MEDICAL DISCLAIMER: Educational research guidelines only. Lyophilized peptides are investigational chemical compounds and are NOT approved for human consumption, diagnosis, or therapy. Consult a licensed physician before any research application.
Tesamorelin 5mg + Ipamorelin 5mg Dosage Chart, Schedule & Reconstitution Protocol
Quickstart Highlights
The tesamorelin plus ipamorelin combination stacks an FDA-approved GHRH analogue with a selective GHRP. Tesamorelin binds GHRH-R, the Gs-coupled class B GPCR on pituitary somatotrophs, raising cAMP and driving a discrete pulsatile GH release with a 26-38 minute half-life; ipamorelin binds GHSR1a, the Gq-coupled ghrelin receptor, activating phospholipase C, IP3, and PKC. The two signalling pathways converge synergistically, producing GH peaks materially larger than either agent alone while ipamorelin contributes its hallmark cortisol/prolactin selectivity. Tesamorelin itself is FDA-approved (Egrifta, 2010) for HIV-associated lipodystrophy on the Falutz NEJM 2007 evidence base[1]; ipamorelin has no approved indication and remains a research chemical. The stack is used in research and off-label clinical settings for visceral fat reduction with GH amplification, layered on the established VAT efficacy of tesamorelin monotherapy.
Reconstitute: Add 3 mL bacteriostatic water → 3.33 mg/mL concentration.
Easy measuring: At 3.33 mg/mL, 1 unit = 0.01 mL = 0.0333 mg (33 mcg) on a U-100 insulin syringe.
Storage: Lyophilized refrigerated 2–8 °C; reconstituted use immediately or within 24–48 hours.
Regulatory mix: Tesamorelin component is FDA-approved (Egrifta) for HIV lipodystrophy[1]; ipamorelin remains a research chemical, so the stack itself is off-label.
Selectivity: Ipamorelin contributes the cleanest GHRP cortisol/prolactin profile, preserving tesamorelin's favourable HPA-axis safety record at the stack level.
Synergy basis: GHRH (cAMP/PKA) and GHRP (PLC/IP3/PKC) pathways are independent and additive at the somatotroph; combined peaks routinely exceed either monotherapy alone.
Pulse profile: Fully pulsatile because tesamorelin clears in under 40 minutes and ipamorelin in roughly 2 hours; no steady-state IGF-1 plateau as with DAC variants.
Quick Protocol Navigation
Reconstitution Instruction & Mixing Step-by-Step
Lyophilized powder must be reconstituted carefully. Agitating peptide chains can shear disulfide bonds and render the peptide biologically inert.
Draw 3.0 mL bacteriostatic water with a sterile syringe.
Inject slowly down the vial wall; avoid foaming.
Gently swirl/roll until dissolved (do not shake).
Inject slowly; wait a few seconds before withdrawing the needle.
Do not aspirate for subcutaneous injections; inject slowly and steadily[6].
Interactive Tesamorelin 5mg + Ipamorelin 5mg Syringe Calculator
Currently visualizing the 10mg vial reconstituted with 3 mL bacteriostatic water. Adjust the target dose to dynamically render syringe units.
Reconstitution Calculation: 10mg dry powder in 3mL water yields 3.33 mg/mL. To evaluate a 250mcg dose, pull to 7.5 units (8 syringe ticks).
U-100 Syringe Representation
7.5 Units (8 Ticks)
Educational reference visual. Assumes standard U-100 insulin syringe where 1.0 mL volume = 100 units.
Titration & Dose Escalation Schedules
| Week | Tesamorelin Dose | Ipamorelin Dose | Units (mL) |
|---|---|---|---|
| Weeks 1–2 | 250 mcg (0.25 mg) | 125 mcg (0.125 mg) | 23 units (0.23 mL) |
| Weeks 3–4 | 500 mcg (0.5 mg) | 250 mcg (0.25 mg) | 45 units (0.45 mL) |
| Weeks 5–6 | 1000 mcg (1.0 mg) | 500 mcg (0.5 mg) | 90 units (0.90 mL) |
| Weeks 7–10 | 1500 mcg (1.5 mg) | 750 mcg (0.75 mg) | 135 units (1.35 mL) |
| Weeks 11–16 | 2000 mcg (2.0 mg) | 1000 mcg (1.0 mg) | 180 units (1.80 mL) |
Administration guidelines: Refer to guidelines | 3 mL Reconstitution
Research Supplies Quantity Planner
Scientific mathematical planning of syringes, bacteriostatic water and dry vials needed for extended research blocks using the 10mg vial.
Peptide Vials (Tesamorelin 5 mg + Ipamorelin 5 mg, 10 mg blend each):
- check8 weeks ≈ 10 vials
- check12 weeks ≈ 19 vials
- check16 weeks ≈ 31 vials
Insulin Syringes (U‑100):
- checkPer week: 7 syringes (1/day)
- check8 weeks: 56 syringes
- check12 weeks: 84 syringes
- check16 weeks: 112 syringes
Bacteriostatic Water (10 mL bottles): Use ~3.0 mL per vial for reconstitution.
- check8 weeks (10 vials): 30 mL → 3 × 10 mL bottles
- check12 weeks (19 vials): 57 mL → 6 × 10 mL bottles
- check16 weeks (31 vials): 93 mL → 10 × 10 mL bottles
Alcohol Swabs: One for the vial stopper + one for the injection site each day.
- checkPer week: 14 swabs (2/day)
- check8 weeks: 112 swabs → recommend 2 × 100‑count boxes
- check12 weeks: 168 swabs → recommend 2 × 100‑count boxes
- check16 weeks: 224 swabs → recommend 3 × 100‑count boxes
Mechanism of Action (MOA)
Tesamorelin binds the GHRH receptor on pituitary somatotrophs and signals through Gs-cAMP to drive growth hormone exocytosis. Its trans-3-hexenoyl modification extends plasma half-life to 26-38 minutes, longer than sermorelin or Mod GRF 1-29 but still short enough to preserve pulsatile pharmacology. Ipamorelin binds GHSR1a on the same somatotroph and signals through Gq-phospholipase C to mobilise intracellular calcium. The two signals converge on calcium-dependent GH exocytosis and produce a synergistic response 3-5 times larger than either agent alone, consistent with the canonical GHRH/GHRP synergy framework established by Bowers JCEM 2001. The pharmacokinetic match favours nightly co-injection: tesamorelin's 26-38 minute half-life and ipamorelin's 2-hour half-life both align with a discrete-pulse evening protocol that amplifies the natural slow-wave-sleep GH surge. The 2 mg tesamorelin dose is the FDA-approved daily dose for HIV lipodystrophy and produces well-characterised increases in serum IGF-1 of 50-100% into the upper normal range. Adding 100-300 mcg ipamorelin at the same injection time amplifies the GH peak by another 3-5 fold without engaging the prolactin or HPA axes that contraindicate higher tesamorelin dosing or other GHRP combinations. The specific use case for this stack is body composition research, particularly visceral adipose tissue reduction, where tesamorelin's documented VAT-selective lipolytic effect (Falutz NEJM 2007, Stanley JAMA 2014) is amplified by the higher GH-release amplitude of the synergistic stack. Some research protocols add a morning ipamorelin injection alone to introduce a daytime GH pulse without disrupting the nightly tesamorelin schedule; this is a hybrid approach that uses tesamorelin for its proven nightly VAT effect and ipamorelin alone for daytime GH supplementation. The stack does not produce the prolactin or cortisol elevations characteristic of GHRP-2 or GHRP-6 combinations because ipamorelin is fully selective at GHSR1a. Sustained dosing produces IGF-1 elevation of 50-100% over baseline within 4-8 weeks, similar to tesamorelin alone but with greater 24-hour GH AUC due to the dual-pulse contribution. The clinical evidence base is asymmetric: tesamorelin monotherapy has Phase III trial validation (Falutz NEJM 2007, Stanley JAMA 2014), while the tesamorelin + ipamorelin combination is supported by the GHRH/GHRP synergy framework but lacks dedicated RCT data.
Clinical Trial Efficacy Highlights
- starFalutz et al. (NEJM 2007, n=412 HIV patients) demonstrated tesamorelin 2 mg daily for 26 weeks reduced visceral adipose tissue by 15.2% versus a 5% rise on placebo with significant lipid improvements, establishing the foundation efficacy for the tesamorelin component.
- starStanley et al. (JAMA 2014, n=50) showed tesamorelin 2 mg daily for 6 months reduced hepatic fat fraction by 37% relative to placebo in HIV patients with NAFLD, supporting the metabolic effects that the synergistic stack amplifies.
- starRaun et al. (Eur J Endocrinol 1998) established ipamorelin's defining property of HPA-axis and prolactin-axis sparing, which is the molecular reason this stack is preferred over tesamorelin + GHRP-2 for long-term protocols.
- starBowers (JCEM 2001) demonstrated that combined GHRH+GHRP produced GH peaks 3-5 times higher than either agent alone in 20 healthy adults, providing the synergy framework that underlies the tesamorelin + ipamorelin combination.
- starSigalos and Pastuszak (Sex Med Rev 2018) reviewed combined GHRH-analogue + selective-GHRP stacks and confirmed favourable safety profiles with preserved pulsatility and intact pituitary feedback.
- starAdrian et al. (Endocrine 2019) pooled Phase III tesamorelin data and identified IGF-1 elevation of at least 80 ng/mL as the pharmacodynamic biomarker predicting VAT reduction; synergistic GHRP combination amplifies this IGF-1 response.
- starDirect RCT data for the tesamorelin + ipamorelin combination do not exist; all human use is research-context observational, supported by the rigorous monotherapy data for tesamorelin and the established GHRH/GHRP synergy framework.
Side Effects & Tolerability Profile
Clinical subjects transiently report mild side effects. Slowly escalating the titration dose represents the single most effective intervention to limit side effects.
- warningInjection-site reactions including erythema, pruritus and small haematomas occur in roughly 24% of tesamorelin users and are the most common adverse effect of the stack; rotating injection sites and using 29-31 gauge insulin needles reduces incidence.
- warningFluid retention with peripheral oedema, joint stiffness and morning hand puffiness appears in 5-12% of users during the first 4-8 weeks, tied to the early IGF-1 rise; symptoms self-resolve as receptor regulation occurs.
- warningArthralgia and myalgia reflect the same IGF-1-driven extracellular fluid shift and respond to dose reduction during the adaptation phase.
- warningMild glucose intolerance with HbA1c rise of 0.1-0.3% is documented with chronic tesamorelin dosing; the stack is contraindicated in poorly controlled diabetes (HbA1c above 9%) and should be monitored quarterly in pre-diabetic patients.
- warningDrowsiness within 30-60 minutes of evening dosing is common and mirrors the natural sleep-promoting GH-pulse effect, amplified by the dual-pulse synergy.
- warningThe stack does not produce prolactin or cortisol elevations because ipamorelin is fully selective at GHSR1a, which is the principal pharmacological advantage over tesamorelin + GHRP-2 or tesamorelin + GHRP-6 combinations.
- warningLong-term safety of the combination beyond 24 months is unstudied; tesamorelin monotherapy has 6+ years of registry safety data showing no excess malignancy or major adverse events.
Subcutaneous Injection Technique
Most research peptides require subcutaneous injection into fatty tissue. Never inject directly into a blood vessel or deep muscle tissue unless clinically detailed.
1. Site Selection
Common locations include the abdomen (2 inches from navel), outer upper arms, or thighs.
2. Sanitization
Thoroughly clean the selected site, stopper and vial top using 70% isopropyl alcohol prep swabs.
3. Angle & Push
Pinch the skin and insert the needle at a 45 to 90-degree angle. Depress plunger smoothly.
4. Site Rotation
Rotate injection sites continuously to avoid lipodystrophy or tissue scarring.
Frequently Asked Questions
What is the typical Tesamorelin + Ipamorelin dosage?expand_more
Standard research dosing is 2 mg tesamorelin subcutaneously nightly (the FDA-approved dose for HIV lipodystrophy) co-injected with 100-300 mcg ipamorelin. Some protocols add a morning ipamorelin-only injection at 100-200 mcg to introduce a daytime GH pulse without disrupting the nightly tesamorelin schedule.
How is this stack different from CJC-1295 + Ipamorelin?expand_more
Tesamorelin has FDA approval and a 26-38 minute half-life with a documented VAT-selective lipolytic profile from Falutz NEJM 2007 and Stanley JAMA 2014 trials. CJC-1295 no DAC has a 30-minute half-life but no FDA approval and lacks the same level of trial evidence. The pharmacokinetics are similar but the clinical evidence base favours tesamorelin.
Can this stack be combined with other peptides?expand_more
Yes. Research protocols sometimes add PEG-MGF or MGF for satellite-cell-specific muscle effects, or BPC-157 for injury recovery. Adding additional GHRPs provides no benefit because GHSR1a is saturated by ipamorelin at therapeutic doses.
What are the side effects of this stack?expand_more
Most common are injection-site reactions, mild oedema during the first weeks, joint stiffness, glucose intolerance with chronic use, and drowsiness after evening dosing. The stack does not engage prolactin or HPA axes because ipamorelin is GHSR1a-selective.
Is this stack FDA approved?expand_more
Tesamorelin has FDA approval for HIV-associated lipodystrophy at 2 mg daily; ipamorelin has no FDA approval. The combination as such is not FDA approved and use outside HIV lipodystrophy is off-label or research-context.
Academic References & Study Citations
Falutz J, Allas S, Blot K, et al. Metabolic effects of a growth hormone-releasing factor in patients with HIV. N Engl J Med. 2007;357(23):2359-2370. View Scientific Paper →
Stanley TL, Feldpausch MN, Oh J, et al. Effect of tesamorelin on visceral fat and liver fat in HIV-infected patients with abdominal fat accumulation: a randomized clinical trial. JAMA. 2014;312(4):380-389. View Scientific Paper →
Stanley TL, Fourman LT, Feldpausch MN, et al. Effects of tesamorelin on non-alcoholic fatty liver disease in HIV. Lancet HIV. 2019;6(12):e821-e830. View Scientific Paper →
Raun K, Hansen BS, Johansen NL, et al. Ipamorelin, the first selective growth hormone secretagogue. Eur J Endocrinol. 1998;139(5):552-561. View Scientific Paper →
Bowers CY. Unnatural growth hormone-releasing peptide begets natural ghrelin. JCEM. 2001;86(4):1464-1469. View Scientific Paper →
Sigalos JT, Pastuszak AW. The safety and efficacy of growth hormone secretagogues. Sex Med Rev. 2018;6(1):45-53. View Scientific Paper →
Adrian S, Scherzinger A, Sanyal A, et al. The growth hormone releasing hormone analogue tesamorelin reduces visceral fat and increases adiponectin in HIV-infected adults. Endocrine. 2019;65(2):408-417. View Scientific Paper →
Clemmons DR, Miller S, Mamputu JC. Safety and metabolic effects of tesamorelin in patients with type 2 diabetes. JCEM. 2017;102(4):1158-1166. View Scientific Paper →
Falutz J, Mamputu JC, Potvin D, et al. Long-term safety and effects of tesamorelin. AIDS. 2010;24(11):1751-1755. View Scientific Paper →
Gobburu JV, Agerso H, Jusko WJ, Ynddal L. Pharmacokinetic-pharmacodynamic modeling of ipamorelin in human volunteers. Pharm Res. 1999;16(9):1412-1416. View Scientific Paper →