Zepbound constipation: What to expect and how to manage it

In this article:

• Can Zepbound cause constipation?
• Why might Zepbound cause constipation?
• How long does Zepbound constipation last?
• Other possible Zepbound side effects
• Tips for reducing and preventing Zepbound constipation
• When to see a doctor about Zepbound constipation

In this article

• Can Zepbound cause constipation?
• Why might Zepbound cause constipation?
• How long does Zepbound constipation last?
• Other possible Zepbound side effects
• Tips for reducing and preventing Zepbound constipation
• When to see a doctor about Zepbound constipation

Zepbound (tirzepatide) is a prescription injectable medication approved by the Food and Drug Administration (FDA) for weight loss in adults with obesity or who are overweight with a weight-related medical condition. It is also approved to treat moderate to severe obstructive sleep apnea (OSA) in adults with obesity. Like other drugs in its class, the most common side effects of Zepbound affect the digestive system. We’ll explain the relationship between Zepbound and constipation, and what experts might recommend for patients experiencing this symptom.

Can Zepbound cause constipation?

Yes, constipation is one of the most common side effects in people using Zepbound. Constipation is when someone has irregular or difficult bowel movements and can be caused by many different factors. In clinical trials, about 11%–21% of people on Zepbound experienced constipation. 

“Most people have very mild issues with constipation while on tirzepatide, if they have any problems at all,” says Jennifer Brown, MD, obesity medicine specialist at MyObesityTeam. In clinical trials, there were no reports of subjects stopping the study because of constipation, even after up to 88 weeks (almost two years) of treatment.

Why might Zepbound cause constipation?

Constipation is a common side effect of glucagon-like peptide-1 receptor agonists (GLP-1s). These drugs work by mimicking GLP-1, a hormone produced by the body to slow down digestion and reduce appetite. This results in weight loss and weight management, but can also cause constipation because food isn’t moving through the digestive system at the same rate without the medication. 

Rekha Kumar, MD, endocrinologist, obesity medicine specialist, and senior medical adviser at Found, explains, “Tirzepatide can slow down digestive motility, meaning food moves through the intestines more slowly. That slowing can cause constipation for some patients, especially early in treatment.”

Ashley Koff, RD, Nutrition Director for University of California at Irvine’s Susan Samueli Integrative and Functional Medicine Fellowship, adds that if someone already experiences bloating or has sluggish digestion, they may be at higher risk of constipation with Zepbound. She explains that factors that can increase the chances of constipation include low fiber and water intake, a high protein diet, not being physically active, and taking certain supplements, such as iron. 

How long does Zepbound constipation last?

Constipation due to Zepbound can typically improve once your body adapts to your maintenance dose. In clinical trials, most gastrointestinal symptoms from taking Zepbound decreased over time. However, side effects can show up differently for everyone. “In most cases, constipation is temporary and improves as patients adjust to the medication,” Dr. Kumar says. 

“Constipation resolves in many patients once they have been on tirzepatide for a couple of months, but others struggle with constipation as long as they remain on the medication,” Dr. Brown adds.

Other possible Zepbound side effects

Constipation is just one common side effect of starting Zepbound. Other possible side effects of Zepbound include nausea, diarrhea, vomiting, abdominal pain, and irritation at the injection site. The most common side effect of Zepbound is nausea, reported by 25%–28% of patients in clinical trials. 

Diarrhea is a possible side effect of Zepbound that’s more common than constipation. In clinical trials, between 19% and 23% of patients reported diarrhea. 

Tips for reducing and preventing Zepbound constipation

There are ways to reduce and prevent constipation caused by Zepbound, including:

• Maintaining hydration by drinking at least 80 ounces of water a day
• Eating soluble fiber-rich foods such as oats, chia seeds, and flax seeds
• Taking fiber supplements to increase fiber intake
• Sticking to smaller, balanced meals with whole foods instead of ultraprocessed foods 
• Walking 10–20 minutes daily
• Spacing out high-protein meals

Koff suggests working with a dietitian to help with an appropriate treatment for constipation. She adds, “A good starting point is the concept of ‘pit stops,’ about every three hours get in water, move your body, get in a balance of macros (carbs, protein, fats, and fiber), and assess the need for supplemental sources of nutrients like minerals.”

“If a patient still has problems with constipation, I recommend they start either an over-the-counter (OTC) stool softener like Colace or a mild laxative like Miralax,” Dr. Brown says.  Sometimes, patients have such severe constipation that they have to stop taking tirzepatide.

When to see a doctor about Zepbound constipation

Constipation is a common side effect of Zepbound, but there may be times when medical care is needed. “If they have not had a bowel movement in the past three days, they should contact their doctor,” Dr. Brown says. 

Dr. Kumar says, “I advise patients to contact their doctor if constipation lasts more than a week, is accompanied by severe pain, vomiting, or blood in the stool. While constipation is usually mild, it’s important to rule out anything more serious. I also might ask patients to skip a dose to stimulate movement or bowel activity.”

Severe abdominal pain, vomiting, and blood in the stool are serious side effects of Zepbound that you should see your healthcare provider about right away. Other serious side effects of Zepbound to look for include:

• Blood in urine
• Allergic reactions
• Symptoms of low blood sugar (hypoglycemia), including sweating, shaking, dizziness, and hunger, especially in people with Type 2 diabetes
• Suicidal ideation or suicidal behavior

Bottom line: Zepbound constipation is typically mild

Based on published clinical trials and healthcare providers’ experiences, constipation due to Zepbound is typically mild and temporary. It’s less common than other side effects, such as nausea and diarrhea, and it can be easily managed by lifestyle adjustments, such as staying hydrated, increasing physical activity, and adding more fiber to the diet. 

Even if this side effect is mild and temporary, it can be helpful to work with a healthcare provider to prevent and treat constipation due to Zepbound. Prescribers can adjust your Zepbound treatment, while nutrition professionals, such as dietitians, can provide specific recommendations on meal timing, ways to increase dietary fiber, and supplement adjustments to support regular bowel movements. If you haven’t had a bowel movement in three days, or if you have abdominal pain or blood in your stool, contact your healthcare provider right away.