Tirzepatide nausea: causes and 8 ways to get relief

Tirzepatide, the active ingredient in Zepbound and Mounjaro, is largely considered a rockstar treatment for weight loss and type 2 diabetes. But for all its positives (of which there are a lot, BTW), the drug does come with some negatives, such as nausea.

In clinical trials, 12%--18% of people taking Mounjaro and 25%--29% of people taking Zepbound reported nausea. Translation: Nausea is the most common side effect of tirzepatide. But you can get rid of it with a few simple strategies, such as eating smaller meals more frequently, avoiding trigger foods and drinks, and staying hydrated. 

Ahead, we break down what causes tirzepatide nausea and offer research-backed tips to get relief. 

It’s unclear exactly why tirzepatide can cause nausea. However, there are some theories — many (if not all) of which have to do with how the drug works. 

As a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, tirzepatide affects the digestive system in several ways. While these gastrointestinal (GI) effects can help regulate blood sugar and promote weight loss, they can also lead to nausea. 

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Here’s a closer look at the reasons why tirzepatide can cause nausea. 

1. Slowed digestion

Tirzepatide delays gastric emptying, i.e. the rate at which food moves through your gut. Essentially, food lingers in your stomach and moves from your tum into the small intestine more gradually.  

This can help you feel fuller longer and stabilize blood sugar. But it can also lead to nausea in addition to other side effects, such as vomiting, bloating, and abdominal pain. 

2. Increased feeling of fullness 

As mentioned, tirzepatide can make you feel fuller longer by delaying gastric emptying or keeping food in the stomach for longer. But it can also increase satiety (i.e. fullness) by acting on the areas of the brain that regulate appetite. Together, these effects can contribute to nausea.

When food stays in your stomach longer and your appetite is reduced, it’s easier to feel uncomfortably full — especially at the beginning of treatment or when your dose increases. 

That's because it can take some time to figure out the right portion sizes on tirzepatide. You’ll likely need less food than you did pre-treatment to feel satisfied. So, if you eat your usual amount, you may become too full and, in turn, nauseated. 

3. Activation of central nervous system receptors

Tirzepatide doesn’t just act on the stomach and small intestine — it also acts on the nervous system. The GLP-1 and GIP receptors in the brain are thought to be involved in appetite control, among other functions. 

Activation of GLP-1 receptors in the central nervous system may cause a nausea response. However, this theory is mainly based on findings from some animal models.

Nearly 15% of people taking tirzepatide or semaglutide, another GLP-1 medication, for obesity discontinue the treatment due to side effects like nausea. However, there’s some good news: GI side effects from tirzepatide are usually mild to moderate in severity and decrease over time.

Still, there are several practical ways to reduce nausea on tirzepatide and get relief. Here’s what the research suggests.

1. Stick to your dose escalation schedule  

Medications containing tirzepatide come in multiple dosage strengths. For example, Zepbound dosages range from 2.5 mg to 15 mg. Each medication also comes with a dose escalation schedule. The medication is typically started at a low dose, which is gradually increased every four weeks or so.

While side effects could occur at any dose, they’re more common at higher strengths. If you’re experiencing nausea after increasing your dose, it may be worth having a discussion with your healthcare provider about titrating back down. 

Not everyone’s maintenance dose (i.e. the dosage strength that marries effectiveness and tolerability) is the same. You may find that you fare better on a lower dose than the highest recommended dose.

2. Eat smaller, more frequent meals 

Tirzepatide slows digestion and increases feelings of fullness. So, eating larger portions (such as those you ate pre-treatment) can cause you to get uncomfortably full, fast. Sound familiar? Then consider eating smaller meals more often during the day. For example, splitting three meals a day into four or more. 

This tactic can help you get your fill of essential nutrients without becoming overly full and nauseated. Just remember to pack your plate (even if it’s a small one) with fiber, protein, and other tirzepatide-friendly foods.  

3. Avoid trigger foods and drinks

Honing your dietary habits to tirzepatide nausea relief may also include avoiding foods known to trigger symptoms. When you’re nauseated, experts generally recommend avoiding the following foods and drinks:

• Greasy, processed foods (e.g. sausages, fast-food burgers, fried foods)

• High-sodium (salty) foods (e.g. chips, packaged snacks and foods)

• Foods with strong smells

• Caffeine, alcohol, and carbonated drinks

• Very spicy foods

• Dairy products

4. Stay hydrated

When your nausea leads to vomiting, it can have some serious consequences, such as dehydration. Therefore, increased fluid intake is recommended to offset the loss. 

The target daily intake for water is about 7 cups (1,600 mL) on average, for adults. Keep in mind that if you’re nauseated, you’ll want to sip on fluids slowly and avoid drinking them with a straw.

Drinking plenty of water is always important, but you can also hydrate with water-rich foods, such as soup, yogurt, and gelatin.

5. Opt for bland, easily digestible food

We’ve discussed foods to avoid when you’re feeling nauseous, but what should you eat instead? A balanced, nutrient-rich diet is always a good idea, but certain food choices may be best suited for nausea relief.

Take a bland diet, for example. Bland foods are easy to digest, giving the GI tract a rest when it’s been stressed. These include foods that are soft, low in fiber, cooked, and/or not spicy. Here are some examples of bland foods:

• Eggs

• Broth 

• Tofu

• Lean meat, such as skinless chicken and fish

• Vegetables, such as beets, carrots, and spinach

Taking it a step further, a BRAT diet may also help alleviate nausea and vomiting. This includes:

• Bananas

• Rice

• Applesauce

• Toast

6. Avoid lying down or exercising after eating  

When you eat, food moves down the esophagus and through the GI tract. It gets a little help from gravity, which is why it’s recommended to stop eating several hours before going to bed. 

Similarly, lying down or reclining after eating allows stomach acid and undigested food to flow in the wrong direction — back the way it came. So, try to remain upright after eating as well as eating too close to bedtime.

However, this doesn’t mean you should participate in strenuous activities after eating. Your GI tract needs blood flow to function properly. But when you exercise, those working muscles need blood flow too. 

Give your food a chance to settle before getting active. At most, you might consider a light walk after meals, which has been shown to improve GI symptoms like nausea.

7. Look into anti-nausea medication

When other remedies aren’t helping, it may be time to look into anti-nausea medication. There are both over-the-counter (OTC) and prescription options available, though you should first check in with your healthcare provider to see what they recommend.

You can find OTC options like bismuth subsalicylate (Pepto Bismol) and dimenhydrinate (Dramamine) at most pharmacies. Talk to your provider to see if you’re a good candidate for prescription options, such as ondansetron (Zofran).

These medicines usually offer relief fairly quickly — within 30–60 minutes after taking them.

8. Consider tirzepatide alternatives

Tirzepatide is just one weight loss medication of many. While other, alternative drugs can also cause nausea, they may be more tolerable for you. Research generally suggests that the risk of nausea is less with other GLP-1 medications, such as semaglutide (the active ingredient in Ozempic and Wegovy).

If you find that your tirzepatide nausea isn’t letting up, ask your healthcare provider if switching to a different medication is an option. In addition to tirzepatide and semaglutide, liraglutide (Saxenda) is another GLP-1 medication to know.

Severe symptoms or those that won’t go away can warrant medical attention, and severe or persistent nausea is no different. If your tirzepatide nausea isn’t improving, it’s wise to let your healthcare provider know.

You should also seek care if you experience any of the following on tirzepatide:

• Signs of pancreatitis, such as severe abdominal pain

• Stomach pain that radiates to your back

• Signs of an allergic reaction, such as swelling of the throat and trouble swallowing 

• Other GI symptoms that won’t go away, such as vomiting, diarrhea, and upset stomach

Depending on your situation, your healthcare provider might recommend:

• Lowering your dose. Nausea on tirzepatide is more common at higher strengths. So, titrating down to a lower strength may help. While the medication is generally increased over time, some people find that a lower "maintenance dose” is still effective while curbing side effects.

• Staying on your current dose. Mild tirzepatide nausea generally goes away or improves on its own. You may just need more time for your body to adjust to the medication. Increasing your dose could also come with more nausea, which is why your provider may prefer for you to stay where you’re at for longer.

• Anti-nausea medication. If your other efforts to reduce nausea haven’t panned out, it may be time for some anti-nausea medicine. Your healthcare provider might recommend starting with an OTC option (e.g. Pepto Bismol) or go straight to prescribing an Rx treatment (e.g. ondansetron). It all depends on the severity of your symptoms and other individual factors. 

• Switching medications. Tirzepatide is more likely to cause nausea than other similar medications (e.g. semaglutide). So, your prescriber may recommend switching to a different medication that you may tolerate better.

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Tirzepatide nausea is common, but that doesn’t make the discomfort any easier. Fortunately, there are some ways to manage this side effect. Keep the following in mind as you navigate nausea while taking tirzepatide:

• Roughly one in five people taking tirzepatide will experience nausea. It’s the most common side effect of this medication. Fortunately, it’s usually mild and subsides as your body adjusts.

• The exact reason why tirzepatide can cause nausea isn’t fully understood. It’s usually chalked up to how the medication affects digestion. 

• At-home remedies may help you navigate this and other GI side effects. These include eating bland foods, avoiding trigger foods and drinks, and sticking to smaller, more frequent meals. 

• Let your healthcare provider know if tirzepatide nausea isn’t improving. They may recommend adjusting your dose, trying anti-nausea medication, or switching to a different medication.