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Key takeaways
Zepbound is an injectable weight loss medication for people with obesity and who are overweight with a weight-related health condition.
It’s considered safe for most, but there are side effects such as nausea, diarrhea, constipation, or injection site reactions.
Certain people should not take Zepbound, including those with a personal or family history of medullary thyroid carcinoma or those with Multiple Endocrine Neoplasia syndrome type 2.
Zepbound (tirzepatide) is a brand-name weight loss medication. It mimics two different hormones—glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1)—to reduce appetite, slow down digestion, and help you lose weight. Zepbound is also FDA approved to treat moderate to severe obstructive sleep apnea in adults with obesity. Zepbound contains the same active ingredient as Mounjaro, which is approved to improve blood sugar levels in people with Type 2 diabetes.
Zepbound is considered safe for most people, but it’s not risk-free. People with certain health conditions shouldn’t take it because of the potential side effects. Here’s what to know.
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Is Zepbound safe?
Most people who are either obese or overweight with one weight-related complication can safely use Zepbound, according to Jennifer Brown, MD, an obesity medicine specialist based in West Virginia. Approved by the U.S. Food and Drug Administration (FDA), Zepbound underwent rigorous clinical trials to test both its safety and effectiveness. The approval means it met strict standards for use in eligible patients. FDA approval is the “gold standard” for medications in the U.S., adds Angela Baalmann, Pharm.D., assistant professor of clinical sciences at High Point University’s Fred Wilson School of Pharmacy.
That doesn’t mean Zepbound (or any other FDA-approved drug) is completely risk-free, but it does mean that:
- People taking Zepbound can expect to improve their health without undue safety issues.
- Any identified safety concerns are disclosed to people considering use of the medication.
- The FDA will continue to review Zepbound’s safety and efficacy even after its approval.
Who is Zepbound for?
Zepbound is for obese or overweight people who need to lose weight or have obstructive sleep apnea (OSA). The goal in both uses is to help you lose excess body weight and maintain your weight loss.
To meet the criteria for treatment with Zepbound, you need to either:
- Have a body mass index (BMI) of 30 or higher (obesity)
- Have a BMI of 27 or higher, plus at least one weight-related condition (like high blood pressure, type 2 diabetes, or high cholesterol) or moderate-to-severe OSA
Most people will also need to have tried and failed to lose weight through diet and exercise for three to six months before a provider will agree to prescribe Zepbound. In fact, it’s recommended to use Zepbound alongside lifestyle changes, such as a reduced-calorie eating plan and regular physical activity. In other words, the medication should be an additional tool in your toolbox for weight loss, not the only strategy.
Common side effects
Many people have few or no side effects when taking Zepbound. Some people have more, especially when just starting the medication. The most common side effects of Zepbound include:
- Upset stomach (nausea and vomiting or abdominal pain)
- Diarrhea or constipation
- Indigestion, burping, heartburn, and acid reflux
- Injection site reactions
- Fatigue
- Hair loss
These side effects often improve in a few weeks once your body has adjusted to the medication. You can manage side effects by drinking plenty of water, eating smaller, more frequent meals, and eating enough protein. It may also help to avoid high-fat foods and eat bland foods, like rice and crackers, until gastrointestinal symptoms improve. People with symptoms of an allergic reaction (such as hives, trouble breathing, or swelling) should seek emergency medical help.
Serious risks and contraindications
Like any medication, there are some rare side effects that can be serious, such as inflammation of the pancreas or kidney issues. Additionally, because animal studies have shown a potential link between GLP-1 drugs and thyroid cancer, certain individuals should not take Zepbound. Here’s what you need to know.
Thyroid tumors
Zepbound has a boxed warning, the most serious warning required by the FDA. Rodent studies have found an association between tirzepatide and thyroid C-cell tumors, which include medullary thyroid carcinoma (MTC). Experts don’t know why this link exists or if it applies to humans. The warning states that people with a personal or family history of MTC, as well as people with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), should not use Zepbound. Any individual who uses Zepbound should be alert to symptoms of thyroid cancer, including a lump in your throat, hoarseness or cough, and trouble swallowing or breathing.
Pancreatitis
Pancreatitis is inflammation of your pancreas, an organ that helps with digestion and produces insulin. If you have a history of pancreas problems, be sure to tell your healthcare provider. Symptoms of pancreatitis include severe stomach pain that will not go away, with or without vomiting, nausea, fever, and chills. You may feel the pain from your abdomen to your back.
Gallbladder disease
Your gallbladder is an organ near your liver that helps you break down fats using a type of digestive fluid called bile. Zepbound and similar drugs have been linked to a higher risk of gallbladder problems, such as gallstones, inflammation, or cholecystitis. Symptoms of gallbladder problems include upper stomach pain (possibly extending as far up as the shoulder), fever, nausea, vomiting, yellowing of the skin or whites of the eyes (jaundice), or clay-colored stools.
Kidney injury
Zepbound can cause dehydration in some people, particularly if you’re experiencing excessive nausea, vomiting, or diarrhea. According to Dr. Brown, anyone with existing kidney problems should be cautious when starting Zepbound because dehydration can worsen kidney issues. Keep an eye out for symptoms like decreased urination, swelling in the lower extremities, fatigue, and flank pain.
Gastroparesis
Gastroparesis is a condition in which the stomach slows or stops moving food through the digestive system. Common symptoms include feeling full quickly or for longer than normal, nausea, and vomiting. The prescribing information notes that Zepbound is associated with these gastrointestinal reactions, which can sometimes be severe, and people with severe gastrointestinal problems or severe gastroparesis should not use this medicine.
Diabetic retinopathy
Diabetic retinopathy occurs when persistently high blood sugar damages the retina of the eye. Symptoms include vision changes and, in later stages, dark spots or streaks in the vision. In rare cases, taking Zepbound may temporarily exacerbate this condition because it can trigger dramatic drops in blood sugar, a risk factor for diabetic retinopathy. Dr. Brown says anyone with diabetic retinopathy should have regular exams to make sure their eye disease isn’t worsening.
Who should not take Zepbound?
Before using Zepbound, tell your healthcare provider about all of your medical conditions and medical history. There are some medical conditions that require cautious use of Zepbound, although some people should not use Zepbound at all because they have a significantly higher risk for serious side effects or complications. This includes people with:
- A personal or family history of medullary thyroid cancer (MTC) or those who have MEN 2
- A known allergy or previous allergic reaction to tirzepatide or any ingredient in Zepbound
- A history of severe gastrointestinal problems or severe gastroparesis
You should also notify your healthcare provider if you have any upcoming surgeries or procedures, since the medication may cause aspiration during anesthesia. You may have to pause the medicine for about a week before surgery. Your healthcare provider can give you guidance.
Zepbound is not FDA-approved for use in people under age 18 and should not be used during pregnancy. The risks of Zepbound in breastfeeding individuals are not known, so if you are breastfeeding, check with your healthcare provider for medical advice.
Important considerations and precautions for treatment
Zepbound may also interact with certain drugs, so make sure you tell a healthcare professional about any medications or over-the-counter supplements you take, especially:
Make sure you follow your healthcare provider’s dosing instructions carefully and keep them updated about any moderate to severe or persistent side effects. Zepbound is meant to be started at a low dose and increased slowly to reduce the severity of side effects like vomiting and diarrhea, says Dr. Baalmann. This also gives you and your provider a chance to assess if Zepbound is working for you the way it’s supposed to. Never increase the dose without consulting your healthcare team.
“[These] dosing guidelines help everyone involved see if the medication is right for the person using it, both from a safety and efficacy standpoint,” Dr. Baalmann says. “If they aren’t followed, increased side effects may occur, and weight loss effects [could] be harder to understand.”
Is Zepbound right for you?
Zepbound is highly effective, helping many lose up to 20% of their body weight after 72 weeks. Losing weight can make you healthier overall, reducing your risk for serious events like heart attack and stroke. Many can take this medication with minimal or temporary side effects that go away as you adjust to the medication.
However, Zepbound isn’t right for everyone, and some people shouldn’t use it at all. It’s best to work with your healthcare team to come to a shared decision on whether Zepbound is safe for you, taking into consideration your overall health, disease risk factors, and medical history, advises Dr. Brown
- FDA approves new medication for chronic weight management, U.S. Food & Drug Administration (2023)
- FDA approves first medication for obstructive sleep apnea, U.S. Food & Drug Administration (2024)
- Highlights of prescribing information, Eli Lilly and Company (2025)
- Your weekly Zepbound routine, Eli Lilly and Company (2025)
- Multiple endocrine neoplasia (MEN) type 2, American Thyroid Association
- Acute pancreatitis caused by tirzepatide, Cureus (2024)
- Gallbladder disease, NewYork-Presbyterian
- Association of glucagon-like peptide-1 receptor agonist use with risk of gallbladder and biliary diseases, JAMA Internal Medicine (2022)
- Acute kidney injury (AKI), National Kidney Foundation, Inc. (2024)
- Gastroparesis, National Institute of Diabetes and Digestive and Kidney Diseases (2018)
- Tendency of semaglutide to induce gastroparesis: A case report, Cureus (2024)
- Diabetic retinopathy, National Eye Institute (2025)
- Popular weight loss drug does not appear to worsen diabetic eye disease in most patients, new study suggests, American Academy of Ophthalmology (2023)
- Multisociety clinical practice guidance for the safe use of glucagon-like peptide-1 receptor agonists in the perioperative period, Surgery for Obesity and Related Diseases (2024)