Tesamorelin Dosing Guide: FDA GHRH Analog (Egrifta)

What Is Tesamorelin?

Tesamorelin is a synthetic analog of growth hormone-releasing hormone (GHRH). It is a 44-amino-acid peptide based on the natural GHRH(1-44) sequence, with a stabilizing modification that resists rapid breakdown in the bloodstream. It is sold as Egrifta, Egrifta SV, and Egrifta WR (developmental code TH9507, the acetate salt tesamorelin acetate), and it is FDA-approved to reduce excess abdominal fat in HIV-infected adults with lipodystrophy (Egrifta WR label, DailyMed).

Unlike injected recombinant human growth hormone (hGH), tesamorelin does not supply GH directly. It signals the pituitary gland to make and release the body's own growth hormone, which raises circulating IGF-1 (Dhillon 2011, BioDrugs, PMID 22050344). That puts it in the same functional family as sermorelin and CJC-1295 / ipamorelin, the GHRH-pathway peptides, rather than the ghrelin-mimetic GHRPs like ipamorelin.

How Tesamorelin Works and What the Trials Show

Because tesamorelin works through the pituitary, it tends to preserve the natural pulsatile pattern of GH release instead of flooding the system with a flat, constant level. In the pivotal 26-week, double-blind, placebo-controlled trial of 412 HIV patients, tesamorelin cut visceral adipose tissue (VAT) by roughly 15% while placebo VAT rose about 5%, with triglycerides improving and no clinically significant worsening of glucose control over that window (Falutz 2007, N Engl J Med, PMID 18057338).

A later randomized trial in HIV patients with abdominal fat accumulation found a net VAT treatment effect of about -42 cm² and a net -2.9% reduction in liver fat (lipid-to-water percentage) versus placebo (Stanley 2014, JAMA, PMID 25038357). The catch is that the VAT effect reverses once the drug is stopped, and the drug did not meaningfully change subcutaneous fat (Dhillon 2011, BioDrugs, PMID 22050344). This focus on visceral fat is also what separates tesamorelin from a fat-loss fragment like AOD-9604, which acts on a different mechanism.

Tesamorelin Dosing

The approved formulations differ, and the FDA explicitly states they are not interchangeable on a milligram basis because they use different concentrations and reconstitution steps (Egrifta WR label, DailyMed):

• Original Egrifta: 2 mg subcutaneously once daily.
• Egrifta SV: 1.4 mg (0.35 mL of reconstituted solution) subcutaneously once daily, from a 2 mg vial (Egrifta SV label, DailyMed).
• Egrifta WR: 1.28 mg (0.16 mL) subcutaneously once daily, from an 11.6 mg vial reconstituted to 8 mg/mL (Egrifta WR label, DailyMed).

Across all three, the effective daily delivered dose lands in roughly the 1.28-2 mg (1280-2000 mcg) range once daily. Every form is injected into the abdomen, with the injection site rotated to limit local reactions (Egrifta SV label, DailyMed). Dosing is continuous and daily; benefits build over months and reverse once you stop. To turn any of these vial strengths into a draw volume on your syringe, run the numbers through the tesamorelin dosage calculator.

How to Reconstitute Tesamorelin

Tesamorelin ships as a lyophilized (freeze-dried) powder that has to be reconstituted before injection. The pharmaceutical instructions are specific to each formulation:

• Egrifta SV: reconstitute the 2 mg vial with 0.5 mL of Sterile Water for Injection, mix by gently rolling the vial for about 30 seconds (do not shake), then inject (Egrifta SV label, DailyMed).
• Egrifta WR: reconstitute the 11.6 mg vial with 1.3 mL of Bacteriostatic Water for Injection to yield 8 mg/mL (Egrifta WR label, DailyMed).

The two labels treat storage very differently. The older Egrifta SV is meant to be reconstituted with sterile water and injected right away, with no refrigeration of the prepared solution. The newer Egrifta WR is reconstituted with bacteriostatic water and stays stable at room temperature for up to 7 days, but it must not be frozen (Egrifta WR label, DailyMed). The calculator on this page defaults to a common research-grade vial (e.g., 10 mg) reconstituted with bacteriostatic water. Always match your math to the actual vial strength in front of you, since calculating from the wrong formulation is the easiest way to mis-dose. If mixing is new to you, the beginner reconstitution guide walks through the mechanics step by step.

Tesamorelin Half-Life and What to Expect

Tesamorelin clears the body fast. Its elimination half-life runs about 8 minutes for Egrifta SV and 11 minutes for Egrifta WR in healthy subjects, absolute subcutaneous bioavailability is under 4%, and peak levels arrive within roughly 10 minutes (Egrifta WR label, DailyMed). What matters clinically is the downstream rise in GH and IGF-1, not the peptide's own brief presence in plasma, which is why you dose daily despite that short half-life. In the trials, visible changes in abdominal fat showed up over 26 weeks, not days (Falutz 2007, N Engl J Med, PMID 18057338).

Tesamorelin Safety and Side Effects

Tesamorelin is contraindicated in pregnancy, active malignancy, disruption of the hypothalamic-pituitary axis, and known hypersensitivity to the drug (Egrifta SV label, DailyMed). Labeled warnings cover elevated IGF-1 (with uncertain long-term consequences), a higher risk of glucose intolerance and diabetes, fluid retention (edema, arthralgia, carpal tunnel-type symptoms), and a theoretical concern about neoplasm growth (Egrifta WR label, DailyMed). The most common adverse reactions (at least 5%) are arthralgia, injection-site erythema and pruritus, pain in extremity, peripheral edema, and myalgia (Egrifta SV label, DailyMed). Serious adverse events were uncommon (under 4%) during 26 weeks of therapy in the review of the approval trials (Dhillon 2011, BioDrugs, PMID 22050344).

This page is educational and is not medical advice. Tesamorelin is a prescription drug; talk to a qualified clinician about whether it is appropriate for you and about IGF-1 and glucose monitoring.

References

1. Falutz J, et al. Metabolic effects of a growth hormone-releasing factor in patients with HIV. N Engl J Med. 2007. PMID 18057338. https://pubmed.ncbi.nlm.nih.gov/18057338/
2. Stanley TL, 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. PMID 25038357. https://pubmed.ncbi.nlm.nih.gov/25038357/
3. Dhillon S. Spotlight on tesamorelin in HIV-associated lipodystrophy. BioDrugs. 2011. PMID 22050344. https://pubmed.ncbi.nlm.nih.gov/22050344/
4. EGRIFTA WR (tesamorelin) Prescribing Information, DailyMed/FDA. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=839334d3-8c1d-4c26-9036-2ab524a6ea75
5. EGRIFTA SV (tesamorelin) Prescribing Information, DailyMed/FDA. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3d783378-b02d-4f19-99dd-0fc91a042224