Tesamorelin and Ipamorelin: Combining Them, Dosage and Risks
Tesamorelin is FDA-approved; ipamorelin is not. What sources say about combining them, the dose each has evidence for, what no study has tested, and legal status.
The short version
Tesamorelin is FDA-approved, as Egrifta WR, for excess abdominal fat in HIV-associated lipodystrophy, with one label dose. Ipamorelin has no FDA-approved product and no approved dose. Its two published human studies used intravenous infusion, not the subcutaneous injection sold to consumers. Clinic and wellness pages describe combining the two for a larger growth hormone pulse, but no published clinical trial has tested them given together.
- Tesamorelin has one FDA-approved dose, 1.28 mg subcutaneously once daily, for one approved indication.
- Ipamorelin has no FDA-approved product or dose. Its published studies used IV infusion, not injection.
- No published clinical trial has tested tesamorelin and ipamorelin given together as a combination.
- Sources describing the combination disagree on timing: same injection versus staggered morning and evening.
Tesamorelin and ipamorelin are often grouped together as growth-hormone-axis peptides, but they stand in very different places with FDA. Tesamorelin is an approved prescription medicine with a label and randomised-trial evidence behind it. Ipamorelin has clean animal pharmacology but has never been approved by any regulator. This page covers what sources say about combining them, the dose each has evidence for, and what no study has tested.
Side by side
| Tesamorelin | Ipamorelin | |
|---|---|---|
| Approval | FDA-approved (Egrifta WR) | Never approved anywhere |
| Approved use | Excess abdominal fat in HIV-associated lipodystrophy | None |
| Receptor | Pituitary GHRH receptor | Ghrelin receptor (GHS-R1a) |
| Route | Subcutaneous injection | Subcutaneous injection (common practice); published trials used IV infusion |
| Dose with evidence | 1.28 mg, once daily (FDA label) | No approved dose; 100-300 mcg common practice, not trial-tested |
| Human trial data | Multiple randomised trials for the approved indication | Two published studies, both by IV infusion, alone |
Full pages: Tesamorelin · Ipamorelin. Dosing detail: tesamorelin dosage · ipamorelin dosage.
Tesamorelin’s approved dose: the only number FDA set
Tesamorelin is sold as Egrifta WR, an FDA-approved prescription medicine. Its label states one dose: 1.28 mg injected subcutaneously once daily into the abdomen, from a vial reconstituted with the supplied diluent and used within 7 days. That dose was set for one indication, reducing excess visceral abdominal fat in adults with HIV-associated lipodystrophy. In a 12-month study of 404 patients, visceral fat fell 10.9% on tesamorelin against 0.6% on placebo over the first six months Falutz 2010 - Falutz J, Potvin D, Mamputu JC et al. Effects of tesamorelin, a growth hormone-releasing factor, in HIV-infected patients with abdominal fat accumulation: a randomized placebo-controlled trial with a safety extension. J Acquir Immune Defic Syndr. 2010;53(3):311-22., in the references below. The label states tesamorelin is not indicated for weight loss management generally, and no dose has been established for any other use. Full detail: tesamorelin dosage.
Ipamorelin: no approved product, no approved dose
Ipamorelin has never been approved by the FDA or any other regulator, for any indication. Its clinical development reached Phase 2 for postoperative ileus. It was discontinued after a trial in 117 patients found no significant benefit over placebo on its main outcome Beck 2014 - Beck DE, Sweeney WB, McCarter MD. Prospective, randomized, controlled, proof-of-concept study of the Ghrelin mimetic ipamorelin for the management of postoperative ileus in bowel resection patients. Int J Colorectal Dis. 2014;29(12):1527-34., in the references below.
That trial and a separate pharmacokinetic study Gobburu 1999 - Gobburu JV, Agersø H, Jusko WJ et al. Pharmacokinetic-pharmacodynamic modeling of ipamorelin, a growth hormone releasing peptide, in human volunteers. Pharm Res. 1999;16(9):1412-6., in the references below both gave ipamorelin alone, by intravenous infusion in a clinical setting. Neither used the subcutaneous, self-injected dosing sold to consumers. Clinic and vendor dosing guides most often describe 100-300 mcg by subcutaneous injection for an 8-12 week cycle as current practice, not a dose any trial has tested. Full detail and sourcing: ipamorelin dosage.
Common protocol
What is commonly used, not a dose established in trials. No regulator has set a dose for Ipamorelin. Sources differ, so the ranges below span them.
- Dose per administration
- 100-300 mcg
- How often
- once nightly on 5 days a week in physician-supervised protocols, up to three times daily on an empty stomach in less structured use
- Route
- Subcutaneous injection
- Cycle length
- 8-12 weeks
- Break between cycles
- 4 weeks
- Common vial size
- 5 mg
- Timing
- On an empty stomach - commonly before bed, 20-30 minutes before eating, or right after a workout.
- Commonly paired with
- CJC-1295
A named clinic network (Beverly Hills Rejuvenation Center) describes pairing ipamorelin with CJC-1295 (no-DAC) in one bedtime injection, 5 nights a week, starting at 100 mcg and titrating to 200-300 mcg; a vendor guide describes the same dose range used up to three times daily rather than once. Both agree on dose (100-300 mcg), 8-12 week cycles and a roughly 4-week break; they differ materially on how often per week, so that range is kept wide and flagged as varying.
Plan a cycle in the protocol builder or work out injection volume in the dosage calculator.
The common Ipamorelin dose is 100-300 mcg, once nightly on 5 days a week in physician-supervised protocols, up to three times daily on an empty stomach in less structured use. From a 5 mg vial mixed with 2 mL of bacteriostatic water, 200 mcg is 8 units (0.08 mL) on a U-100 insulin syringe.
Ipamorelin 5 mg vial: units per dose
Full 5 mg vial page: mixing, doses per vial, how long it lasts →
| Water added | Concentration | 1 unit = | 100 mcg | 200 mcg | 300 mcg |
|---|---|---|---|---|---|
| 1 mL | 5 mg/mL | 50 mcg | 2 units | 4 units | 6 units |
| 2 mL | 2.5 mg/mL | 25 mcg | 4 units | 8 units | 12 units |
| 3 mL | 1.67 mg/mL | 16.67 mcg | 6 units | 12 units | 18 units |
Ipamorelin 10 mg vial: units per dose
Full 10 mg vial page: mixing, doses per vial, how long it lasts →
| Water added | Concentration | 1 unit = | 100 mcg | 200 mcg | 300 mcg |
|---|---|---|---|---|---|
| 1 mL | 10 mg/mL | 100 mcg | 1 unit | 2 units | 3 units |
| 2 mL | 5 mg/mL | 50 mcg | 2 units | 4 units | 6 units |
| 3 mL | 3.33 mg/mL | 33.33 mcg | 3 units | 6 units | 9 units |
All Ipamorelin vial sizes: 5 mg · 10 mg
Units are on a standard U-100 insulin syringe (100 units = 1 mL), rounded to the nearest half unit - half-unit marks are on 0.3 mL syringes. Water volumes are examples: more water means more units per dose, not more doses per vial. For any other vial or dose, use the dosage calculator.
How many 5 mg vials a cycle takes
| Scenario | Dose | Doses a week | Weeks | Total | 5 mg vials |
|---|---|---|---|---|---|
| Low end of the common protocol | 100 mcg | 5 | 8 | 4 mg | 1 |
| High end of the common protocol | 300 mcg | 21 | 12 | 75.6 mg | 16 |
Whole vials, rounded up. Plan a cycle with your own numbers in the protocol builder. Keep mixed vials cold and use them within the window in how long reconstituted peptides last; where to inject: subcutaneous injection sites.
What sources say about combining them
Tesamorelin acts on the pituitary’s GHRH receptor. Ipamorelin acts on a separate receptor, the ghrelin receptor (GHS-R1a), the pathway a 1998 pharmacology paper identified in animal and in vitro research Raun 1998 - Raun K, Hansen BS, Johansen NL et al. Ipamorelin, the first selective growth hormone secretagogue. Eur J Endocrinol. 1998;139(5):552-61., in the references below.
Two wellness-clinic sources make the same mechanism argument. Pairing a GHRH agent with a ghrelin-receptor agonist is said to produce a larger, still-pulsatile growth hormone release than either alone. The reason given is that the two receptors act on the pulse through different steps. The sources differ on timing:
- One clinic’s page frames ipamorelin as helping sustain the GH pulse that tesamorelin starts. It describes no specific schedule beyond the mechanism argument.
- A separate wellness-business page suggests staggering the two, tesamorelin in the morning and ipamorelin in the evening, to spread the signal across the day. It also notes that avoiding overuse depends on medical oversight rather than a fixed rule.
Neither source reports having run or cited a controlled trial of the combination.
The idea has some support elsewhere in the class. In six healthy men, a different GHRP, hexarelin, given with GHRH produced a higher growth hormone peak than the two did separately, added together Massoud 1996 - Massoud AF, Hindmarsh PC, Matthews DR et al. The effect of repeated administration of hexarelin, a growth hormone releasing peptide, and growth hormone releasing hormone on growth hormone responsivity. Clin Endocrinol (Oxf). 1996;44(5):555-62., in the references below. That was a different pair of molecules, given intravenously. It makes the combination plausible, not tested.
What no study has tested
I could not find a published clinical trial that gave tesamorelin and ipamorelin together, at any dose, timing or schedule. Tesamorelin’s approval trials tested it alone, at its labelled dose, in adults with HIV-associated lipodystrophy Falutz 2010 - Falutz J, Potvin D, Mamputu JC et al. Effects of tesamorelin, a growth hormone-releasing factor, in HIV-infected patients with abdominal fat accumulation: a randomized placebo-controlled trial with a safety extension. J Acquir Immune Defic Syndr. 2010;53(3):311-22., in the references below. Ipamorelin’s two published human studies also tested it alone, by IV infusion, in different populations entirely: healthy volunteers and post-surgical patients Gobburu 1999 - Gobburu JV, Agersø H, Jusko WJ et al. Pharmacokinetic-pharmacodynamic modeling of ipamorelin, a growth hormone releasing peptide, in human volunteers. Pharm Res. 1999;16(9):1412-6., in the references below Beck 2014 - Beck DE, Sweeney WB, McCarter MD. Prospective, randomized, controlled, proof-of-concept study of the Ghrelin mimetic ipamorelin for the management of postoperative ileus in bowel resection patients. Int J Colorectal Dis. 2014;29(12):1527-34., in the references below.
No source this page cites claims a trial exists for the pairing. The clinic and wellness pages that describe it are proposing a combination on mechanism grounds, not reporting one.
Side effects of each
Tesamorelin’s label lists warnings from its own clinical trial program:
- increased risk of neoplasms (growth hormone is a growth factor)
- elevated IGF-1, with unknown effects of prolonged elevation
- fluid retention (oedema, joint pain, carpal tunnel syndrome)
- glucose intolerance or new diabetes
- hypersensitivity reactions, reported in 4% of trial patients
The label directs evaluating and monitoring glucose status during treatment and discontinuing for recurrent malignancy. Full detail: tesamorelin dosage.
Ipamorelin’s Phase 2 trial reported treatment-emergent adverse events in a majority of both its ipamorelin and placebo groups (87.5% versus 94.8%). The paper did not single out a severe reaction specific to ipamorelin at the dose tested Beck 2014 - Beck DE, Sweeney WB, McCarter MD. Prospective, randomized, controlled, proof-of-concept study of the Ghrelin mimetic ipamorelin for the management of postoperative ileus in bowel resection patients. Int J Colorectal Dis. 2014;29(12):1527-34., in the references below. That was one small, week-long hospital trial by IV infusion. No comparable safety data exists for the subcutaneous, outpatient dosing sold to consumers, and no long-term human safety data exists at all.
Neither side-effect record says anything about the two compounds given together. No published source has measured that.
Regulatory status
Tesamorelin
US legal status - FDA-approved · prescription only
FDA-approved as EGRIFTA WR for excess abdominal fat in HIV-infected adults with lipodystrophy. Requires a prescriber, and the approval does not extend to any other use, including combining it with an unapproved compound.
Ipamorelin
US legal status - Research use only
No FDA-approved product or dose. Sold as a research chemical, not legally marketed for human use. Ipamorelin acetate appears in FDA’s category 2 compounding-risk table.
AU legal status - Not on the ARTG
Schedule 4 of the Poisons Standard and named under Appendix D - prescription only, and not on the ARTG.
Regulators reach their own conclusions on their own timelines. Where these two disagree, the difference is the point - not an error.
A prescriber can lawfully prescribe tesamorelin for its approved indication. Because ipamorelin has no FDA approval, no clinic can lawfully prescribe it the way a licensed prescriber prescribes tesamorelin. It reaches consumers only through the research-chemical channel, with none of the identity or purity assurance an approved drug carries. Combining the two does not create a reviewed product. It combines one approved medicine, used outside its approved combination, with one unapproved research chemical.
For where research-labelled peptides such as ipamorelin are sourced, see this site’s research-access page, which sends readers to a specific research-peptide supplier and discloses that relationship on that page. Tesamorelin, as an approved prescription medicine, is obtained through a licensed prescriber and pharmacy, not that channel.
Related
- Tesamorelin: what the approval covers
- Ipamorelin: what the clinical record shows
- Tesamorelin vs MK-677
- Tesamorelin dosage: the approved label
- Ipamorelin dosage: the study doses
- US peptide regulation tracker
Common questions
Can you combine tesamorelin and ipamorelin?
People do, and clinic and wellness pages describe protocols for it, but no published clinical trial has tested them given together. Tesamorelin's FDA approval covers only its use alone, at the labelled dose, for excess abdominal fat in HIV-associated lipodystrophy. Adding ipamorelin is outside that approval and outside any trial either compound has been through.
What is the tesamorelin dosage?
The FDA label for Egrifta WR states 1.28 mg injected subcutaneously once daily into the abdomen, from a vial reconstituted with the supplied diluent. That is the only approved dose, for the approved indication. See the full dosing page for reconstitution detail.
Is ipamorelin legal?
No product containing ipamorelin has FDA approval. It is sold as a research chemical, not legally marketed for human use in the US. The WADA Prohibited List names it as a growth hormone secretagogue, prohibited at all times in sport.
Has tesamorelin and ipamorelin been tested together in a study?
I could not find any published clinical trial that gave tesamorelin and ipamorelin together. Tesamorelin's trials tested it alone, at its approved dose, in adults with HIV-associated lipodystrophy. Ipamorelin's two published human studies also tested it alone, by intravenous infusion. The sources describing the combination are clinic and wellness pages, not trial data.
What are the side effects of combining tesamorelin and ipamorelin?
Each compound has its own documented side effects, covered below. No published study has measured what happens when the two are given together, at any dose or schedule, so the combination has no dedicated human safety data.
Why do people combine tesamorelin and ipamorelin?
Sources describing the pairing say the two act on different receptors that both lead to a growth hormone pulse: tesamorelin on the GHRH receptor, ipamorelin on the ghrelin receptor. They say combining the two produces a larger pulse than either alone. That is a mechanism argument repeated on clinic and wellness pages, not a finding from a trial of the combination.
References (9 sources)
Bibliographic detail is fetched from PubMed, not written by me - so a citation here cannot drift from the paper it names. Study design comes from PubMed's own tags rather than my judgement.
- 1.Falutz J, Potvin D, Mamputu JC et al. Effects of tesamorelin, a growth hormone-releasing factor, in HIV-infected patients with abdominal fat accumulation: a randomized placebo-controlled trial with a safety extension. J Acquir Immune Defic Syndr. 2010;53(3):311-22.Randomised trialPMID 20101189
- 2.Raun K, Hansen BS, Johansen NL et al. Ipamorelin, the first selective growth hormone secretagogue. Eur J Endocrinol. 1998;139(5):552-61.StudyPMID 9849822
- 3.Gobburu JV, Agersø H, Jusko WJ et al. Pharmacokinetic-pharmacodynamic modeling of ipamorelin, a growth hormone releasing peptide, in human volunteers. Pharm Res. 1999;16(9):1412-6.Randomised trialPMID 10496658
- 4.Beck DE, Sweeney WB, McCarter MD. Prospective, randomized, controlled, proof-of-concept study of the Ghrelin mimetic ipamorelin for the management of postoperative ileus in bowel resection patients. Int J Colorectal Dis. 2014;29(12):1527-34.Randomised trialPMID 25331030
- 5.Massoud AF, Hindmarsh PC, Matthews DR et al. The effect of repeated administration of hexarelin, a growth hormone releasing peptide, and growth hormone releasing hormone on growth hormone responsivity. Clin Endocrinol (Oxf). 1996;44(5):555-62.Randomised trialPMID 8762732
- 6.EGRIFTA WR (tesamorelin) - current prescribing information on DailyMed: indication, dosage of 1.28 mg subcutaneously once daily, contraindications and warnings.- DailyMed, National Library of Medicinelabel
- 7.FDA - Certain Bulk Drug Substances for Use in Compounding that May Present Significant Safety Risks. Ipamorelin acetate entry, category 2.- US Food and Drug Administrationregulatory
- 8.One clinic’s page- secretmedspa.comother
- 9.A separate wellness-business page- ivvitamintherapy.comother