Zepbound
Zepbound, a brand name for tirzepatide, is an injectable medication that's used along with diet and exercise to help with weight loss. It's approved for certain adults who meet criteria for weight management therapy. Zepbound (tirzepatide) is also approved to treat moderate-to-severe sleep apnea. This medication belongs to the drug class called GIP and GLP-1 agonists. The typical dosage is 1 injection under the skin once per week. Common side effects include nausea, diarrhea, stomach pain, and injection site reactions.
What is Zepbound (tirzepatide)?
What is Zepbound (tirzepatide) used for?
In addition to diet and exercise:
Weight loss and long-term weight management in adults considered obese or overweight with at least one weight-related condition (e.g., high blood pressure, Type 2 diabetes)
Moderate-to-severe obstructive sleep apnea (OSA) in adults considered obese
How Zepbound (tirzepatide) works
Zepbound (tirzepatide) is a glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist.
It works by acting like GLP-1 and GIP, two hormones that your gut releases into the body. These hormones are thought to play a role in controlling your appetite (how hungry you feel). In turn, they can affect how much food you're eating. By helping you feel full longer and less hungry, Zepbound (tirzepatide) can help you lose weight.
By reducing weight, the medication helps improve sleep apnea.
Drug Facts
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What are the side effects of Zepbound (tirzepatide)?
Common Side Effects
- Nausea (25-29%)
- Diarrhea (19-23%)
- Constipation (11-17%)
- Vomiting (8-13%)
- Stomach pain (9-10%)
- Indigestion (9-10%)
Other Side Effects
- Injection site reactions (e.g., bruising, redness, pain, itching)
- Feeling tired
- Dizziness
- Burping
- Excessive gas
- Bloating
- Hair loss
Serious Side Effects
- Serious allergic reaction: hives; trouble breathing; swelling of your lips, tongue, throat, or face
- Dangerously low blood sugar: feeling hungry, fast heartbeat, shakiness, anxiety, sweating, tingling, dizziness, weakness, drowsiness, confusion
- Kidney damage: nausea, vomiting, trouble urinating, muscle cramps, feeling confused, swelling in the ankles or feet, trouble breathing
- Inflammation of the pancreas: nausea, vomiting, stomach pain
- Gallbladder problems: stomach pain, fever, clay-colored stools, yellowing of the skin or whites of your eyes
- Suicidal thoughts and behavior
Source: FDA
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The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Change in vision
- Dehydration—increased thirst, dry mouth, feeling faint or lightheaded, headache, dark yellow or brown urine
- Fast or irregular heartbeat
- Gallbladder problems—severe stomach pain, nausea, vomiting, fever
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Pancreatitis—severe stomach pain that spreads to your back or gets worse after eating or when touched, fever, nausea, vomiting
- Thoughts of suicide or self-harm, worsening mood, feelings of depression
- Thyroid cancer—new mass or lump in the neck, pain or trouble swallowing, trouble breathing, hoarseness
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Constipation
- Diarrhea
- Loss of appetite
- Nausea
- Upset stomach
Pros and cons of Zepbound (tirzepatide)
Pros
Injected once weekly
Can take with or without food
Different strengths available
Can store at room temperature for up to 21 days (3 weeks) if needed
Cons
Can cause bothersome side effects, like nausea, diarrhea, and stomach pain
Only available as an injection
Has many potential interactions, including with certain diabetes medications, warfarin (Coumadin), and birth control pills
Not recommended during pregnancy
Pharmacist tips for Zepbound (tirzepatide)
You can inject Zepbound (tirzepatide) at any time of the day, with or without food. Try to inject it at the same time on the same day each week so the levels of medication stay consistent in your body.
You can change the day of the week that you usually inject Zepbound (tirzepatide). If you do, make sure there's at least 3 days (72 hours) between two doses. This can help lower your risk of side effects.
If you miss a dose of Zepbound (tirzepatide), inject the medication as soon as possible if within 4 days (96 hours) of when you should take it. If your next dose is in fewer than 3 days, skip the missed dose and wait for your next usual dose to take the medication. Continue with your normal once-weekly dosing schedule.
Store unused Zepbound (tirzepatide) pens and vials in the refrigerator and in the original container to protect the medication from light. Don't freeze the medication because this could damage it.
If needed, you can keep Zepbound (tirzepatide) pens and vials at room temperature (up to 86 degrees Fahrenheit) but only for up to 21 days. Throw them away after this time. Don't put Zepbound (tirzepatide) back in the refrigerator once it's at room temperature.
Tell your care team about all the medications you're taking. Zepbound (tirzepatide) can interact with some medications. For example, it might make birth control pills work less well, which can lead to an unplanned pregnancy. Use a back-up method for 4 weeks after starting Zepbound (tirzepatide) and for 4 weeks after each time your dose is raised if you're sexually active and you can get pregnant.
Tell your prescriber if you're going to have any procedures or surgeries while you're taking Zepbound (tirzepatide). They can discuss with you about the possible risk for problems related to having food or liquids in the lungs when you're having your operation. They might tell you to stop taking Zepbound (tirzepatide) during the time surrounding your procedure to lessen this risk.
How to inject Zepbound (tirzepatide):
A trained healthcare professional will teach you how to inject Zepbound (tirzepatide) properly and safely. Read the Instructions for Use for the pens or vials, depending on which one you're prescribed. Ask your care team if you have any questions.
Before injecting Zepbound (tirzepatide), make sure the medication is clear and colorless to slightly yellow. Don't use the medication if it's a different color or if it has particles inside.
Wash your hands each time before you inject Zepbound (tirzepatide) to prevent infection. Also clean the area of skin you'll be injecting into with an alcohol wipe.
Inject Zepbound (tirzepatide) under the skin of your stomach, thigh, or upper arm. Someone else should help you inject the medication in the back of your upper arm. Choose a different place to inject each week each week to prevent skin irritation.
For Zepbound (tirzepatide) pens: Pull off the gray cap. Put the clear base of the pen flat against your skin, and then unlock the pen when you're ready to inject. To inject the medication, press and hold the purple button for up to 10 seconds. You'll hear two clicks: the first for when the injection started and the second for when the injection is done. You should see the gray plunger when your injection is complete.
For Zepbound (tirzepatide) vials: Follow your prescriber's instructions to draw up your dose into the syringe safely. Insert the needle into the skin and push down on the plunger. To make sure you've gotten your full dose, make sure the needle stays in your skin for at least 5 seconds. Then, pull the needle straight out.
After each injection, throw away used Zepbound (tirzepatide) pens, syringes, and vials in a sharps container. This will help prevent needle-stick injuries.
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Frequently asked questions about Zepbound (tirzepatide)
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What are the risks and warnings for Zepbound (tirzepatide)?
Zepbound (tirzepatide) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of thyroid cancer
Risk factors: Personal or family history of certain thyroid cancers
Based on animal studies, there's a possibility that Zepbound (tirzepatide) can put you at higher risk for certain thyroid cancers. It's not known whether Zepbound (tirzepatide) can cause thyroid cancer in people.
Tell your prescriber if you have a personal or family history of thyroid cancers because they might need to discuss with you about other treatment options. Get medical attention right away if you notice a lump on your neck or have trouble breathing, trouble swallowing, or hoarseness that won't go away while you're taking Zepbound (tirzepatide). These might be signs of thyroid cancer.
Stomach problems
Risk factors: Higher Zepbound (tirzepatide) dose
Zepbound (tirzepatide) can cause stomach problems, including stomach pain, nausea, vomiting, and diarrhea. Sometimes, these problems can be severe. Zepbound (tirzepatide) isn't recommended for people who have severe stomach issues, such as gastroparesis (slowed emptying of your stomach). Contact your prescriber if you have concerns.
Kidney damage
Risk factors: History of kidney problems | Dehydration due to nausea, vomiting, or diarrhea
Zepbound (tirzepatide) can cause or worsen kidney problems. This medication can also commonly cause side effects like nausea, vomiting, and diarrhea that can lead to dehydration. And if dehydration is severe enough, it could cause kidney damage.
Drink plenty of fluids and stay hydrated if you have stomach-related side effects from Zepbound (tirzepatide). Let your prescriber know if you have these side effects during treatment, if you can't urinate, or if you're not urinating as you normally do. You might need lab tests done to make sure your kidneys are okay.
Gallbladder problems
Although rare, some people have had gallbladder problems, such as gallstones, while they were taking Zepbound (tirzepatide). Contact your prescriber right away if you have severe pain in the upper part of your stomach, nausea, vomiting, or fever.
Inflammation of the pancreas (pancreatitis)
Some people who've taken Zepbound (tirzepatide) have had inflammation of their pancreas (pancreatitis). Stop taking this medication and contact your prescriber if you have symptoms of pancreatitis, such as severe stomach pain, back pain, or vomiting.
Allergic reactions
Risk factors: Allergy to GLP-1 agonists
In some rare cases, Zepbound (tirzepatide) can cause serious allergic reactions. In addition, people who've had a severe reaction to medications similar to Zepbound (tirzepatide), such as Wegovy (semaglutide), might be at risk for these reactions. Get emergency medical help if you have trouble breathing; swelling of your lips, tongue, throat, or face; or a rash or hives.
Low blood sugar (hypoglycemia)
Risk factors: Using insulin | Taking medications that raise the amount of insulin in your body (e.g., sulfonylureas like glipizide)
Zepbound (tirzepatide) can lower your blood sugar levels. Sometimes, your blood sugar levels can get too low (hypoglycemia). Taking Zepbound (tirzepatide) with medications that raise the amount of insulin in your body, like sulfonylureas or insulins, can put you at risk for dangerously low blood sugar. Ask your prescriber whether you need any dose changes to your medications before you start Zepbound (tirzepatide) to minimize this risk.
Make sure you know how to tell and what to do when you have low blood sugar. Keep glucose tablets or hard candy with you at all times so you can take them when your blood sugar drops too low. Get medical help right away if you still feel shaky, nervous, dizzy, irritated, weak, or confused, even after you've treated yourself for low blood sugar.
Worsened eye problems in people with Type 2 diabetes
Risk factors: Diabetic retinopathy
If you have Type 2 diabetes and diabetic retinopathy (damage to the blood vessels in the eye), Zepbound (tirzepatide) might make your eye problem worse. Let your prescriber know if you have diabetic retinopathy, and also tell your eye specialist that you're taking this medication. You'll need to get your vision checked regularly while you're taking Zepbound (tirzepatide). Get medical attention if you notice unusual changes in your vision.
Suicidal thoughts and behavior
Some people have reported suicidal thoughts and behaviors with other long-term weight management medications. Contact your prescriber if you or your loved ones notice a change in your mood or behavior, including signs of depression. Your prescriber can make sure it's still safe for you to take Zepbound (tirzepatide). Get medical help right away if you have thoughts of harming yourself.
Possible risks during general anesthesia
Although rare, people who've taken GLP-1 agonists similar to Zepbound (tirzepatide) have had lung problems during surgery or procedures that require general anesthesia. You're given instructions to stop eating and drinking before your procedure. But it's possible that any remaining food or liquids can get into your lungs (pulmonary aspiration) during these procedures if you take Zepbound (tirzepatide). This is because the medication makes it take longer for food to move through the digestive system.
Be sure to tell your prescriber if you have any planned procedures or surgeries. They'll discuss with you about what you should do to lessen this risk, such as pausing your treatment with Zepbound (tirzepatide). Also let your surgery team know that you're taking Zepbound (tirzepatide) so they can monitor you for this risk.
Zepbound (tirzepatide) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 4 prefilled pens of 2.5mg/0.5ml | 1 carton | $25.00 | $25.00 |
| 4 prefilled pens of 5mg/0.5ml | 1 carton | $25.00 | $25.00 |
| 4 prefilled pens of 7.5mg/0.5ml | 1 carton | $25.00 | $25.00 |
| 4 prefilled pens of 10mg/0.5ml | 1 carton | $25.00 | $25.00 |
| 4 prefilled pens of 12.5mg/0.5ml | 1 carton | $25.00 | $25.00 |
| 4 prefilled pens of 15mg/0.5ml | 1 carton | $25.00 | $25.00 |
Typical dosing for Zepbound (tirzepatide)
Zepbound (tirzepatide) is injected under the skin once a week.
Weeks 1 to 4: The typical starting dose is 2.5 mg once a week.
Weeks 5 to 8: The typical dose is 5 mg once a week.
Weeks 9 and beyond: Depending on what you're using the medication for and how well it's working for you, your prescriber might raise your dose. Your dose is raised by no more than 2.5 mg each time. Dose adjustments are made at least 4 weeks apart.
For weight loss: The recommended maintenance dose is 5 mg, 10 mg, or 15 mg once a week.
For sleep apnea: The recommended maintenance dose is 10 mg or 15 mg once a week.
The maximum dose is 15 mg once a week.
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How much does Zepbound (tirzepatide) cost?
Zepbound (tirzepatide) contraindications
Personal or family history of medullary thyroid cancer (MTC)
What are alternatives to Zepbound (tirzepatide)?
In addition to diet and exercise:
Weight loss and long-term weight management in adults considered obese or overweight with at least one weight-related condition (e.g., high blood pressure, Type 2 diabetes)
Moderate-to-severe obstructive sleep apnea (OSA) in adults considered obese
Weight loss and long-term weight management in:
Lowering the risk of heart attack, stroke, and death due to heart problems in adults with a larger body size and heart disease
To help with weight management along with a lower-calorie diet and exercise in:
What is the latest news about Zepbound (tirzepatide)?
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References
Best studies we foundEli Lilly and Company. (2023). Instructions for use: Zepbound™ (Zehp-bownd) (tirzepatide) injection, for subcutaneous use.
Eli Lilly and Company. (2024). Instructions for use: Zepbound™ (Zehp-bownd) (tirzepatide) injection, for subcutaneous use.
Eli Lilly and Company. (2024). Zepbound (tirzepatide) injection, for subcutaneous use [package insert].
Heise, T., et al. (2023). Tirzepatide reduces appetite, energy intake, and fat mass in people with type 2 diabetes. Diabetes Care.
MedlinePlus. (2023). Dehydration.
National Cancer Institute. (2019). Medullary thyroid cancer (MTC).
National Heart, Lung, and Blood Institute. (n.d.). Assessing your weight and health risk.
National Organization for Rare Disorders. (2024). Multiple endocrine neoplasia type 2.
Packer, M., et al. (2024). Tirzepatide for heart failure with preserved ejection fraction and obesity. The New England Journal of Medicine.
Transportation Security Administration. (n.d.). Disabilities and medical conditions.
U.S. Food and Drug Administration. (2023). FDA approves new medication for chronic weight management.
U.S. Food and Drug Administration. (2024). FDA approves first medication for obstructive sleep apnea.
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