Everything You Need to Know About Zepbound

Zepbound is the newest medication approved in the U.S. by the Food and Drug Administration (FDA) for chronic weight management. 

Although not specifically approved to treat these conditions, it also helps people with insulin resistance achieve better blood sugar and A1c levels and lower blood pressure and cholesterol levels. 

This article will explain everything you need to know about Zepbound before taking the medication. 

(Image courtesy of Eli Lilly and Company.)

What is Zepbound?

Zepbound belongs to the dual-action class of medications known as glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonists. These drugs are designed to mimic hormones that regulate blood sugar levels and suppress appetite in response to the intake of specific nutrients, primarily carbohydrates and fats.

Approved by the FDA on November 8, 2023, Zepbound is manufactured by Eli Lilly and Company. 

Its active ingredient, tirzepatide, is administered as a once-weekly injection for chronic weight management in adults who are obese or overweight and have one or more weight-related conditions, such as type 2 diabetes, high blood pressure, or high cholesterol.

Zepbound is part of a broader category of medications for weight management that includes FDA-approved GLP-1 receptor agonists like Wegovy (semaglutide) and Saxenda (liraglutide).

Are Zepbound and Mounjaro the same thing?

Mounjaro is a sister medicine to Zepbound. While both drugs have tirzepatide as their active ingredient, their approved uses differ, with Mounjaro FDA-approved for managing blood sugar levels in people with type 2 diabetes.

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

What are the benefits of Zepbound?

Zepbound is a powerful medication. There are many benefits to taking Zepbound, including the following:

Weight loss

In one clinical trial for Zepbound, participants who completed a 36-week treatment protocol experienced an average weight loss of 20.9 percent.

From week 36 to week 88, participants who continued with Zepbound experienced an additional average weight reduction of approximately 5.5 percent, whereas those who were switched to the placebo (inactive treatment) saw an average weight gain of 14 percent. This demonstrates Zepbound’s effectiveness in sustaining the weight loss achieved during the initial treatment phase.

Overall, 89.5 percent of the study participants receiving Zepbound at 88 weeks maintained at least 80 percent of their weight loss compared to 16.6 percent receiving the placebo. 

The overall weight loss from the start of the study to week 88 was 25.3 percent for those taking Zepbound versus 9.9 percent for those taking the placebo. 

The study authors noted that participants who were switched to a placebo, effectively stopping Zepbound, regained much of the weight they had lost. This highlights the importance of continuous treatment with Zepbound to sustain the benefits of weight loss.

In other research, Zepbound has been found to be even more effective for weight loss than Ozempic. Participants who took Zepbound lost between 15 to 21 percent of their body weight, on average, compared to 14.9 percent for those who took Ozempic.

Lower blood pressure

Although Zepbound is not specifically approved for treating high blood pressure, clinical trials have shown that people taking Zepbound, alongside diet and exercise, experienced reductions in blood pressure. 

This finding underscores the potential cardiovascular benefits associated with weight loss and metabolic improvement achieved through Zepbound, which could be particularly useful for people with diabetes, who often deal with coexisting high blood pressure.

Lower cholesterol

In the clinical trials, participants taking Zepbound, along with a healthy diet and exercise, experienced improvements in their cholesterol levels. 

While Zepbound is not officially approved for cholesterol management, these improvements highlight the broader benefits of substantial weight loss achieved with the medication. Maintaining healthy cholesterol levels is extremely important for people with diabetes, given their heightened risk for heart disease and stroke.

Better blood sugar levels 

Compared to the placebo, Zepbound was associated with significant improvements in blood sugar (fasting blood glucose) and A1c levels (a measure of glucose control over the previous 2 to 3 months) in study participants as well.

This may be because GIP/GLP-1 medications work by helping the pancreas produce more insulin, decreasing the amount of sugar released by the liver, increasing the body’s sensitivity to insulin, and slowing digestion, making you feel full longer.

Although Zepbound itself is marketed for weight management, tirzepatide, as noted earlier, is also approved under the brand name Mounjaro for treating type 2 diabetes. Therefore, the observed improvements in blood sugar levels present an added benefit, especially considering the common overlap between obesity and type 2 diabetes.

Why would you be prescribed Zepbound?

Zepbound is FDA-approved specifically for chronic weight management. 

The medicine is approved for use in adults 18 and older who have a body-mass index (BMI, a measure of weight relative to height) of 30 or higher, or if their BMI is 25 or higher and they have one weight-related medical condition, such as type 2 diabetes, high blood pressure, or high cholesterol. 

Zepbound may lower blood sugar levels and improve A1c, but it is not a diabetes medication. (Remember that its active ingredient, tirzepatide, is also approved for treating type 2 diabetes under the brand name Mounjaro.)

If you do not meet the criteria to take Zepbound, you may qualify for a GLP-1 medication such as Ozempic, Trulicity (dulaglutide), or Victoza (liraglutide), based on your doctor’s assessment.

What are the side effects of Zepbound?

The most common side effects experienced in clinical trials were mild to moderate gastrointestinal events, such as nausea, diarrhea, and vomiting. 

Other common side effects may include: 

• Stomach pain
• Constipation 
• Hypoglycemia (low blood sugar), if you take insulin 

Although rare, more severe complications may include: 

• Thyroid tumors, including cancer
• Pancreatitis (inflammation of the pancreas)
• Changes in vision (such as worsening of diabetic retinopathy)
• Kidney problems
• Gallbladder problems, which may present as upper abdominal pain, fever, jaundice, or clay-colored stools
• Serious allergic reactions
• Hair loss and hair thinning (this may be a result of rapid weight loss and not a side effect of the medication itself)

Several of these more severe side effects can lead to health complications and death. 

Call your doctor or seek emergency medical attention if you:

• Develop a fever
• Experience changes or worsening of your vision 
• Feel weak or in pain after taking the medication 
• Think you may be having an allergic reaction to the medication 

Seek emergency medical attention if you’re experiencing severe low blood sugar levels, which can be fatal if not treated quickly. 

Does Zepbound affect hunger?

Yes — suppressing appetite is a key mechanism through which Zepbound aids in weight loss.

Zepbound does this in a few ways. First, it inhibits the release of glucagon from the liver, which naturally lowers blood sugar levels and decreases hunger pangs. 

Second, it slows stomach emptying to keep you feeling fuller for longer and less likely to snack on empty calories.

Third, it increases insulin sensitivity by prompting the pancreas to release insulin when blood sugar levels are high. This stops blood sugar swings and decreases hunger at its core. 

Additionally, Zepbound, through its GLP-1 receptor agonist activity, directly affects appetite centers in the brain, further contributing to a reduced sense of hunger and lower calorie intake.

What are the doses of Zepbound?

Zepbound comes in several different doses tailored to meet individual needs, with the appropriate dose depending on factors such as your weight, tolerance to the medication, any side effects experienced, health history, goals, and lifestyle. The decision on the best dose in your situation will be determined between you and your doctor. 

Zepbound is administered subcutaneously (under the skin) using a single-dose injection pen, and is available in the following incremental doses to allow for dose adjustment :

• 2.5 milligrams (mg): This is the starting dose.
• 5 mg
• 7.5 mg
• 10 mg
• 12.5 mg
• 15 mg

Each dose is administered once weekly with or without food, ideally on the same day and at the same time each week, to maintain consistent blood levels of the medication.

Any changes to your dosing regimen should be made under the guidance of your doctor, who can consider your response to the treatment and any side effects you may encounter.

How much Zepbound should I take?

This decision should be made in consultation with your doctor. However, initially, everyone who takes Zepbound starts with a 2.5 mg weekly injection to minimize the risk of side effects and allow the body to adjust to the medication. 

This starting period lasts for at least four weeks, providing an opportunity to monitor for any adverse reactions. In clinical trials, 7 percent of participants stopped taking the medication due to adverse side effects. 

Based on your response and the medication’s tolerability, your doctor may adjust your dose, with 15 mg once weekly being the maximum recommended dose. It’s crucial to follow your doctor’s instructions and not to change your dose without medical advice.

What happens if I take too much Zepbound?

If you take too much Zepbound you may experience severe adverse side effects, including:

• Debilitating nausea 
• Excessive vomiting (with the inability to keep food down)
• Diarrhea
• Stomach pain 
• Low blood sugar, especially if you’re also on insulin — this can be fatal if not treated immediately

Call your doctor or seek emergency medical attention immediately if you’ve accidentally taken too much Zepbound or accidentally taken your dose twice within one week. 

Do I need to change my diet to lose weight on this medication?

Changing your diet is not strictly necessary to lose weight while taking Zepbound. However, the medication is most effective when used in conjunction with increased physical activity and healthy dietary changes.

Additionally, the medication may make you nauseous, and it may make it harder to eat large meals and meals high in fat, especially when you first start taking the drug.

Talk with your doctor if you’re interested in changing your diet, or meet with a registered dietitian (RD) to formulate a meal plan that will work for you and your health goals. 

Also speak with your doctor if you’re experiencing adverse side effects like nausea and vomiting and are having trouble eating regular meals and snacks. 

You may also need to lower your dose if you’re dealing with low blood sugars due to persistent nausea or vomiting. 

What happens if I miss a dose of Zepbound?

It is no big deal if you forgot to take your weekly dose of Zepbound. However, consistency is key to the greatest health benefits and success. 

If you miss a dose of your medication, try to take it as soon as possible. However, if it’s been more than four days (96 hours) since your missed dose, just skip that week and wait until your next weekly dose to resume taking your medication. This approach helps ensure you don’t take doses too close together, which could increase the risk of side effects.

After addressing a missed dose, you can continue with your regular once-weekly dosing schedule. If needed, the specific day of your weekly dose can be adjusted, as long as there is a minimum interval of 3 days (72 hours) between doses. This flexibility allows you to maintain the treatment’s effectiveness while accommodating any necessary changes to your routine.

Always check with your doctor if you’re unsure about how to manage a missed dose or if you have any concerns about your Zepbound treatment.

How do I take Zepbound?

Zepbound is taken via a subcutaneous (under-the-skin) injection using a pen device, designed for self-administration at home. It does not come in pill form. 

If there are any particles or discoloration present in the medication, do not use the pen, as it could be expired. 

Before injecting, clean the injection site with isopropyl rubbing alcohol. Rotate injection sites each week to prevent injuries and the development of scar tissue. 

Zepbound can typically be injected under the skin in the thigh, abdomen, or upper arm. 

Who shouldn’t take Zepbound?

Only take Zepbound if it has been prescribed to you by your doctor. This medication is not meant for the treatment of type 1, type 2, or gestational diabetes. 

Zepbound is not appropriate for people under 18 years old.

It is not recommended for use if you are pregnant, planning on becoming pregnant, or if you are breastfeeding.

Do not use Zepbound if you or any of your family members have ever had medullary thyroid carcinoma (MTC) or if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). 

Do not use Zepbound if you are allergic to tirzepatide. 

How can I stop taking Zepbound?

Never stop taking your medications without consulting with your doctor first. Doing so may result in rapid weight gain and insulin resistance. 

Your doctor can provide guidance on the best approach to discontinuing Zepbound, which may include gradually tapering the dose.

Also talk to your doctor about an alternative medication, exercise, or meal plan to help combat any rebound effects you may experience if you decide to stop taking Zepbound. 

Does Zepbound replace insulin?

No. Zepbound is not insulin and it is not an insulin replacement. It is not FDA-approved for the treatment of diabetes.

If you’ve been prescribed Zepbound for chronic weight management and also have diabetes, you will need to continue taking your diabetes medications, including insulin, as prescribed. 

Can I take Zepbound along with other medications?

This will depend on what other types of medications you’re currently prescribed. 

Always talk to your doctor before beginning a new medication if you take Zepbound. 

If you’re being prescribed Zepbound, disclose all the current medications you take to your doctor and ask about any contraindications for your safety and well-being. 

If you take birth control pills, be aware that Zepbound may reduce their effectiveness during the first four weeks of treatment and for four weeks following each dose increase, requiring a discussion on alternative or supplementary forms of contraception with your healthcare provider.

Zepbound is generally not recommended to be used along with other GLP-1 or GIP/GLP-1 medications like Wegovy, Mounjaro, Victoza, or Ozempic, due to the potential for additive effects or increased risk of side effects. Zepbound can be taken along with insulin.

How is Zepbound stored?

Zepbound should be kept refrigerated between 36 to 46 degrees Fahrenheit (2 to 8 degrees Celsius). Do not freeze Zepbound and do not use the medication if it is or has been frozen. 

How can I get a prescription for Zepbound?

Talk to your doctor if you wish to get a prescription for Zepbound. They can see if you qualify based on your health history and BMI and/or waist circumference. 

Talk with your doctor if you do not qualify for Zepbound but are looking to lose weight. 

They may be able to recommend other FDA-approved weight-loss medications that may be a better fit for you, such as Wegovy. 

How much does Zepbound cost?

How much you pay for the medicine will depend on your insurance coverage. The list price for Zepbound is $1,059.87 for a 30-day supply of the medication. 

Most people with insurance coverage will not pay anywhere near the list price of the medication. However, coverage and costs do vary by insurance plan. 

Unfortunately, at this time, Medicare does not cover weight loss medications, including Zepbound. However, financial assistance or patient support programs offered by the medication’s manufacturer may be available to help reduce costs for eligible people.

Final thoughts

Zepbound marks a notable advancement in chronic weight management, offering a new option for adults who are obese or overweight with related health conditions. 

As with any medication, it’s important to consider the benefits against potential side effects and to use Zepbound as part of a broader health strategy that includes lifestyle changes. Cost and insurance coverage are also important factors to consider. 

If you are interested in using Zepbound for weight loss, speak with your healthcare provider to determine if it’s right for you.