Mounjaro is a prescription medicine, and not everyone qualifies. The eligibility criteria reflect both who benefits in the clinical evidence and who can safely take the medication. This page covers both layers.
The SAHPRA Approved Criteria
For type 2 diabetes
Adults with type 2 diabetes whose blood sugar control is inadequate on lifestyle measures and other diabetes medications. Used as monotherapy or in combination with other diabetes treatments. Details here.
For chronic weight management
Adults with:
- BMI of 30 kg/m² or higher (clinical obesity), or
- BMI of 27 to 29.9 kg/m² with at least one weight related comorbidity (type 2 diabetes, hypertension, dyslipidaemia, obstructive sleep apnoea, cardiovascular disease, PCOS with metabolic features)
Used as an adjunct to a reduced calorie diet and increased physical activity.
How To Calculate Your BMI
BMI is weight in kilograms divided by height in metres squared. Example: 90 kg divided by (1.75 x 1.75) = 29.4.
BMI categories:
- Below 18.5: underweight
- 18.5 to 24.9: normal weight
- 25 to 29.9: overweight
- 30 to 34.9: class 1 obesity
- 35 to 39.9: class 2 obesity
- 40 and above: class 3 obesity
BMI does not distinguish muscle from fat, so very muscular people can have elevated BMI without excess body fat. The consulting doctor considers BMI alongside waist circumference and the full clinical picture.
The Eligibility Considerations Beyond BMI
Cardiovascular disease
Established cardiovascular disease lowers the relevant BMI threshold and adds the cardiovascular benefit consideration. More on the cardiovascular evidence.
Type 2 diabetes
For people with type 2 diabetes and excess weight, both indications apply simultaneously. Treatment can address both conditions with a single medication.
Sleep apnoea
Recognised as a weight related comorbidity, which lowers the BMI threshold for weight management indication.
PCOS
Polycystic ovary syndrome with metabolic features is a recognised comorbidity that meets the comorbidity criterion. Women's considerations here.
Find Out If You Qualify
An online consultation reviews your BMI, comorbidities, and medical history against the eligibility criteria.
Start ConsultationWho Mounjaro Is Not Suitable For
Absolute contraindications
- Personal or family history of medullary thyroid carcinoma
- Multiple endocrine neoplasia type 2 (MEN2) syndrome
- Prior serious allergic reaction to tirzepatide or any ingredient
Reasons not to use or to use with great caution
- Pregnancy or planning to conceive within one month
- Breastfeeding
- Active or recent pancreatitis
- Severe gastrointestinal disease, particularly gastroparesis
- Active gallbladder disease
- Severe liver disease (limited data)
- Severe kidney impairment (eGFR below 30, caution and monitoring)
- Type 1 diabetes (Mounjaro is not indicated)
- Diabetic ketoacidosis
- Active or recent severe eating disorder (case by case)
- Significant uncontrolled mental health condition (case by case)
- Severe diabetic retinopathy (caution, eye assessment first)
- Children and adolescents under 18 (not approved in SA)
Special Considerations
Older adults
No upper age limit. Older adults may need extra attention to kidney function, polypharmacy interactions, and risk of dehydration from gastrointestinal side effects.
Previous bariatric surgery
Mounjaro can be used after bariatric surgery in some cases, particularly with weight regain. The altered gut anatomy needs consideration.
Eating disorder history
An appetite suppressing medication requires careful consideration for anyone with restrictive eating history. Some can safely use it under close supervision. Others cannot. The consulting doctor assesses individually.
Mental health considerations
People with significant mental health history should discuss this with the prescribing doctor. Treatment is not automatically declined but requires honest assessment.
What If You Are Not Eligible
If Mounjaro is not appropriate, alternatives include:
- Wegovy (semaglutide) for adolescent use or where the oral contraceptive interaction is unacceptable
- Liraglutide (Saxenda), an older GLP-1 daily injection
- Orlistat (Xenical), an oral medication blocking fat absorption
- Structured non-medication weight management
- Bariatric surgery for severe obesity
Frequently Asked
BMI of 30 or higher, or BMI of 27 to 29.9 with at least one weight related condition (type 2 diabetes, high blood pressure, sleep apnoea, high cholesterol, established cardiovascular disease).
Not in South Africa. Mounjaro is approved for adults only here. Wegovy is the only GLP-1 medication SAHPRA approved for adolescents aged 12 and older.
No. The weight management indication requires BMI of 27 or higher with at least one comorbidity, or BMI of 30 or higher without. Cosmetic weight loss in people below these thresholds is not an appropriate use.
Mild to moderate kidney impairment is generally compatible with treatment. Severe kidney impairment requires caution and additional monitoring. The treating doctor reviews your kidney function before prescribing.