Tirzepatide (obesity)
ZEPBOUND
Pronunciation: tir-ZEP-a-tide (ZEP-bownd)
“Zeppelin bound”
What it isDual GIP and GLP-1 receptor agonist for chronic weight management and obstructive sleep apnea in adults with obesity.
Why this oneIt was the first drug approved to treat obstructive sleep apnea itself, rather than only its daytime sleepiness.
What limits itNausea, vomiting and constipation drive discontinuation; delayed gastric emptying matters before anesthesia.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Chronic weight management (obesity, or overweight with ≥1 weight-related comorbidity) | Adults | 2.5 mg SC once weekly ×4 weeks | 5, 10, or 15 mg QW | 15 mg QW |
| Moderate-to-severe obstructive sleep apnea with obesity | Adults | 2.5 mg SC once weekly ×4 weeks | 10 or 15 mg QW | 15 mg QW |
Titration Increase by 2.5 mg no sooner than every 4 weeks
Renal No adjustment needed
Hepatic No adjustment needed
Once weekly; do not coadminister with other tirzepatide-containing products or any GLP-1 receptor agonist
Instructions
- Inject SC in abdomen, thigh, or upper arm; rotate sites
- Administer once weekly at any time of day, with or without meals
- Use with a reduced-calorie diet and increased physical activity
Available strengths
- inj 2.5, 5, 7.5, 10, 12.5, 15 mg/0.5 mL
- inj 20, 30, 40, 50, 60 mg/2.4 mL
Contraindications
- Personal or family history of medullary thyroid carcinoma or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
Cautions
- Severe gastrointestinal reactions
- Acute kidney injury from volume depletion
- Acute gallbladder disease
- Acute pancreatitis
- Hypoglycemia (with insulin or insulin secretagogue)
- Diabetic retinopathy complications (type 2 diabetes)
- Pulmonary aspiration during general anesthesia/deep sedation
- Hypersensitivity reactions
Adverse reactions
- Nausea
- Diarrhea
- Vomiting
- Constipation
- Abdominal pain
- Dyspepsia
- Injection site reactions
- Fatigue
- Eructation
- Hair loss
- Gastroesophageal reflux disease
Pregnancy Weight loss offers no benefit and may cause fetal harm; discontinue when pregnancy is recognized
Lactation Tirzepatide undetectable or low in breast milk; no data on breastfed infant
Cost
| Strength | #/mo | generic $/unit | brand $/unit | CostPlus | |
|---|---|---|---|---|---|
| 2.5 mg/0.5 mL | inj | per unit | — | $532.45/mL | not offered |
| 5 mg/0.5 mL | inj | per unit | — | $532.36/mL | not offered |
| 7.5 mg/0.5 mL | inj | per unit | — | $532.34/mL | not offered |
| 10 mg/0.5 mL | inj | per unit | — | $532.36/mL | not offered |
| 12.5 mg/0.5 mL | inj | per unit | — | $525.85/mL | not offered |
| 15 mg/0.5 mL | inj | per unit | — | $532.22/mL | not offered |
| 20 mg/2.4 mL | inj | per unit | — | not offered | |
| 30 mg/2.4 mL | inj | per unit | — | not offered | |
| 40 mg/2.4 mL | inj | per unit | — | not offered | |
| 50 mg/2.4 mL | inj | per unit | — | not offered | |
| 60 mg/2.4 mL | inj | per unit | — | not offered |
Other forms: Tirzepatide (MOUNJARO)
⚠ BOXED WARNING
- Thyroid C-cell tumors in rodents
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilityGI intolerance, gallbladder disease and rare pancreatitis; hypoglycemia is uncommon without insulin or sulfonylureas.
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