Thyroid eye disease (TED) can affect much more than how your eyes look. Swelling around the eyes, bulging eyes, eye pain or pressure, redness, and double vision can interfere with everyday activities and affect how you feel about your appearance.
If your doctor has prescribed Tepezza (teprotumumab-trbw), you may have questions about how the treatment works, how many infusions you will need, what happens during an infusion, potential side effects, and how insurance coverage works.
Tepezza is an intravenous treatment given on a defined schedule, with a full course consisting of eight infusions. This guide explains what patients should know before starting treatment and what to discuss with their healthcare team.
What Is Tepezza?
Tepezza (teprotumumab-trbw) is a prescription medication used to treat thyroid eye disease.
TED is an autoimmune condition that affects tissues around the eyes. It is commonly associated with Graves’ disease, although thyroid eye disease and thyroid disease are separate conditions that may require different treatments.
Tepezza is an insulin-like growth factor-1 receptor (IGF-1R) inhibitor. It works by blocking IGF-1R signaling, which plays a role in the biological processes involved in thyroid eye disease.
The FDA approved Tepezza in 2020, and it is indicated for the treatment of thyroid eye disease. Clinical studies evaluated its effects on features of TED including eye bulging (proptosis) and double vision. Individual responses can vary, so your ophthalmologist or other treating specialist can help you understand what results may be realistic for you.
How Many Tepezza Infusions Will I Need?
A complete Tepezza treatment course consists of 8 IV infusions, with one infusion given every 3 weeks.
That means the full course takes approximately 5 months from the first infusion to the last.
Tepezza dosing is based on your actual body weight:
- The first infusion is 10 mg/kg.
- Infusions 2 through 8 are 20 mg/kg.
- Infusions are administered every 3 weeks.
- The full treatment course consists of 8 infusions.
Completing the prescribed treatment course is important because the clinical studies that established Tepezza’s effectiveness evaluated patients receiving the full eight-infusion course.
Your healthcare provider will determine the appropriate dose for you and may make adjustments based on your individual circumstances.
How Long Does a Tepezza Infusion Take?
The length of a Tepezza infusion can vary depending on where you receive treatment and how you tolerate the medication.
Under the current prescribing information, Tepezza is administered by IV infusion over 60 to 90 minutes. The manufacturer’s patient materials describe the first two infusions as approximately 90 minutes, with later infusions potentially reduced to about 60 minutes if tolerated.
Your total appointment may take longer than the infusion itself because you may need time for:
- Check-in and medication review
- Weight measurement
- IV placement
- Pre-infusion assessments
- The infusion
- Monitoring afterward
Ask your infusion team how much time you should plan for your specific appointment.
What to Expect on Tepezza Infusion Day
If this is your first IV specialty medication, knowing what to expect can make the appointment feel less unfamiliar.
1. Check-In
Your care team will review your treatment plan and may ask about changes in your health, medications, allergies, blood sugar, hearing, or other symptoms.
Because Tepezza can affect several systems, tell your care team about any new or ongoing symptoms before your infusion.
2. Weight and Health Assessment
Because Tepezza dosing is weight-based, your treatment team will use your weight to determine the appropriate dose.
Depending on your medical history, your team may also review blood glucose levels, hearing status, and symptoms related to inflammatory bowel disease.
3. IV Placement
A nurse or other qualified healthcare professional will place an IV, generally in a vein in your hand or arm.
If you are nervous about needles or have had difficult IV placement in the past, let your nurse know.
4. Tepezza Infusion
Tepezza is administered through the IV over the prescribed infusion period.
Your care team will monitor you during treatment for signs of an infusion reaction or other problems.
5. Monitoring and Going Home
Your healthcare team will determine when you are ready to leave based on your condition and the facility’s procedures.
Ask your infusion team what activities are appropriate after treatment and what symptoms should prompt you to contact your healthcare provider.
Tepezza Side Effects: What Patients Should Know
Tepezza can cause side effects, and some require particular attention.
The current prescribing information identifies infusion reactions, inflammatory bowel disease, hyperglycemia, and hearing impairment including hearing loss as important warnings and precautions.
Hearing Changes
Hearing impairment is one of the most important issues to discuss before starting Tepezza.
Tepezza may cause hearing impairment, including hearing loss, and some cases may be permanent.
Tell your healthcare provider promptly if you notice:
- Hearing loss
- Ringing in your ears
- A feeling of fullness or pressure in your ears
- Changes in how you hear sounds
The prescribing information recommends assessing hearing before, during, and after treatment. Your healthcare provider can determine the appropriate hearing-monitoring schedule for you.
High Blood Sugar
Tepezza can cause hyperglycemia, or elevated blood glucose.
This is especially important if you have diabetes or preexisting problems with blood sugar. The FDA prescribing information recommends assessing patients for elevated blood glucose and symptoms of hyperglycemia before infusions and continuing to monitor during treatment.
Make sure your infusion team knows about diabetes, prediabetes, or medications that affect your blood sugar.
Inflammatory Bowel Disease
Tepezza may cause or worsen inflammatory bowel disease (IBD).
Contact your healthcare provider if you develop new or worsening gastrointestinal symptoms, particularly persistent diarrhea or other symptoms that concern you.
The current prescribing information recommends monitoring for signs and symptoms of IBD, including in patients without a previous history of the condition.
Infusion Reactions
Infusion reactions can occur during or after treatment.
Possible symptoms may include flushing, headache, changes in blood pressure, or other reactions.
If an infusion reaction occurs, the healthcare team can slow or interrupt the infusion and provide appropriate medical management.
Other Common Side Effects
The current prescribing information lists several adverse reactions that occurred in more than 5% of patients in clinical trials, including muscle spasms, nausea, hair loss, diarrhea, fatigue, hyperglycemia, hearing impairment, dry skin, changes in taste, headache, decreased weight, and nail disorders.
Not every patient experiences these effects, and your individual experience may be different.
Tepezza and Pregnancy
Tepezza can cause harm to a developing fetus.
For females who can become pregnant, effective contraception should be used before starting treatment, during treatment, and for 6 months after the last dose according to the current prescribing information.
Talk with your healthcare provider before starting Tepezza if you are pregnant, planning to become pregnant, or could become pregnant.
What Does Tepezza Cost?
Tepezza is a specialty medication, and the amount a patient pays depends on factors such as insurance coverage, benefits, prior authorization requirements, deductibles, coinsurance, and eligibility for financial assistance.
Your insurer may require prior authorization before approving treatment. This can involve documentation from your healthcare provider regarding your diagnosis and treatment history.
Before starting therapy, ask:
- Does my insurance cover Tepezza?
- Is prior authorization required?
- Do I have an infusion benefit or specialty pharmacy requirement?
- What will my estimated out-of-pocket cost be?
- Am I eligible for manufacturer assistance?
- Are there additional infusion or administration charges?
A specialty pharmacy team may be able to help with benefits verification, prior authorization, and available financial-assistance resources.
You can also learn more about the prior authorization process through our guide on how long prior authorization takes and how to speed it up and our guide to financial help for specialty medications.
Can Tepezza Be Given at an Infusion Center?
Tepezza is administered through an IV by a qualified healthcare professional. Treatment may be provided in different settings, including an infusion center, physician practice, hospital, or, when appropriate, the patient’s home. The appropriate setting depends on the patient’s prescription, clinical needs, insurance coverage, and available services.
If you are considering an infusion center, confirm beforehand that the location:
- Is authorized to administer Tepezza
- Accepts your insurance
- Can obtain the medication
- Has appropriate clinical monitoring procedures
- Can accommodate the complete eight-infusion schedule
RE Pharmacy service availability should be confirmed before publication.
Questions to Ask Before Starting Tepezza
A five-month treatment course involves multiple appointments, so it is worth discussing the details with your healthcare provider before your first infusion.
Consider asking:
- Why do you recommend Tepezza for my thyroid eye disease?
- What changes should I expect from treatment?
- How will we measure my response?
- When should I expect to notice changes?
- Will I need a hearing test before treatment?
- How will my hearing be monitored during and after treatment?
- How will my blood sugar be monitored?
- What symptoms could indicate inflammatory bowel disease?
- What should I do if I experience an infusion reaction?
- What are my options if I miss an infusion?
- Does my insurance require prior authorization?
- What will my expected out-of-pocket cost be?
Keeping a record of your symptoms before and during treatment can also help your healthcare team evaluate how you are responding.
Frequently Asked Questions About Tepezza
How many Tepezza infusions will I need?
The recommended course consists of 8 IV infusions, administered once every 3 weeks. The complete course takes approximately 5 months.
How long does each Tepezza infusion take?
Tepezza is administered over 60 to 90 minutes. The first two infusions are generally given over about 90 minutes, while subsequent infusions may be reduced to about 60 minutes if tolerated.
Does Tepezza cure thyroid eye disease?
Tepezza is a treatment for thyroid eye disease, but it should not be described as a guaranteed cure. Clinical results vary between patients, and some people may experience persistent or recurrent symptoms or require additional treatment.
Your eye specialist can explain what treatment goals make sense for your individual condition.
Will I need a hearing test while taking Tepezza?
Your healthcare provider may recommend hearing assessments before, during, and after treatment because Tepezza can cause hearing impairment, including hearing loss that may be permanent. Discuss a hearing-monitoring plan before your first infusion.
Can Tepezza raise blood sugar?
Yes. Tepezza can cause hyperglycemia. Patients with diabetes or other blood-sugar concerns may need closer monitoring during treatment.
Can Tepezza affect the digestive system?
Yes. Inflammatory bowel disease is an important warning associated with Tepezza. Tell your healthcare provider about new or worsening gastrointestinal symptoms during treatment.
Can I receive Tepezza outside a hospital?
Tepezza may be administered in an infusion center, physician practice, hospital, or, when appropriate, at home. The appropriate location depends on your clinical situation, prescription, insurance, and available services.
Eight Infusions Deserve a Team That Helps You Stay on Track
Tepezza treatment involves eight appointments spread across approximately five months. Staying on schedule, monitoring for potential side effects, communicating with your healthcare team, and navigating insurance requirements can make the treatment process feel like a lot to manage.
A specialty pharmacy team can help coordinate the administrative side of treatment, including benefits verification and prior authorization when applicable.
If Tepezza has been prescribed for you, talk with your healthcare provider about what to expect and ask your pharmacy or infusion provider about the services available to support your treatment.
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This article is for educational purposes only and does not constitute medical advice. Tepezza is a prescription medication. Treatment decisions should be made with your healthcare provider. Insurance coverage, financial assistance, infusion locations, and pharmacy services vary by patient and plan. Always review the current prescribing information and discuss potential risks and benefits with your healthcare professional.