Zepbound is a prescription drug for chronic weight management first approved by the U.S. Food and Drug Administration (FDA) in 2023. 

This strong medication is very effective but can cause a variety of adverse side effects in people who take it. 

This article will explain everything you need to know about Zepbound side effects and what to do if you’re experiencing them.

Scale on ground with measuring tape

Key Points:

  • Zepbound is the newest GIP/GLP-1 receptor agonist medication approved by the FDA for chronic weight management for people who are obese or overweight, providing significant benefits for weight loss and metabolic health. 
  • Common side effects, as seen in clinical trials, include nausea, vomiting, diarrhea, and injection site reactions, with significant numbers of users experiencing at least one adverse effect in trials, mostly when starting treatment. These side effects are generally manageable and may diminish over time.
  • Lifestyle modifications, including eating smaller, more frequent meals and staying hydrated, along with medical guidance on dosage, can lessen most side effects.
  • While Zepbound shows promise in long-term weight management and metabolic health improvement, its short history of use means long-term side effects are not fully known.

What is Zepbound?

Zepbound (tirzepatide) is a once-weekly injectable medication used for chronic weight management. 

It is part of the dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide (GLP)-1 receptor agonist drug class, which works to mimic the hormones in the body that decrease appetite and regulate blood sugar levels. 

Zepbound can make people feel fuller for longer and it increases insulin sensitivity. It also delays stomach emptying, which can help lead to an overall reduction in calorie intake.

This is how the medication is effective in helping people lose weight, and lower blood sugar, blood pressure, and cholesterol levels. 

Read more in: Everything You Need to Know About Zepbound.

How does Zepbound work?

Zepbound works by activating the intestinal hormone receptors for glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which play key roles in reducing appetite and food intake.

Taken once per week in an injection, Zepbound has been proven effective in helping people lose significant amounts of weight (and maintain this weight loss). 

Zepbound works best when combined with changes to diet (reduction in calorie intake) and increases in physical activity. 

Learn more in: Everything You Need to Know About Zepbound.

What are the side effects of Zepbound?

Like all medications, Zepbound can cause side effects, although not everyone experiences them. Understanding these effects can help you manage them effectively with your healthcare provider’s guidance.

What are the more common side effects of Zepbound?

Most people may experience mild to moderate side effects that typically improve as the body adjusts to the medication. Common side effects include:

  • Nausea: Often goes away after the initial weeks of treatment.
  • Digestive issues: Diarrhea, vomiting, constipation, and stomach pain are common but usually decrease over time.
  • Injection site reactions: Redness and swelling at the injection site may occur.
  • Other: Fatigue, mild allergic reactions (such as fever or rash), burping, and symptoms of gastroesophageal reflux disease (GERD).

Managing mild side effects

Mild side effects like headaches, dizziness, and upset stomach generally do not disrupt daily activities and often resolve without intervention. If side effects persist or worsen, it’s important to speak with your physician.

What are the more rare, but serious side effects of Zepbound?

While less common, Zepbound can lead to more serious health concerns, including:

  • Severe hypoglycemia (<40 mg/dL), especially in people taking insulin or sulfonylureas.
  • Thyroid tumors, including a risk of cancer. 
  • Pancreatitis: Severe abdominal pain could indicate this condition.
  • Vision changes: Report any new or worsening vision issues promptly.
  • Kidney problems: Changes in urination frequency or color may be a sign of kidney issues.
  • Severe allergic reactions: Symptoms like difficulty breathing or facial swelling require immediate medical attention.
  • Hair loss: While some users report hair thinning, its direct link to Zepbound is not fully established and may relate to rapid weight loss rather than the medicine itself.

When to seek emergency help

Immediate medical attention is critical if you experience severe symptoms following a Zepbound injection, such as high fever, significant vision changes, intense pain, or signs of a severe allergic reaction. Fast treatment of severe low blood sugar is also vital to prevent life-threatening complications.

Note: Following the approval of a medication by the FDA, the agency continues to monitor its side effects. Should you experience any adverse effects from using Zepbound, you are encouraged to report them to the FDA through their MedWatch program.

Does Zepbound cause long-term side effects?

While clinical trials of Zepbound have established its safety and efficacy, the full scope of long-term side effects is still being investigated. 

As with any recently approved medication, especially those with new methods of treatment like Zepbound’s dual GIP and GLP-1 receptor agonism, continuing research is necessary to understand the long-term safety profile.

While most side effects tend to develop early in treatment, it’s important to remember that side effects can emerge at any point during prolonged medication use. Continuous monitoring by your healthcare providers is important to detect and manage any new or changing side effects.

If your doctor has prescribed you Zepbound for chronic weight management, you should expect to take the medication as part of a long-term treatment plan.

Is Zepbound safe for older adults?

It is. Zepbound is FDA-approved for adults 18 years and older and there is no age limit to the medication. 

If you are an older adult, however, talk with your doctor about any safety concerns they may have about putting you on the medication. 

For instance, if you’re older, on insulin, and are no longer detecting low blood sugar levels (a condition known as hypoglycemia unawareness), your doctor may not want you on a medication that potentially increases the likelihood of them, especially if you live alone. 

Each person is different, so always talk with your doctor if you’re interested in learning more. 

How can you decrease the side effects of Zepbound?

Managing the side effects of Zepbound effectively often involves simple lifestyle adjustments and open communication with your healthcare provider. While many side effects should improve as your body gets used to the medication, typically within the first few weeks of treatment, there are strategies to lessen them:

  • Dietary changes: Eating smaller, more frequent meals can help manage nausea and vomiting. Opt for low-fat, bland foods rather than high-fat or fried options to ease digestive discomfort.
  • Hydration: Increasing your fluid intake is important, especially if experiencing diarrhea or vomiting, to prevent dehydration.
  • Medication for nausea: If nausea is especially problematic, speak with your healthcare provider about the possibility of using anti-nausea medications, such as Zofran (ondansetron).
  • Dose adjustments: If side effects continue and are bothersome, talk to your healthcare provider. They may consider adjusting your Zepbound dosage or exploring alternative treatment options.

Always consult your healthcare provider before making any changes to your treatment plan, including dietary adjustments or adding new medications.

Does taking more make Zepbound side effects worse?

Zepbound is dose-dependent, meaning that the more medication you take, the more effective it is. However, this also means that the more medication you take, the more likely you are to experience adverse side effects.

While most side effects go away after your body gets used to the medication, each time you increase your dose, you risk experiencing more, new, or worsening side effects. 

This is why you should always only take the prescribed amount of Zepbound and never increase your dose without talking with your doctor first. 

Your doctor will work with you to determine the appropriate dose and dosing schedule, taking into account your health condition, treatment goals, and how you respond to the medication.

If the dose you’re on is not currently working for you, your doctor can determine how and when to calibrate it up or down to better meet your needs. 

Are side effects expected?

If you’ve recently been prescribed Zepbound, you can expect to experience at least one adverse side effect, especially when you first start taking the medication.

In the SURMOUNT-4 randomized clinical trial, 81 percent of participants reported at least one treatment-related adverse side effect during the treatment period, with the most frequent side effects being nausea (35.5 percent), diarrhea (21.1 percent), constipation (20.7 percent), and vomiting (16.3 percent). 

If you’re experiencing side effects that last more than several weeks or if they’re getting worse, call your doctor. 

Do you have to take Zepbound with food?

No, Zepbound can be taken either with or without food. 

Unlike medications like insulin, Zepbound does not cause acute low blood sugar levels. It does, however, subtly lower blood sugar levels (and increase insulin sensitivity) over time. 

Who should not take Zepbound? 

Only take Zepbound if you’ve been prescribed the medication. 

Zepbound is typically prescribed for people who have either:

Zepbound should not be used in people who are allergic to tirzepatide (its active ingredient). 

Zepbound has been shown to cause thyroid C-cell tumors in rats. If you have a personal or family history of medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome type 2, do not take this medication. 

(The medicine has a boxed warning for the risk of thyroid cancer, which is the most serious warning from the FDA.)

Zepbound is not FDA-approved for people younger than 18 years old. It should not be used in children. Zepbound is not appropriate for the treatment of type 1 diabetes, or in people who are pregnant, planning on becoming pregnant, or breastfeeding. 

If you are taking Zepbound and become pregnant, speak with your healthcare provider immediately. 

Talk with your doctor if you have pancreatitis, gallbladder problems, consistent low blood sugar levels, acute kidney injury or kidney disease, diabetic retinopathy, or suicidal ideation, as the medication can make these conditions worse. 

Help is available 

For immediate support during a crisis involving thoughts of suicide or self-harm, consider these options:

  • Reach out to the 988 Suicide and Crisis Lifeline by calling or texting 988 in the United States.
  • For text-based support, send “HOME” to the Crisis Text Line at 741741.
  • If you’re outside the United States, Befrienders Worldwide can help you find a local helpline.
  • In urgent situations where you feel safe, contacting 911 or your local emergency services is also a viable option.

Are there alternatives to Zepbound?

Yes. GLP-1 medications including Wegovy (semaglutide) or Saxenda (liraglutide) are also FDA-approved for chronic weight management and may be appropriate alternatives to Zepbound. 

Speak with your doctor about other weight-loss medications that might be appropriate choices for you.

Final thoughts

Zepbound represents a significant advancement in chronic weight management for people who are overweight or obese, offering a new treatment option with its approval by the FDA in 2023. As a powerful GIP/GLP-1 receptor agonist, it has shown promise in reducing appetite, improving insulin sensitivity, and contributing to significant weight loss and improvements in blood sugar, blood pressure, and cholesterol levels.

However, a majority of users may encounter side effects ranging from mild to severe. It’s important to take preventive measures to reduce the likelihood and severity of these effects, with strategies like dietary adjustments and hydration, and in close collaboration with your healthcare providers. Most side effects will go away on their own after your body gets used to the medication, usually after the first few weeks.

If all else fails, your doctor may lower your dose or recommend an alternative medication for you. 

Ultimately, Zepbound is not a standalone solution but part of a comprehensive treatment plan that includes lifestyle changes, dietary modifications, increased physical activity, and, where necessary, psychological support. 

Speak with your doctor if you’re interested in learning more about Zepbound and to determine if you’re eligible for treatment.