The figures below come from the approved FDA labeling for Egrifta. They are reported as label facts, not as a protocol for anyone to follow. Actual dosing is set by a prescriber, and unregulated "research" vials are not the approved product.
Overview
Tesamorelin is a once-daily subcutaneous injection with a single fixed dose and no titration ladder — unusual among the peptides discussed on this site, most of which are weekly and escalated. It is approved to reduce excess abdominal fat in adults with HIV-associated lipodystrophy.
The number most often quoted for tesamorelin is 2 mg daily. That figure comes from the original phase 3 trials and the discontinued first-generation product; it is not the dose of either currently marketed formulation.
The approved doses
| Product | Daily dose | Vial strength | Reconstitution |
|---|---|---|---|
| EGRIFTA SV | 1.4 mg subcutaneously | 2 mg | one vial per dose, used immediately |
| EGRIFTA WR | 1.28 mg subcutaneously | 11.6 mg | one vial reconstituted weekly, supplying 7 daily doses |
EGRIFTA SV is reconstituted with 0.5 mL of sterile water and 0.35 mL of the resulting solution is injected (EGRIFTA SV prescribing information). EGRIFTA WR uses an 11.6 mg vial reconstituted with 1.3 mL of bacteriostatic water and stored for a week of daily doses (EGRIFTA WR prescribing information).
The label is emphatic that the two are not substitutable: they differ in dose, number of vials per dose, reconstitution instructions, and storage requirements. Swapping one product's instructions onto the other's vials is a documented route to a wrong dose.
There is no dose escalation. The trials that established the effect ran a fixed 2 mg daily for 26 to 52 weeks (J Clin Endocrinol Metab 2010; PMID 20554713).
Why it is dosed daily, not weekly
Tesamorelin prompts the pituitary to release growth hormone in its own pulses rather than flooding the body with exogenous GH. That stimulus is short-lived, so the schedule has to repeat daily to sustain it — there is no long-acting depot version, and the extended-action engineering used in weekly incretin drugs would defeat the point of preserving pulsatility.
Consistency over months is what produces the effect. The phase 3 data show visceral fat reduction deepening from roughly 15% at week 26 to 17.5% at week 52, and reversing rapidly once the drug is stopped (J Acquir Immune Defic Syndr 2010; PMID 20101189). It is an ongoing therapy, not a course.
How it is administered
The approved product is a lyophilised powder reconstituted before injection into the skin of the abdomen, with site rotation to reduce irritation. Injection site reactions affected 25% of patients in trials versus 14% on placebo, so technique and rotation are not cosmetic details.
The branded kits supply pre-measured vials, defined diluent volumes, and syringes matched to the intended dose — which is what makes 1.4 mg or 1.28 mg an actual delivered amount rather than an estimate. With raw research powder, the delivered dose depends on how much diluent was added and on reading syringe units as a volume, and neither the peptide's identity nor its concentration has been verified by anyone.
Why oversight matters
Tesamorelin is contraindicated in active malignancy, in pregnancy, in hypersensitivity to the drug or mannitol, and in people with a disrupted hypothalamic-pituitary axis. Its label also requires monitoring of IGF-1, with discontinuation considered if it stays elevated, and warns about glucose intolerance — 5% of trial patients reached an HbA1c of 6.5% or higher versus 1% on placebo.
Screening for those conditions and running that monitoring is what a prescriber contributes. The milligram figure is the easy part of this drug; the surveillance around it is the part that makes it safe to use.