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Tirzepatide titration may continue as follows: Week 8: 7.5 mg weekly (if 5 mg was well-tolerated) Week 12: 10 mg weekly (for patients who need additional appetite suppression) Week 16: Up to 12.5 mg or 15 mg (maximum doses, used selectively) Ipamorelin adjustments: If well-tolerated at 200 mcg, may increase to 250 to 300 mcg daily Some physicians add a second daily dose (morning, fasted) for enhanced GH support If water retention or joint stiffness develops, dose may be reduced Labs at the 8-week mark should include IGF-1, thorough metabolic panel, HbA1c, and lipids

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