions (7.1)].The risk of hypoglycemia may be lowered by reduction in the dose of sulfonylurea (or other concomitantly administered insulin secretagogue) or insulin. Inform patients using these concomitant medications of the risk of hypoglycemia and educate them on the signs and symptoms of hypoglycemia.. 5.4 Hypersensitivity Reactions. Hypersensitivity reactions have been reported with MOUNJARO in clinical trials (e.g., urticaria and eczema) and were sometimes severe. If hypersensitivity reactions occur, discontinue use of MOUNJARO; treat promptly per standard of care, and monitor until signs and symptoms resolve. Do not use in patients with previous serious hypersensitivity reaction to tirzepatide or any of the excipients in MOUNJARO [see Contraindications (4)].Anaphylaxis and angioedema have been reported with GLP-1 receptor agonists. Use caution in patients with history of angioedema or anaphylaxis with GLP-1 receptor agonist because it is unknown whether such patients will be predisposed to these reactions with MOUNJARO.. 5.5 Acute Kidney Injury. MOUNJARO has been associated with gastrointestinal adverse reactions, which include nausea, vomiting, and diarrhea [see Adverse Reactions (6.1)]. These events may lead to dehydration, which if severe could cause acute kidney injury.In patients treated with GLP-1 receptor agonists, there have been postmarketing reports of acute kidney injury and worsening of chronic renal failure, which may sometimes require hemodialysis. Some of these events have been reported in patients without known underlying renal disease. majority of the reported events occurred in patients who had experienced nausea, vomiting, diarrhea, or dehydration. Monitor renal function when initiating or escalating doses of MOUNJARO in patients with renal impairment reporting severe gastrointestinal adverse reactions.. 5.6 Severe Gastrointestinal Disease. Use of MOUNJARO has been associated with gastrointestinal adverse reactions, sometimes severe [see Adverse Reactions 6.1]. MOUNJARO has not been studied in patients with severe gastrointestinal disease, including severe gastroparesis, and is therefore not recommended in these patients.. 5.7 Diabetic Retinopathy Complications in Patients with History of Diabetic Retinopathy. Rapid improvement in glucose control has been associated with temporary worsening of diabetic retinopathy. MOUNJARO has not been studied in patients with non-proliferative diabetic retinopathy requiring acute therapy, proliferative diabetic retinopathy, or diabetic macular edema. Patients with history of diabetic retinopathy should be monitored for progression of diabetic retinopathy.. 5.8 Acute Gallbladder Disease. Acute events of gallbladder disease such as cholelithiasis or cholecystitis have been reported in GLP-1 receptor agonist trials and postmarketing.In MOUNJARO placebo-controlled clinical trials, acute gallbladder disease (cholelithiasis, biliary colic, and cholecystectomy) was reported by 0.6% of MOUNJARO-treated patients and 0% of placebo-treated patients. If cholelithiasis is suspected, gallbladder diagnostic studies and appropriate clinical follow-up are indicated.

INFORMATION FOR PATIENTS SECTION.