Eli Lilly and Company’s Zepbound is an FDA-approved injection medication for moderate-to-severe sleep apnea and chronic weight management for adults living with obesity or who are overweight with at least one weight-related condition (such as Type 2 diabetes) in addition to adhering to a reduced calorie diet and an increased physical activity level.
Medication Overview:
- Brand Name: Zepbound
- Generic Name: Tirzepatide
- Treatment for: Chronic Weight Management
- Manufacturer: Eli Lilly and Company
- FDA Approval: November 2023
| Indicated Condition | Indication | Age | Date Approved |
|---|---|---|---|
| Obesity | in combination with a reduced-calorie diet and increased physical activity: to reduce excess body weight and maintain weight reduction long term in adults with obesity or adults with overweight in the presence of at least one weight-related condition. | Adult | November 2023 |
| Moderate-to-severe Sleep Apnea | in combination with a reduced-calorie diet and increased physical activity: to treat moderate to severe obstructive sleep apnea in adults with obesity. | Adult | December 2024 |
Warnings and Precautions:
- Severe gastrointestinal adverse reactions: Use has been associated with gastrointestinal adverse reactions, sometimes severe. Has not been studied in patients with severe gastrointestinal disease and is not recommended in these patients.
- Acute kidney injury: Monitor renal function in patients reporting adverse reactions that could lead to volume depletion.
- Acute gallbladder disease: Has been reported in clinical trials. If cholecystitis is suspected, gallbladder studies and clinical follow-up are indicated.
- Acute pancreatitis: Has been reported in clinical trials. Discontinue promptly if pancreatitis is suspected.
- Hypersensitivity reactions: Serious hypersensitivity reactions (e.g., anaphylaxis, angioedema) have been reported postmarketing with tirzepatide. If suspected, advise patients to promptly seek medical attention and discontinue Zepbound.
- Hypoglycemia: Concomitant use with insulin or an insulin secretagogue may increase the risk of hypoglycemia, including severe hypoglycemia. Reducing dose of insulin or insulin secretagogue may be necessary. Inform all patients of the risk of hypoglycemia and educate them on the signs and symptoms of hypoglycemia.
- Diabetic retinopathy complications in patients with type 2 diabetes mellitus: Has not been studied in patients with non-proliferative diabetic retinopathy requiring acute therapy, proliferative diabetic retinopathy, or diabetic macular edema. Monitor patients with a history of diabetic retinopathy for progression.
- Suicidal behavior and ideation: Monitor for depression or suicidal thoughts. Discontinue Zepbound if symptoms develop.
- Pulmonary aspiration during general anesthesia or deep sedation: Has been reported in patients receiving GLP-1 receptor agonists undergoing elective surgeries or procedures. Instruct patients to inform healthcare providers of any planned surgeries or procedures.
Dosage and Administration:
- Recommended dose escalation schedule: The recommended starting dosage is 2.5 mg injected subcutaneously once a week for four weeks. Then, increase the dosage by 2.5 mg increments after at least four weeks until the recommended maintenance dosage is achieved. Consider treatment response and tolerability when selecting the maintenance dosage.
- Recommended Maintenance and Maximum Dosage:
- For weight reduction and long-term maintenance: 5 mg, 10 mg, or 15 mg injected subcutaneously once weekly.
- For obstructive sleep apnea: 10 mg or 15 mg injected subcutaneously once weekly.
- Maximum recommended dosage: 15 mg injected subcutaneously once weekly.
Contraindications:
Zepbound is contraindicated in patients with:
- A personal or family history of medullary thyroid carcinoma or in patients with multiple endocrine neoplasia syndrome type 2
- Known serious hypersensitivity to tirzepatide or any of the excipients in Zepbound Serious hypersensitivity reactions, including anaphylaxis and angioedema, have been reported with tirzepatide
- Personal or family history of medullary thyroid carcinoma or in patients with multiple endocrine neoplasia syndrome type 2
- Known serious hypersensitivity to tirzepatide or any of the excipients in Zepbound
Drug Interactions:
Zepbound delays gastric emptying and has the potential to impact the absorption of concomitantly administered oral medications.
Adverse Reactions:
- Acute gallbladder disease
- Acute kidney injury
- Acute pancreatitis
- Diabetic retinopathy complications in patients with type 2 diabetes mellitus suicidal behavior and ideation
- Hypersensitivity reactions
- Hypoglycemia
- Pulmonary aspiration during general anesthesia or deep sedation
- Risk of thyroid C-cell tumors
- Severe gastrointestinal adverse reactions
The most common adverse reactions, reported in ≥5% of patients treated with Zepbound are: nausea, diarrhea, vomiting, constipation, abdominal pain, dyspepsia, injection site reactions, fatigue, hypersensitivity reactions, eructation, hair loss, and gastroesophageal reflux disease.
Examples of Tirzepatide in Guidelines
- Diabetes Standards of Care 2025, American Diabetes Association
- 8.17: In people with diabetes and overweight or obesity, the preferred pharmacotherapy should be a glucagon-like peptide 1 receptor agonist or dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide 1 receptor agonist with greater weight loss efficacy (i.e., semaglutide or tirzepatide), especially considering their added weight-independent benefits (e.g., glycemic and cardiometabolic).”
Please note: This article is current as of June 12, 2025. Consult our clinical guidelines library or drug information tool to ensure you always have the most up-to-date information.
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