Tirzepatide dose escalation: what 5mg actually means clinically

What did @kaylaleemills actually say?

She's nine weeks into a compounded tirzepatide regimen, sourced from a med spa, and just bumped her dose to "50 units" before correcting herself to say that's 5 milligrams. She's also injecting compounded NAD alongside it. She mentioned starting at 2.5mg, stepping to 3.5mg, and now landing at 5mg, which she frames as a benefit of the compounded route: more flexibility on increments. She also copped to missing her injection by a full day before catching herself.

Credit where it's due: she self-corrected the "units" language in real time and acknowledged the measurement confusion herself. That's more self-awareness than most GLP-1 content on TikTok. But there's enough here to unpack carefully.

Does the science back this up?

The dose progression she describes loosely mirrors the FDA-approved titration schedule for tirzepatide (Mounjaro/Zepbound), but with one meaningful difference: 3.5mg is not a standard branded dose. The approved schedule runs 2.5mg, then 5mg, then higher. That non-standard middle step is a compounding feature, not a clinical one backed by phase III trial data.

The SURMOUNT-1 trial (Jastreboff et al., 2022, NEJM) used 5mg, 10mg, and 15mg maintenance doses to produce the weight loss results tirzepatide is famous for. The titration to those doses followed a specific ramp. Whether the 3.5mg stepping-stone changes tolerability outcomes hasn't been studied in a published RCT. It might be gentler on GI side effects. It also might not matter. We don't know, because compounding pharmacies aren't running randomized trials.

Stacking tirzepatide with NAD injections is essentially uncharted territory. There's no peer-reviewed evidence examining this combination's safety or efficacy profile. That doesn't make it automatically dangerous, but it does mean anyone watching this shouldn't take the stack as validated practice.

What did they get wrong (or right)?

The "units" confusion is worth addressing directly. Insulin is dosed in units. GLP-1 agonists like tirzepatide are dosed in milligrams. These are not interchangeable terms, and mixing the language in a video with 21,900 views matters. Someone drawing up a compounded injectable could misinterpret dosing instructions if they're already confused about measurement systems. She corrected herself, but the correction came after the wrong word was already out there.

On the compounding point: she never claims her compounded tirzepatide is equivalent to Zepbound or Mounjaro, which is the right call. The FDA has consistently warned that compounded drugs are not FDA-approved and are not proven to be the same as their branded counterparts in potency, sterility, or stability (FDA, 2024 guidance on compounded semaglutide and tirzepatide). She doesn't make that equivalency claim, which keeps her on the right side of accuracy.

Missing a once-weekly dose by one day is generally considered clinically minor if the next scheduled dose is still days away, per the prescribing information for tirzepatide. She handled it correctly by injecting when she remembered.

What should you actually know?

Compounded tirzepatide is in a complicated regulatory moment. The FDA placed tirzepatide on its shortage list, which briefly opened a window for compounding pharmacies to legally produce it. As of early 2025, the FDA declared the shortage resolved for some formulations, which means the legal landscape for compounded tirzepatide is actively shifting. If you're getting this from a med spa, you should be asking your provider about current regulatory status, not just your next dose increment.

The NAD injection combination she describes has no published clinical evidence supporting its use alongside GLP-1 therapy. NAD precursors have been studied in contexts like metabolic health (Yoshino et al., 2021, Science), but injectable NAD stacked with a dual GIP/GLP-1 agonist is not a validated protocol. Viewers should not interpret her personal regimen as a recommendation.

Finally, anyone sourcing injectables from a med spa without an endocrinologist or obesity medicine specialist in the loop is missing clinical oversight. Med spas vary widely in prescribing standards. A missed injection is a minor issue. Dosing errors with compounded injectables of unknown concentration are not.