Tesamorelin dosage: Egrifta SV and WR doses, mixing and syringe units

Tesamorelin has one dose per product, set by the FDA label, with no titration (step-by-step increase). The confusion comes from there being two current products: Egrifta SV is 1.4 mg a day and Egrifta WR is 1.28 mg a day, and they use different vials, diluents and concentrations. Both are injected once a day into the abdomen. Those doses are for the one approved use, reducing excess abdominal fat in adults with HIV and lipodystrophy. For what the drug is and what the trials found, see the tesamorelin overview. The prescriber sets the regimen; nothing here replaces the label or the pharmacist’s instructions.

The label dose, side by side

The tesamorelin calculator uses these label figures. Both labels say the two products “are not substitutable”: a person switched from one to the other needs a new prescription and new instructions, not a conversion. The original 1 mg-vial Egrifta, dosed at 2 mg a day from two vials, is no longer listed on DailyMed.

The manufacturer has said Egrifta WR will gradually replace Egrifta SV as insurance coverage allows. If your pharmacy changes your product, the mixing, the water, the volume and the number on the syringe all change with it.

How each is mixed, per the label

Egrifta SV. Use only the supplied Sterile Water for Injection. Draw 0.5 mL into the syringe, add it to one 2 mg vial, and roll the vial gently between the hands for 30 seconds. Do not shake. The solution should be clear and colorless. The instructions then say to draw all the liquid, which sits “at around the 0.4 mL mark,” remove air bubbles, and push the plunger to the 0.35 mL mark before injecting. The remaining solution and the opened water bottle are thrown away.

Egrifta WR. Use only the supplied Bacteriostatic Water for Injection, which contains benzyl alcohol as a preservative. Using the 3 mL mixing syringe in the kit, add 1.3 mL to one 11.6 mg vial and swirl in a circle. Do not shake. For each daily injection, the instructions say to use a new injection syringe, draw to the 18 mark (0.18 mL), tap out air, and adjust to exactly the 16 mark (0.16 mL). That 0.16 mL is the 1.28 mg dose. The kit holds four vials, one per week, with one mixing syringe per week and daily injection syringes.

Two details trip people up:

• The Egrifta WR arithmetic does not divide evenly. 11.6 mg in 1.3 mL works out to about 8.9 mg/mL, but the label states the mixed concentration as 8 mg/mL and builds the 0.16 mL dose on that number. Seven doses use 1.12 mL. The leftover is not an extra dose; the label says to discard the vial 7 days after mixing.
• The Egrifta SV vial is single use. The powder is preservative-free and is mixed with plain sterile water, so the label says to inject right away and throw away what is left. A fresh vial is mixed every day.

General guidance on mixing technique is in how to reconstitute, and the difference between sterile and bacteriostatic water is in bacteriostatic water. Neither replaces the kit’s own instructions. Do not use a solution that is cloudy, colored or has solid particles in it. The manufacturer’s support program also offers one-on-one injection training for people on Egrifta WR.

Reading the dose on a syringe

Insulin-syringe units measure volume, not drug. On a U-100 scale, 100 units equals 1 mL, so 1 unit equals 0.01 mL. The concentration decides how much tesamorelin is in each unit.

The same 16 units of Egrifta SV would hold only 0.64 mg, and 35 units of Egrifta WR would hold 2.8 mg, more than twice its label dose. That is the practical reason the labels forbid substitution. The kits supply their own syringes; the Egrifta WR instructions refer to “the 16 mark,” which is the same 0.16 mL. The mg/mL to units converter does this arithmetic for any concentration.

Injection sites

Both labels say to inject into the abdomen, rotating to different areas of the abdomen each time, and not into scar tissue, bruises or the navel. Rotation matters here more than for many drugs: injection site reactions occurred in 25% of people on tesamorelin versus 14% on placebo in the first 26 weeks of the trials. The injection sites guide shows abdominal rotation patterns.

The thigh and arm sites used for some other drugs are not in the tesamorelin labels, which name only the abdomen.

When to inject tesamorelin

The labels do not specify a time of day, only once daily. The bedtime timing you may read about comes from a research trial of a different dose, described below.

What happens at each step

There are no steps. Neither label describes a dose increase, a maintenance step or a taper, so day 1 and week 26 use the same dose.

The 2026 Ditta meta-analysis found visceral fat reductions were significant only in trials of 26 weeks or longer, which fits that timeline.

What if a dose is missed?

Neither the Egrifta SV nor the Egrifta WR patient information addresses missed doses. Ask your prescriber or pharmacist, or call the number on the label, 1-833-23-THERA. Two things do follow from the labels. The dose is once a day, and neither label describes a double dose. And with Egrifta WR, a skipped day does not stretch the vial: the label still says to discard it 7 days after mixing.

Doses used outside the label

Published trials of tesamorelin for other purposes used doses close to the original label. The liver-fat trials in adults with HIV used 2 mg of the original formulation daily. A 2012 trial of thinking and memory in adults aged 55 to 87 used 1 mg daily, self-injected 30 minutes before bedtime, for 20 weeks. Those were research protocols, not approved regimens, and those milligram figures refer to older product, so they do not transfer to either current product.

Common mistakes

• Swapping products at the same volume. 16 units of WR and 16 units of SV are not the same dose.
• Using the wrong water. Each kit’s diluent is specific, and the labels say to use only the one supplied.
• Keeping leftover Egrifta SV. It is single use and mixed fresh for each dose.
• Using Egrifta WR past day 7. The label says to discard it 7 days after mixing, even with liquid left.
• Refrigerating a mixed vial. Both labels say not to refrigerate or freeze the mixed solution, although Egrifta WR is kept at room temperature for the week.
• Shaking the vial. Roll Egrifta SV and swirl Egrifta WR.
• Treating a research vial as Egrifta. Tesamorelin sold “for research use only” may be shipped only for lab work under 21 CFR 312.160, is not legal to use on people, and none of the numbers above applies to it.
• Sharing a syringe. The label says never to share one, even if the needle is changed.

What to watch for

The label lists who should not use tesamorelin: anyone with a damaged or removed pituitary, active cancer, a known allergy to it, or a pregnancy. While on it, the label asks the prescriber to check IGF-1 and blood glucose periodically, and to consider stopping if IGF-1 stays well above normal or glucose problems develop without a clear benefit. Allergic reactions such as rash, hives or flushing mean stopping and getting prompt medical attention, and swelling of the face or throat, trouble breathing or fainting means emergency care. The full list, with percentages, is in tesamorelin side effects.