Zepbound
Zepbound (tirzepatide) is an injectable medication that's used along with diet and exercise. It helps with weight loss in adults who meet criteria for weight management therapy. It's also approved to treat moderate-to-severe sleep apnea. This medication belongs to the drug class called GIP and GLP-1 agonists. The dosage is 1 injection under the skin once a week. Common side effects include nausea, diarrhea, and injection site reactions. Zepbound (tirzepatide) is only available as a brand-name medication.
What is Zepbound (tirzepatide)?
What is Zepbound (tirzepatide) used for?
In addition to a balanced diet and exercise plan:
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 eat.
By making you feel full longer and less hungry, Zepbound (tirzepatide) can help you lose weight. And by mainly reducing weight, the medication helps improve sleep apnea.
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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 reaction (e.g., bruising, redness, pain, itching)
- Feeling tired
- Feeling dizzy
- Burping
- Excessive gas
- Acid reflux
- Bloating
- Hair loss
- Faster heart rate
Serious Side Effects
- Kidney damage: nausea, vomiting, trouble urinating, muscle cramps, feeling confused, swelling in the ankles or feet, trouble breathing
- Gallbladder problems: upper stomach pain, nausea, vomiting, fever, clay-colored stools, yellowing of your skin or whites of your eyes
- Inflammation of the pancreas: nausea, vomiting, stomach pain (might spread to your back), yellowing of your skin or whites of your eyes
- Serious allergic reaction: hives; trouble breathing; swelling of your lips, tongue, throat, or face
- Very low blood sugar: feeling hungry, fast heartbeat, shakiness, anxiety, sweating, tingling, dizziness, weakness, drowsiness, confusion
- Suicidal thoughts and behavior
Source: DailyMed
More on Zepbound (tirzepatide) side effects
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 a week
Can take with or without food
Different strengths available, so it's adjustable depending on your needs
Cons
Must be injected under the skin
Can cause bothersome side effects, like nausea, diarrhea, and stomach pain
Can't use with other tirzepatide products (Mounjaro) or with other GLP-1 agonists
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. This can be helpful for remembering when to inject the medication.
You can change the day of the week 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 like stomach upset.
If you miss a dose of Zepbound (tirzepatide) and it's within 4 days (96 hours) of your missed dose, inject the medication as soon as you can. But if your next injection is in less than 3 days, skip the missed dose. Just wait to inject the medication on your regular day of the week and time. For both situations, continue your usual once-weekly dosing schedule.
Zepbound (tirzepatide) can cause nausea, vomiting, and diarrhea. These side effects are more common when you first start the medication. They usually get better over a few months. Be sure to drink plenty of fluids to stay hydrated. Tell your care team if these side effects get too severe.
It's best to avoid alcohol while taking Zepbound (tirzepatide). Alcohol can make side effects like nausea and stomach pain worse. It can also make it harder to lose weight since it can add extra calories to your diet. And, it can mess with sleep if you have sleep apnea. Ask your prescriber if you have questions about avoiding alcohol.
Tell your care team about all the medications you take and plan to take. They can make sure your medications are safe to take together. This is important because Zepbound (tirzepatide) can interact with some medications. For example, taking it with insulin can put you at risk of having very low blood sugar, which can be harmful.
Zepbound (tirzepatide) might make birth control pills work less well. This can lead to an unplanned pregnancy. If you can get pregnant and are having sex, use back-up birth control, like condoms, for the first 4 weeks of starting Zepbound (tirzepatide). Also use a back-up method for 4 weeks after each dose increase. Talk to your primary care provider or gynecologist about other birth control options.
How to use and how to inject Zepbound (tirzepatide):
A trained healthcare professional will teach you how to inject Zepbound (tirzepatide). They'll make sure you know how before letting you do it on your own at home. Read the instructions for the pens or vials, depending on which one you have. Ask your care team if you have any questions.
How to store Zepbound (tirzepatide): Store pens and vials in the refrigerator, but don't let them freeze. Keep them in the original container to protect from light. If needed, they can be out of the fridge at room temperature (up to 86ºF) for 21 days. Once at room temperature, don't put the medication back in the fridge. If you don't use the medication within 21 days at room temperature, you must throw it away.
Before injecting Zepbound (tirzepatide): Check that the medication is clear and colorless to slightly yellow. Don't use it if it's a different color or if it has particles inside. Wash your hands and clean the injection area with an alcohol wipe.
Where to inject Zepbound (tirzepatide): Inject the medication under the skin of your stomach or thigh. Someone else can also help inject into the back of your upper arm. Pick a different spot to inject into each week. Don't inject into tender, bruised, scaly, hard, scarred, or damaged skin. This can help prevent skin irritation.
How to inject Zepbound (tirzepatide) using the pen: Pull off the gray cap. Put the clear base of the pen flat against your skin. Unlock the pen when you're ready to inject. Then, press and hold the purple button for up to 10 seconds. The first click you hear tells you when the injection started and the second tells you when it's done. You should see the gray plunger through the pen when you're done.
How to inject Zepbound (tirzepatide) using the vial: Follow your prescriber's instructions to safely draw up your dose into the syringe. Insert the needle into the skin and push down on the plunger. The needle should stay in your skin for at least 5 seconds during this time to make sure you've gotten your full dose. Then, pull the needle straight out.
What to do after each Zepbound (tirzepatide) injection: Throw away used pens, syringes, and vials in a sharps container. This will help prevent you and others from getting hurt from needle sticks.
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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
In studies on rats, some that were given Zepbound (tirzepatide) had a higher risk of thyroid cancer. It was more likely to happen when the rats got higher doses or were given the medication for a long time. We don't know if Zepbound (tirzepatide) can cause thyroid cancer in people.
But because of this risk, you shouldn't use Zepbound (tirzepatide) if you or someone in your family has medullary thyroid cancer (MTC). You also shouldn't use this medication if you have multiple endocrine neoplasia syndrome type 2 (MEN 2).
Talk to your prescriber if you're worried about the risk of thyroid cancer with Zepbound (tirzepatide). Call your care team right away if you notice a lump on your neck. Also let them know if you have trouble breathing, trouble swallowing, or a hoarse voice that won't go away. These might be signs of thyroid cancer.
Stomach problems
Risk factors: Higher Zepbound (tirzepatide) dose
Zepbound (tirzepatide) can cause stomach problems, which can sometimes be severe. They can include stomach pain, nausea, vomiting, and diarrhea. Tell your care team if you have stomach upset that bothers you a lot.
Zepbound (tirzepatide) isn't recommended for people with severe stomach issues. This includes people who have gastroparesis (slowed emptying of your stomach). Talk to your prescriber about other options.
Kidney damage
Risk factors: History of kidney problems | Dehydration due to nausea, vomiting, or diarrhea
Some people who've taken Zepbound (tirzepatide) have had kidney problems. Sometimes, this can be caused by dehydration from side effects like nausea, vomiting, and diarrhea. These side effects can make you lose too much fluid from the body.
If you have stomach upset while taking Zepbound (tirzepatide), be sure to drink plenty of fluids to stay hydrated. Let your prescriber know if you have these side effects during treatment. Also tell them if you can't urinate or if you're not urinating as you usually do. You might need lab tests so your prescriber can make sure your kidneys are okay.
Gallbladder problems
Although it's rare, some people have had gallbladder problems while taking Zepbound (tirzepatide). This can include an inflamed gallblader or gallstones. Call your prescriber right away if you have severe pain in the upper stomach, nausea, vomiting, or fever. These could be signs of gallbladder problems.
Inflammation of the pancreas (pancreatitis)
Some people who've taken Zepbound (tirzepatide) had swelling or inflammation in their pancreas. This problem is called pancreatitis. It can sometimes cause serious damage to the pancreas or bleeding.
Stop using Zepbound (tirzepatide) and tell your care team if you have any signs of pancreatitis. Watch for severe stomach pain that doesn't go away, pain that goes to your back, nausea, or vomiting. Also look out for jaundice, or yellowing of your skin or the whites of your eyes.
Allergic reactions
Risk factors: Allergy to GLP-1 agonists
Some people can have a serious allergic reaction to Zepbound (tirzepatide). Tell your prescriber if you've had an allergic reaction to other GLP-1 agonists. It's not known if you could have a similar reaction to Zepbound (tirzepatide). Also, don't use Zepbound (tirzepatide) if you've had an allergic reaction to Mounjaro (tirzepatide).
Get emergency medical help right away if you have an allergic reaction to Zepbound (tirzepatide). Watch for swelling of your face, lips, or tongue. Also look out for trouble breathing, a rash, hives, or other symptoms of anaphylaxis.
Low blood sugar (hypoglycemia)
Risk factors: Type 2 diabetes | 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. When your blood sugar is too low, it's called hypoglycemia.
Taking Zepbound (tirzepatide) with certain medications can put you at risk of having very low blood sugar. These medications typically raise the amount of insulin in your body. Examples include insulin and sulfonylureas like glipizide. Before you start Zepbound (tirzepatide), ask your prescriber if you need any dose changes to your medications to lessen 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, weak, or confused, even after you've treated yourself for low blood sugar.
Eye problems in people with Type 2 diabetes (diabetic retinopathy)
Risk factors: History of eye problems caused by high blood sugar | Rapid improvement in blood sugar
Let your prescriber know if you have Type 2 diabetes and an eye problem called diabetic retinopathy. Zepbound (tirzepatide) might make your eye problem worse.
Also, tell your eye specialist that you're taking Zepbound (tirzepatide). You'll need to get your eyes checked often to make sure your vision is okay. Call your care team if you notice unusual vision changes.
Possible risk of suicidal thoughts and behavior
Some people have had suicidal thoughts and behaviors while taking other weight loss medications. Because of this, avoid taking Zepbound (tirzepatide) if you've had thoughts of self-harm before.
Call your prescriber if you or your loved ones notice changes in your mood or behavior. This is especially important if there are signs of depression. Your prescriber can check if it's still safe for you to take Zepbound (tirzepatide). If you start thinking about hurting yourself, call 911 right away.
Lung problems during general anesthesia or deep sedation
While under general anesthesia or deep sleep, some people taking GLP-1 agonists like Zepbound (tirzepatide) had a serious lung problem. This happens when food or liquid gets into the lungs.
Although rare, it can happen because Zepbound (tirzepatide) makes food stay in your stomach longer. So even if you followed the instructions about not eating before your procedure, there could still be food in your stomach. And this food could potentially get into the lungs.
Always tell your prescriber if you have any planned procedures or surgeries. And before any surgery, tell the medical team that you're taking Zepbound (tirzepatide). This helps the medical team watch for this lung problem and keep you safe.
Zepbound (tirzepatide) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 4 prefilled pens of 2.5mg/0.5ml | 1 carton | $1071.17 | $1071.17 |
| 4 prefilled pens of 5mg/0.5ml | 1 carton | $1071.25 | $1071.25 |
| 4 prefilled pens of 7.5mg/0.5ml | 1 carton | $1071.22 | $1071.22 |
| 4 prefilled pens of 10mg/0.5ml | 1 carton | $1070.95 | $1070.95 |
| 4 prefilled pens of 12.5mg/0.5ml | 1 carton | $1071.28 | $1071.28 |
| 4 prefilled pens of 15mg/0.5ml | 1 carton | $1070.93 | $1070.93 |
| 4 vials of 12.5mg/0.5ml | 1 carton | $842.82 | $842.82 |
| 4 vials of 15mg/0.5ml | 1 carton | $1039.62 | $1039.62 |
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 injected once a week.
Weeks 5 to 8: The typical dose is 5 mg injected 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 injected once a week.
For sleep apnea: The recommended maintenance dose is 10 mg or 15 mg injected once a week.
The maximum dose is 15 mg injected once a week.
More on Zepbound (tirzepatide) dosage forms
How much does Zepbound (tirzepatide) cost?
Zepbound (tirzepatide) contraindications
Personal or family history of medullary thyroid cancer (MTC)
Allergy to Mounjaro (tirzepatide)
What are alternatives to Zepbound (tirzepatide)?
In addition to a balanced diet and exercise plan:
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
Metabolic dysfunction-associated steatohepatitis (MASH) in adults with moderate-to-advanced liver scarring, but not cirrhosis
To help with weight management along with a lower-calorie diet and exercise in:
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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. (2025). Zepbound (tirzepatide) injection, for subcutaneous use [package insert]. DailyMed.
Heise, T., et al. (2023). Tirzepatide reduces appetite, energy intake, and fat mass in people with type 2 diabetes. Diabetes Care.
Jones, M. W., et al. (2025). Acute cholecystitis. StatPearls.
Malhotra, A., et al. (2024). Tirzepatide for the treatment of obstructive sleep apnea and obesity. The New England Journal of Medicine.
MedlinePlus. (2023). Aspiration pneumonia.
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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