Who shouldn't use it
- A personal or family history of medullary thyroid carcinoma (MTC)
- Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
- A known serious allergy to the medicine or any of its ingredients
Other label warnings
- Pancreatitis. Stop and get care right away for severe stomach pain that won't go away, with or without vomiting, sometimes felt in the back.
- Gallbladder problems. Gallstones and gallbladder inflammation were more common in trials, especially with rapid weight loss. Watch for upper-right belly pain, fever, yellow skin or eyes, or clay-colored stools.
- Low blood sugar. Risk rises when combined with insulin or a sulfonylurea. Signs include shakiness, sweating, fast heartbeat, confusion and dizziness.
- Kidney problems. Vomiting and diarrhea can cause dehydration, which can worsen kidney function. Drink fluids and call your prescriber if you can't keep them down.
- Serious allergic reactions. Get emergency help for swelling of the face, lips, tongue or throat, trouble breathing or a severe rash.
- Severe stomach problems. Not recommended if you already have severe gastroparesis (very slow stomach emptying).
- Aspiration during anesthesia. Tell your care team you take a GLP-1 medicine before any surgery or procedure that uses anesthesia or deep sedation, because food can stay in the stomach longer.
Specific to Zepbound
- Tirzepatide can make birth control pills less effective. The label advises switching to a non-oral method, or adding a barrier method, for 4 weeks after starting and for 4 weeks after each dose increase.
- Tell your prescriber about new or worsening depression or mood changes. In January 2026 the FDA asked makers to remove the suicidal-thoughts warning after a review of 91 trials found no increased risk; check the current label.
Pregnancy
Not recommended during pregnancy. Talk to your prescriber if you plan to become pregnant.
Common questions
Does Zepbound have a boxed warning?
Yes. Risk of thyroid C-cell tumors. In rodent studies these medicines caused thyroid C-cell tumors. It isn't known whether they cause them in people, including medullary thyroid carcinoma (MTC). Don't use them if you or a family member has had MTC, or if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
Who should not take Zepbound?
People with a personal or family history of medullary thyroid carcinoma, people with MEN 2, and anyone with a serious allergy to it.
Sources
Clinician review pending. Drafted from primary sources and waiting for sign-off by a licensed clinician (MD, DO or PharmD) before launch. Every number is checked against its source. Drug facts are re-checked quarterly, prices monthly and whenever a label changes. How we review · Report an error