Tesamorelin (5 mg Vial) Dosage Protocol

Tesamorelin (5 mg)

Dosage Protocol

At a Glance

Tesamorelin 5mg Vial

Tesamorelin is a synthetic analogue of growth hormone-releasing hormone (GHRH) that stimulates pulsatile GH secretion from the pituitary, resulting in increased IGF-1, reduced visceral adipose tissue, and improved body composition.[1] It is FDA-approved as Egrifta SV for HIV-associated lipodystrophy at 2 mg/day.

  • Reconstitute: Add 2.5 mL bacteriostatic water → 2.0 mg/mL concentration.
  • Standard dose: 1–2 mg once daily subcutaneously in the evening.
  • Easy measuring: At 2.0 mg/mL on a U-100 syringe, 1 unit = 0.01 mL = 20 mcg. A 1 mg dose = 50 units / 0.50 mL; a 2 mg dose = 100 units / 1.00 mL.
  • Storage: Lyophilised: freeze at −20 °C; reconstituted: refrigerate at 2–8 °C; use within 3 weeks.

Overview

  • Goal: Reduce visceral adipose tissue and improve body composition via stimulated pulsatile GH secretion and downstream IGF-1 elevation.[1]
  • Schedule: Once-daily subcutaneous injection in the evening (to align with natural GH pulsatility).
  • Dose range: 1–2 mg per day; 2 mg is the FDA-approved clinical dose.
  • Reconstitution: 2.5 mL BAC water per 5 mg vial → 2.0 mg/mL.
  • Cycle: Assess body composition and IGF-1 levels at 12 weeks.

What You’ll Need

Plan based on a 4-week cycle at 2 mg/day (28 injections, 56 mg total).

  • Tesamorelin Vials (5 mg each): 56 mg needed ÷ 5 mg per vial → 12 vials.
  • Insulin Syringes (U-100, 1 mL): 28 injections → 28 syringes.
  • Bacteriostatic Water (10 mL bottles): 2.5 mL per vial → 1 × 10 mL bottle covers 4 vials.
  • Alcohol Swabs: 2 per injection → 56 swabs per 4-week cycle.

How to Reconstitute

  1. Allow frozen lyophilised vial to reach room temperature (10–15 minutes).
  2. Draw 2.5 mL bacteriostatic water with a sterile syringe.
  3. Inject slowly down the inner vial wall; do not inject directly onto the lyophilised cake.
  4. Gently swirl until fully dissolved — do not shake. Solution should be clear and colourless.
  5. Label with reconstitution date; refrigerate at 2–8 °C, protected from light. Use within 3 weeks.

Dosing Schedule

Phase Dose Units (U-100) Volume Frequency
Week 1 (titration) 1 mg 50 units 0.50 mL Once daily (evening)
Week 2+ (standard) 2 mg 100 units 1.00 mL Once daily (evening)

At the standard 2 mg/day research dose, the 5 mg vial (reconstituted in 2.5 mL) provides 2.5 doses. Plan to purchase multiple vials for a sustained protocol. A 4-week cycle at 2 mg/day requires 56 mg total → approximately 12 vials. Evening dosing aligns with the body’s natural overnight GH pulse to amplify the response.[2]

Protocol Details

  • Research start: 1 mg (50 units / 0.50 mL) once daily in the evening for Weeks 1–2.
  • Standard dose: 2 mg (100 units / 1.00 mL) once daily in the evening from Week 3+.[1]
  • Injection site: Abdomen subcutaneous; rotate sites to avoid lipohypertrophy.
  • Cycle length: Minimum 12 weeks to assess visceral fat reduction; continue if tolerated and response is positive.

Storage

  • Lyophilised: Store at −20 °C (−4 °F); protect from moisture and light.
  • Reconstituted: Refrigerate at 2–8 °C. Do not freeze. Use within 3 weeks (tesamorelin is slightly less stable than some peptides post-reconstitution).
  • Appearance: Clear, colourless solution. Discard if cloudy or particulate.

How Tesamorelin Works

Tesamorelin is a synthetic conjugate of the full 44-amino acid GHRH (growth hormone-releasing hormone) sequence with a trans-3-hexenoic acid moiety that stabilises the peptide against plasma dipeptidyl peptidase IV (DPP-IV) degradation, extending its effective half-life.[3]

On binding pituitary GHRH receptors, tesamorelin stimulates pulsatile GH release in a physiologically appropriate pattern — unlike exogenous GH, which suppresses natural pulsatility. Increased GH drives hepatic and peripheral IGF-1 production, which promotes lipolysis in visceral adipocytes (reducing trunk fat), stimulates protein synthesis, and supports lean body mass. The net effect is a shift in body composition toward reduced visceral adipose tissue and preserved or increased lean mass.[1]

Good to Know

  • Inject in the evening to align with the body’s natural overnight GH secretion pulse and maximise pituitary stimulation.[2]
  • Monitor fasting glucose — GH can reduce insulin sensitivity; periodic glucose checks are advisable for individuals with metabolic risk.
  • WADA-prohibited (Category S2: Peptide Hormones, Growth Factors) — athletes under anti-doping rules must not use tesamorelin.
  • Abdominal injection is preferred — tesamorelin was FDA-approved specifically for visceral fat reduction and abdominal injection maximises local effect.
  • Visceral fat reduction: Falutz et al. (2010 NEJM): tesamorelin 2 mg/day for 26 weeks reduced trunk fat by 15.2% vs. 1.6% placebo in HIV-associated lipodystrophy.[2]
  • IGF-1 elevation: Significant increases in serum IGF-1 in all major trials; typically normalises IGF-1 in GH-deficient adults.
  • Lean body mass: Modest preservation or improvement in lean mass alongside fat loss.
  • Side effects: Fluid retention, arthralgia, peripheral oedema, and myalgia occur in a minority of users — dose reduction mitigates these effects.
  • Glucose: GH-mediated insulin resistance is possible; monitor fasting glucose particularly in pre-diabetic individuals.

Tips for Best Results

  • Pair with a calorie-controlled diet and resistance training to maximise and maintain body-composition improvements.
  • Fasted evening injection (≥2 hours after last meal) avoids insulin-driven blunting of the GH pulse.
  • Track waist circumference, fasting glucose, and IGF-1 (if available) at 6 and 12 weeks.
  • Adequate sleep is essential — tesamorelin’s mechanism synergises with sleep-related GH release.

Injection Tips

  • Clean the vial stopper and injection site with separate alcohol swabs; allow both to air-dry fully before proceeding.
  • Using a 29–31 gauge insulin syringe (5/16″ to 1/2″ needle), draw the calculated dose precisely.
  • Pinch a fold of skin and insert the needle at 45° into subcutaneous fat (90° is acceptable with a short needle into a well-pinched fold).
  • Inject slowly over 2–3 seconds; do not aspirate. Withdraw the needle, apply gentle pressure, and do not rub the site.
  • Rotate injection sites (abdomen, thighs, upper arms) and dispose of each syringe in a sharps container immediately after use.

References


  • FDA — Egrifta SV (tesamorelin for injection) Prescribing Information
    — Official US labelling: 2 mg/day SC for HIV-associated lipodystrophy; pharmacokinetics, dosing, safety data

  • Falutz J et al. — NEJM (2010)
    — Tesamorelin 2 mg/day for 26 weeks: 15.2% reduction in trunk fat vs. 1.6% placebo in HIV-associated lipodystrophy (Phase III RCT)

  • Dhillon S — Drugs (2011)
    — Tesamorelin: a review of its use in HIV-associated lipodystrophy; mechanism, pharmacokinetics, and clinical evidence

  • Bachem Peptide Technical Guide
    — Handling and Storage Guidelines for Peptides (lyophilised and reconstituted forms)

  • CDC — General Best Practice Guidelines for Immunization
    — Subcutaneous injection technique, angle, and site rotation guidance

Important Note

This content is intended for educational purposes only and does not constitute medical advice, diagnosis, or treatment. This peptide is not approved for human therapeutic use. For research use only.

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