Zepbound-Branded Tirzepatide Treatment Plan
Written by Steve Silvestro, MD, Ro
Written by Steve Silvestro, MD, Ro
last updated: Nov 30, 2023
Key takeaways
We know you’re excited to start treatment. But before your first shot, take the time to read your entire treatment plan to understand the potential risks and benefits of Zepbound-branded tirzepatide (Zepbound). Please do not hesitate to contact our medical support team in your Ro account chat if you have any questions.
Here's what we'll cover
Quick Facts
How it works:
Zepbound is a dual-action medication that targets two hormone receptors in the body: GLP-1 (glucose-dependent insulinotropic polypeptide) and GIP (glucagon-like peptide-1 receptor agonists), which help regulate your metabolism.
It works by mimicking the function of naturally occurring hormones in your body to slow down how fast your stomach empties after you eat and act on your brain to make you less hungry.
When combined with an appropriate diet and exercise, Zepbound is an effective treatment for weight management.
When to take it:
You’ll use one Zepbound pen each week. Take your Zepbound on the same day each week (for example, every Monday), with or without food.
How to take it:
Zepbound comes in single-use injector pens. You should receive a pack of four pens, each with the same dose.
Each prefilled pen has a tiny needle at the tip. The needle is covered, so it’s okay if you don’t see it. After sterilizing a small area on your abdomen, thigh, or upper arm with an alcohol wipe, place the pen firmly on the skin and press the purple injection button at the top of the pen. Keep the pen and needle on the skin while holding the button for up to 10 seconds.
Each pen is meant to be used only once — after which it should be disposed of safely in a sharps container purchased from your local pharmacy or a heavy-duty plastic container with a screw-on lid.
You can find more detailed instructions and a video from the manufacturer below. If at any time you feel uncertain about how to use your medication, please reach out to your Ro-affiliated provider or a member of your care team.
Potential side effects:
Like those of other GLP-1s and GIP/GLP-1s, Zepbound’s most common side effects often improve within the first few weeks of treatment. Common side effects are often gastrointestinal complaints like nausea, diarrhea, and vomiting (see the full list below). More severe side effects are rare but possible, so please keep reading to learn about them all.
Clinical research on Tirzepatide (the active ingredient in Zepbound):
Research on the impact of tirzepatide on weight management is quite impressive. Tirzepatide was originally a medication developed for the treatment of diabetes. It’s still used for the treatment of diabetes, and it has also been shown to have weight loss effects. In a 72-week study of the use of Zepbound for weight loss, the average patient saw a 15% decrease in body weight if they took a maximum of 5 mg a week, 19.5% decrease for those who took a maximum of 10 mg a week, and 20.9% for those taking the 15-mg weekly dose.
Watch: How to inject Zepbound
You can watch a YouTube video produced by the drug manufacturer for full injection instructions.
Read: Step-by-step injection instructions
Be sure to read the instructions that come with the medication before taking your first dose.
How to store your medication
The injection pens should be stored in the refrigerator at 36–46º F but may be kept between 46–86º F for up to 21 days. If you store the pen at room temperature, do not return it to the refrigerator.
Store the pens in the original packaging to protect the pen from light. Do not freeze the pens. The pen contains glass parts, so If you drop the pen on a hard surface, do not use the pen for your injection.
When to take your dose
You’ll use one pen each week. Take your medication on the same day each week, with or without food.
Preparing the medication
1. Wash your hands before handling your medication.
2. When you use a new pen, make sure that the:
pen indicates the correct medication and dose that you were prescribed
expiration date has not passed
pen is not damaged
3. Inspect the medication. It should:
look clear and colorless, with no debris or particles in it
Not be frozen
Don't use the medication if any of these things are an issue. Instead, contact your pharmacy and your Ro-affiliated provider for further guidance since you may need a new pen.
4. You can now prepare the pen if the medication looks clear, colorless, and particle-free. Make sure the pen is locked.
Do not unlock the pen until you place the clear base on your skin and are ready to inject.
5. Pull the gray base cap straight off the pen and throw it away in your household trash.
Do not put the gray base cap back on or touch the needle.
Choosing your injection site
6. You can choose an injection site in either your stomach, thigh, or upper arm.
You can use the same part of your body each week but don’t inject it into the exact same spot in that body part each time. Injecting into the same spot each time can lead to permanent fatty nodules under the skin that can decrease the effectiveness of the medication. A good guideline is to have your next injection site be at least 1 inch away from your last one.
Administering the injection
7. Use an alcohol wipe to clean the area on the abdomen, thigh, or upper arm you’ve selected.
8. Place the clear base of the pen flat against your skin at the injection site.
9. Unlock the pen by turning the lock ring.
10. Press and hold the purple injection button for up to 10 seconds. You will hear two clicks during this process:
The first click means the injection has started.
The second click means the injection is done. You know the injection is complete when the gray plunger is visible.
11. Once the injection is complete, remove the pen from your skin.
Additional Guidance
In addition to the medication, you should pursue a healthy diet as well as physical activity. Your Ro-affiliated provider and your coach are here to help guide you through these lifestyle changes.
If you miss a shot
If it’s been less than 4 days (96 hours) since your last shot, take your next one as soon as possible.
If it’s been more than 4 days (96 hours) since your last shot, do not administer the shot. Instead, wait until your next scheduled shot.
If it’s been more than 2 weeks since your last shot, do not take your next one. Instead, contact your Ro-affiliated provider for next steps, as your dose may need to be adjusted.
If you take more than prescribed
In the instance that you should take more than the prescribed dose, contact your Ro-affiliated provider and monitor your symptoms.
The primary side effects of taking more than prescribed are severe nausea, vomiting, and possibly low blood sugar. Should symptoms persist, worsen, or are very severe, contact your primary care practitioner and, if necessary, seek emergency medical attention.
Inform your primary care provider of your GLP-1 prescription
Ro’s Body Program is here to help you meet your goal to lose weight, but we’re not a replacement for a primary care provider (PCP).
Your Ro-affiliated provider will manage your GLP-1 prescription and your weight management treatment. Meanwhile, your PCP is responsible for taking care of your overall health and wellness.
Having a PCP is important for everyone, but especially for people who have overweight or obesity. Having overweight or obesity can increase your risk of developing or worsening chronic diseases, such as diabetes, high blood pressure, high cholesterol, or heart disease. These diseases can affect your quality of life and your life expectancy. A PCP can help you prevent or detect these diseases early, and provide you with the best treatment options. They can also provide you with regular check-ups, screenings, immunizations, and referrals to specialists when needed.
It’s important to let your PCP know that you are taking a GLP-1 through Ro so that they can have a clear picture of all the medications you take and your overall health.
Inform your primary care provider of your GLP-1 prescription
If you do not have a PCP, you should find one as soon as possible. Here are some ways to find a PCP near you:
Ask your insurance company for a list of PCPs in your network.
Ask your friends or family for recommendations.
Use online tools, such as Healthgrades or Zocdoc, to search for PCPs and read reviews from other patients.
Full medication details
Side effects of the medication:
The side effects of GLP-1s and GIP/GLP-1s are generally limited to gastrointestinal complaints, with the most common being nausea and diarrhea. Other side effects included vomiting, constipation, abdominal pain, dyspepsia (or upset stomach), abdominal distension, and reflux. Non-gastrointestinal side effects included headache, fatigue, and dizziness.
In patients with type 2 diabetes, there were also reports of low blood sugar in clinical trials evaluating GLP-1s and GIP/GLP-1s. Complications of diabetic retinopathy, an eye condition that can cause vision changes and blindness in people with diabetes, was observed in clinical trials with a greater risk seen in people who had a history of diabetic retinopathy before starting GLP-1 treatment.
Less common were serious side effects, including inflammation of the pancreas (pancreatitis), gallbladder inflammation and stones, kidney injury, increases in heart rate, and complications related to diabetic retinopathy in patients with type 2 diabetes.
Changes in mood have been reported with GLP-1s and GIP/GLP-1s, and you should report these to your Ro-affiliated provider if you experience them. We will also monitor this throughout your treatment.
Possible thyroid tumors, including cancer: You should alert your Ro-affiliated provider if you get a lump or swelling in your neck, develop a hoarse voice, have trouble swallowing, trouble breathing, or shortness of breath. While it is not certain if Wegovy, Ozempic, or Zepbound could cause thyroid tumors or a type of thyroid cancer, Wegovy/Ozempic/Zepbound and medications like them have caused tumors in rodent studies. Cases of medullary thyroid carcinoma (“MTC”) in patients treated with liraglutide (also called Saxenda) have been reported, but the data in these reports are insufficient to establish or exclude a causal relationship between MTC and GLP-1 or GIP/GLP-1 receptor agonist use in humans.
Symptoms of hypersensitivity reactions (allergic reactions) may occur. Do not take it if you are allergic to the GLP-1 medication or any of its ingredients. Stop using the GLP-1 and seek in-person medical care right away if you experience symptoms of a serious allergic reaction, including swelling of your face, lips, tongue or throat, severe rash or itching, very rapid heartbeat, problems breathing or swallowing, or fainting or feeling dizzy.
Side effects of the injection:
Patients occasionally note irritation of the skin or small raised areas near or at the injection site. By ensuring that the area of injection is cleaned with an alcohol swab prior to injection and injecting at a perpendicular angle to the skin, you can decrease the chance of these reactions occurring. These usually go away on their own within 4-8 weeks.
GLP-1s and GIP/GLP-1s are prescription medications that are clinically tested, stimulant-free, and non-habit forming. These medications work by mimicking the functions of a naturally occurring hormone in your body to slow down how fast your stomach empties after you eat and act on your brain to make you less hungry. This helps you feel fuller, causing less food intake without uncomfortable hunger. These medications are meant to be used with a reduced-calorie diet and regular physical activity.
GLP-1s and GIP/GLP-1s aren’t for everyone. You shouldn’t take one if you have any of the following risk factors:
Pregnant, possibly pregnant, or planning to get pregnant in the next 2 months; this applies to both men and women
Breastfeeding
History of hypersensitivity to semaglutide or other GLP-1 medications
Personal or family history of medullary thyroid carcinoma
History of multiple endocrine neoplasia syndrome type 2 (MEN2)
History of pancreatitis
History of delayed gastric emptying or gastroparesis
History of gallbladder disease or bile duct disease
History of suicidal ideation or history of suicide attempts
History of tachycardia or atrial fibrillation
Type 1 diabetes
History of impaired kidney function
Diabetic retinopathy complications due to type 2 diabetes
GLP-1 medications can cause too low blood sugar in patients who take GLP-1s with another glucose control medication, including insulin. Monitor your blood sugar and watch out for signs of too low blood sugar such as dizziness, blurred vision, mood changes, sweating, or fast heartbeat.
Complications of diabetic retinopathy, an eye condition that can cause vision problems and blindness in people with diabetes, have been observed in clinical trials. The risk was higher for people who already had a history of diabetic retinopathy before starting GLP-1 treatment. If you have type 2 diabetes, tell your provider right away if you experience changes in vision.
Medications that affect blood glucose: GLP-1s and GIP/GLP-1s can lower blood glucose, and using them with other medications that lower blood glucose, such as insulin or sulfonylureas, can cause hypoglycemia or significantly low blood sugar. If you are currently taking one of these medications, you should mention these medications to your Ro-affiliated provider as well as consult with your prescribing practitioner regarding its use along with a GLP-1 or GIP/GLP-1.
Oral contraceptives (birth control pills): One effect of GIP/GLP-1s like Zepbound is that they slow down the passage of food and medicines through your gastrointestinal tract. Because of this, birth control pills may have decreased effectiveness, which could result in an unexpected pregnancy.
Ro-affiliated providers recommend that if you use birth control pills while taking Zepbound, you also use a barrier form of contraception (like condoms or a diaphragm). Alternatively, you could see your primary care or gynecological provider to switch to another form of contraception.
Thyroid medication (levothyroxine): If you're on thyroid medication, specifically levothyroxine, GLP-1s, and GIP/GLP-1s can increase the concentration of the levothyroxine in your blood. Please inform your Ro-affiliated provider that you're taking this medication, as well as consult with your prescribing practitioner regarding its use along with a GLP-1 or GIP/GLP-1.
One of the ways that GLP-1s and GIP/GLP-1s help promote weight loss is by slowing down how quickly your stomach empties, helping you feel full longer. That slowdown—called “delayed gastric emptying”—can also affect how well your body absorbs medications that you take by mouth. As a result, some of those oral medications might be less effective while you’re taking your weight loss injection.
While clinical trials of GLP-1s have shown that they don’t seem to change how effective oral medications are, the delayed gastric emptying caused by GIP/GLP-1s (like tirzepatide) has been shown to make some medications less effective.
One type of medication that's been shown to be less effective when taking tirzepatide is oral contraception (birth control pills). The decrease in oral contraception's effectiveness is strongest whenever you start a new tirzepatide dose and improves over time. That's why we recommend the manufacturer's guidance below:
If you're taking an oral contraceptive, you should either:
switch to a non-oral contraceptive method (such as an IUD or implant), OR
continue using your oral contraception AND add a barrier method of contraception (such as condoms)
You’ll need to make either of those changes for 4 weeks after first starting tirepatide (compounded or Zepbound), AND for 4 weeks after each dose increase.
We know that the contraception method you choose is a personal decision. That’s why we want to support you with this information so that you can make the choice that’s right for you.
Most people who take GLP-1s or GIP/GLP-1s notice a decrease in hunger, feeling full for longer or feeling full after less food. Some patients report side effects such as nausea or diarrhea. At lower doses, however, you may not feel any changes at all. That does not mean the medication is not working—you may start seeing small changes on the scale at low doses—but some people may require higher doses before they notice changes in their appetite.
Ultimately, the goal of GLP-1 therapy or GIP/GLP-1 therapy is weight loss, and this may occur without any noticeable differences in how you feel. If you still feel no different and haven't noticed changes on the scale when you've been prescribed higher doses of the medication, discuss this with your Ro-affiliated provider.
Despite the best intentions, accidents sometimes happen.
If you accidentally take more than the prescribed dose of your GLP-1, you may have a higher chance of experiencing side effects, and those side effects may be more severe than your experience with your regular dose. How severe the side effects may be will depend on the dose you took and how your body responds to it.
Daily medications, such as Saxenda reach their peak level within your body and are cleared from your system within a day. You may find that side effects from taking too much Saxenda will follow a similar pattern.
Weekly medications, such as Wegovy, Zepbound, Ozempic, and compounded semaglutide, can take up to a few days to reach their peak in your body and stay in your system for several days. As a result, it’s possible that side effects from taking too much of a weekly medication may take a few days to develop and may persist for several days.
Follow the steps below if you believe you have taken more than your prescribed GLP-1 dose:
If you have no symptoms:
First, call Poison Control at 1-800-222-1222
Next, notify your Ro-affiliated provider
Monitor for any side effects that may develop over the next several days
If you develop mild symptoms:
First, call Poison Control at 1-800-222-1222 if you haven’t already
Next, notify your Ro-affiliated provider
Use the tips in our article on managing side effects
If your side effects aren’t manageable with the help of those tips, or if your side effects become more severe, seek treatment at an emergency care facility
If you develop severe symptoms:
If you experience any of the following symptoms, seek treatment immediately at an emergency care facility:
Severe nausea and vomiting or inability to keep fluids down
Severe abdominal pain that won’t go away or keeps coming back
Severe headache
Lightheadedness or passing out
Seizure
Difficulty breathing or shortness of breath
Lip, tongue, or face swelling
Chest pain
Blood in vomit
Bloody stools
Black tarry stools
Thoughts of hurting yourself
After you’ve received medical care for your symptoms, please contact your Ro-affililated provider to let them know what happened.
Contact your Ro-affiliated provider and all of your healthcare providers if you experience any new symptoms after beginning your GLP-1 or GIP/GLP-1 treatment. If you have any serious signs or symptoms like, but not limited to, blood in your stool, severe diarrhea, fainting, or severe abdominal pain, please seek out emergency medical treatment.
(A) WARNING: RAPID WEIGHT LOSS MAY CAUSE SERIOUS HEALTH PROBLEMS. RAPID WEIGHT LOSS IS WEIGHT LOSS OF MORE THAN 1.5 POUNDS TO 2 POUNDS PER WEEK OR WEIGHT LOSS OF MORE THAN 1 PERCENT OF BODY WEIGHT PER WEEK AFTER THE SECOND WEEK OF PARTICIPATION IN A WEIGHT-LOSS PROGRAM.
(B) CONSULT YOUR PERSONAL PHYSICIAN BEFORE STARTING ANY WEIGHT-LOSS PROGRAM.
(C) ONLY PERMANENT LIFESTYLE CHANGES, SUCH AS MAKING HEALTHFUL FOOD CHOICES AND INCREASING PHYSICAL ACTIVITY, PROMOTE LONG-TERM WEIGHT LOSS.
(D) QUALIFICATIONS OF THIS PROVIDER ARE AVAILABLE UPON REQUEST.
(E) YOU HAVE A RIGHT TO:
1. ASK QUESTIONS ABOUT THE POTENTIAL HEALTH RISKS OF THIS PROGRAM AND ITS NUTRITIONAL CONTENT, PSYCHOLOGICAL SUPPORT, AND EDUCATIONAL COMPONENTS.
2. RECEIVE AN ITEMIZED STATEMENT OF THE ACTUAL OR ESTIMATED PRICE OF THE WEIGHT-LOSS PROGRAM, INCLUDING EXTRA PRODUCTS, SERVICES, SUPPLEMENTS, EXAMINATIONS, AND LABORATORY TESTS.
3. KNOW THE ACTUAL OR ESTIMATED DURATION OF THE PROGRAM.
4. KNOW THE NAME, ADDRESS, AND QUALIFICATIONS OF THE DIETITIAN OR NUTRITIONIST WHO HAS REVIEWED AND APPROVED THE WEIGHT-LOSS PROGRAM ACCORDING TO s. 468.505(1)(j), FLORIDA STATUTES.