Tirzepatide side effects: what to expect and how to manage them

Although the chatter surrounding diabetes and weight loss medications is laser-focused on Ozempic, that’s not the only medication on the block. Tirzepatide is another injectable medication that may be a good option for people looking for additional support to control their blood sugar or lose a significant amount of weight. 

Tirzepatide is available under two brand name medications: Mounjaro, which is indicated for type 2 diabetes,  and Zepbound, which is indicated for weight loss. 

Both medications are effective for blood sugar control and weight loss, but they may not be the right option for everyone. Some people who have used these drugs report unpleasant side effects, and there are potential health warnings and risks to be aware of before starting tirzepatide. 

If you’re interested in tirzepatide but are concerned about the potential side effects, you’re in the right place. Read on to learn more about tirzepatide, its side effects and how to manage them, precautions, lifestyle adjustments, and more.

Tirzepatide is an FDA-approved prescription once-weekly injection medication that you self-inject into your stomach, front of the thigh, or back of the upper arm.

 It is available under two brand names and indications:

Zepbound

• Weight loss for people with obesity (BMI of 30 or higher) or 

• Weight loss for people with overweight (BMI of 27 or higher) who have a weight-related health condition like high blood pressure, high cholesterol, type 2 diabetes, obstructive sleep apnea, or cardiovascular disease

Mounjaro

• Blood sugar control for people with  type 2 diabetes 

Tirzepatide is a dual-agonist GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide) medication. It is different from similar injectable weight loss or type 2 diabetes treatment medications like semaglutide (Ozempic/Wegovy), which are GLP-1 medications only.

Both Zepbound and Mounjaro work by mimicking the effects of the GLP-1 hormone. This is a naturally occurring hormone that stimulates insulin release to bring down blood sugar, reduce hunger cues in the brain, and slow down gastric emptying (how quickly food moves out of your stomach). This not only helps regulate blood sugar but reduces your appetite and causes you to feel full faster after eating, so you consume fewer calories overall. 

Zepbound and Mounjaro are taken weekly and are available in 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, and 15 mg doses. Most people start with the lowest dose and gradually increase over time, depending on how well they tolerate the medication. 

 According to one double-blind, randomized, controlled trial published in The New England Journal of Medicine, different dosages of tirzepatide all led to a meaningful reduction in body weight over 72 weeks when combined with a reduced-calorie diet and 150 minutes of exercise per week. 

Specifically, here is how the average weight loss broke down, depending on dose:

Additional research supports tirzepatide as effective for weight loss. In a meta-analysis published in the International Journal of Obesity in 2023 that looked at 5800 people, 78% lost 5% or more of their body weight. While that number may not seem as significant as other figures, consider that  5% weight loss or more has also been associated with health improvements in metabolic function, including fat loss in the abdomen and liver and insulin sensitivity. 

It’s important to note that weight loss medication alone may not lead to significant weight loss and that not everyone who takes tirzepatide will lose up to 20% of their body weight. These medications are designed to be used with lifestyle interventions, including dietary modifications and exercise. Participants in these trials also followed a reduced-calorie diet and a robust exercise program, aiming for 150 minutes per week.

 Remember that these results represent just one trial, so your weight loss amount may vary. 

The short answer is yes, but there are also potential health risks associated with tirzepatide. 

Tirzepatide is an FDA-approved medication that has been evaluated in clinical trials and is considered to be both safe and effective for use in weight loss and type 2 diabetes. 

That said, there is not much data on the long-term use of tirzepatide, so we don’t fully understand what risks, if any,  are associated with using this medication for long periods. Tirzepatide, like other GLP-1 agonists, also comes with side effects. For the most part, these are mild and manageable, but some people may be at risk for more serious health complications. 

If you’re interested in tirzepatide for weight loss or blood sugar control, talk to your provider. Be sure to discuss your complete health history — including all medications, herbs, and supplements you’re taking, your current and past health conditions, and your family health history. This information can help your provider determine if you are a good candidate for tirzepatide, or if another medication might be a better, safer option. 

Tirzepatide comes with a long list of potential side effects. Like all medications, some of these side effects are more common than others. 

In clinical trials for tirzepatide, the most common side effects involved mild to moderate gastrointestinal problems.

Common side effects of tirzepatide

Here is a list of common side effects seen in trials for tirzepatide:

• Nausea

• Vomiting

• Diarrhea

• Constipation

• Abdominal pain

• Decreased appetite

• DIzziness

• Fatigue

• Flatulence/farting

• GERD

• Hair loss

• Hypersensitivity reactions (such as rash and itching)

• Indigestion/upset stomach

• Injection site reactions

Mounjaro side effects

The most common Mounjaro side effects include:

• Nausea

• Diarrhea

• Abdominal pain

• Constipation

• Decreased appetite

• Indigestion 

• Vomiting

Zepbound side effects

The most common side effects of Zepbound include:

• Nausea

• Diarrhea

• Vomiting

• Constipation

• Abdominal pain

• Indigestion/upset stomach

• injection site reactions

• Fatigue,

• Hypersensitivity reactions

• Belching

• Hair loss

• Gastroesophageal reflux disease (GERD)

GI side effects are generally manageable and tend to go away the longer you are on the medication. Clinical trial participants reported the most discomfort when they first started taking tirzepatide, or when they increased their dose. 

Work with your provider to find strategies to manage common side effects. This might include starting at the lowest dose and slowly increasing it, eating smaller meals, avoiding certain foods, and taking other medications to help minimize symptoms of nausea. 

While most people experience at least one side effect when being treated with the GLP-1 class of medications, tirzepatide may cause fewer adverse events than other drugs in this class, says  Christopher McGowan, MD, an obesity medicine specialist and founder of True You Weight Loss. 

“The overall rate of digestive side effects was lower with tirzepatide than with semaglutide in their respective trials, which is precisely what we see in clinical practice,” he explains. That may be because it acts on GIP receptors, not just GLP-1. 

Still, the risk of side effects remains. To mitigate these effects, Dr. McGown recommends the following:

• Start at the lowest dose and then increase slowly based on the manufacturer’s recommendations. Starting at higher doses or skipping doses can lead to more severe side effects. 

• Ask your provider about taking an anti-nausea medication like ondansetron (Zofran) to settle your stomach

• Stay hydrated by drinking plenty of water throughout the day 

• Eat smaller, more frequent meals to help mitigate indigestion or bloating

• Avoid certain foods that could exacerbate GI side effects, such as greasy foods and carbonated beverages

Most importantly, stay in contact with your provider. If your side effects are mild but impact your quality of life, communicate these issues right away. You don’t have to just power through discomfort. 

“Patients cannot be expected to manage side effects alone, so it is critical to communicate any symptoms to one’s treatment team,” says Dr. McGowan. Decreasing a dose or staying on one dose for longer may be needed. “Over time, most symptoms will improve as the body adapts to the medication,” he says.

More serious side effects can occur with both Mounjaro and Zepbound, though these are far less likely.  Below is a breakdown of rare but serious warnings and precautions to consider with tirzepatide. 

If you experience any of the below side effects, stop taking the medication and talk to your doctor about alternative options.

Hypersensitivity reactions and allergies

Although a mild rash and itching at the injection site are common reactions, more serious issues like hives and eczema are possible. These were found to occur in 3.2% of those on Mounjaro compared to 1.7% in placebo groups. 

While very rare, a life-threatening allergic reaction (anaphylaxis) has also been reported. This occurred in 0.1% of Zepbound patients and it has also been seen in Mounjaro. Always discuss any known allergies with your provider before starting a new medication. 

Pancreatitis

Sudden inflammation of the pancreas (an organ that helps with digestion and blood sugar regulation) can occur, although it is rare and has been reported in 13 patients taking tirzepatide. 

Thyroid C-cell tumors

An increased risk of this specific type of cancer has only been seen in rodent studies, not in humans. Still, it’s listed as a warning for both Zepbound and Mounjaro. If you have a family history of these types of tumors you shouldn’t take tirzepatide. 

Acute gallbladder disease

In trials for Mounjaro, 0.6% of participants reported gallbladder disease—including gallstones, gallbladder inflammation, biliary colic (intermittent or constant abdominal pain), and cholecystectomy (surgical removal of the gallbladder)—compared to 0% in the placebo group. 

Acute kidney injury

Kidney damage occurred in 0.5% of people on Zepbound versus 0.2% in those on placebo. These injuries are most likely caused by dehydration from GI side effects like nausea, diarrhea, and vomiting. It’s important to stay hydrated when taking this medication.

Vision changes

People with diabetic retinopathy (a complication of diabetes that leads to vision loss) may find that their symptoms get worse while taking tirzepatide. This is temporary, but contact your provider if you experience blurry vision, dark spots, or floaters while taking this medication. 

Increased heart rate

Some Mounjaro trial participants experienced an average increased heart rate of 2 to 4 beats per minute, compared to 1 beat per minute in the placebo group. It’s not clear what causes this or if it has any practical implications for treatment with tirzepatide. 

Tirzepatide side effects: key takeaways

• The most common side effects of tirzepatide include nausea, vomiting, diarrhea, and constipation.

• Rare but serious side effects include pancreatitis, diabetic retinopathy, thyroid tumors, and kidney damage. Talk to your doctor if you have a personal or family history of these conditions. 

Talk to your prescriber about all potential health risks before you start a new medication. This includes any medications and supplements you currently take, your complete health history, and your family health history. This will help you and your provider better understand the risks and benefits, and if tirzepatide is a good option for you. 

If you experience the following symptoms or side effects, you should stop taking tirzepatide and seek medical attention:

• Severe stomach pain that won’t go away

• Signs of an allergic reaction like problems breathing, feeling dizzy, or swelling of your face

• Symptoms of low blood sugar like dizziness, lightheadedness, confusion, fast heart rate, or anxiety

• Vision changes such as blurred vision, floaters, or black spots in your vision

• Signs of kidney damage such as infrequent urination or swelling in your ankles, feet, or hands

• A lump in your neck, a hoarse voice that does not go away, trouble swallowing, or shortness of breath, which may be signs of thyroid tumors

Both tirzepatide and semaglutide (Ozempic/Wegovy) carry similar side effects. The most common include:

• Nausea

• Vomiting

• Diarrhea

• Constipation

• Abdominal pain

People taking Wegovy also reported headaches and fatigue in clinical trials. 

While clinical trials show that these drugs share many common side effects, it’s important to note that each clinical trial is unique and conducted under varying conditions, with different sample sizes. 

What’s more, these drugs have different indications and come with varying dosage recommendations and timelines, which can also impact the type and severity of side effects. 

In other words: your results may vary. Treatment decisions should always be made under the guidance of a licensed healthcare provider, considering your unique health history and goals to weigh the risks and benefits of a medication. 

Because tirzepatide slows stomach emptying, it may also affect the absorption of other medications you’re taking and interfere with their effectiveness. That’s why it’s important to always go over the list of medications and supplements you’re currently taking with your provider or a licensed pharmacist before starting tirzepatide. 

Talk to your provider if you are currently taking these medications: 

• Hormonal contraception: Tirzepatide may interfere with the effectiveness of oral hormonal birth control (the pill). Your provider might recommend switching to a different contraceptive method, such as non-oral birth control, or suggest using barrier methods (such as condoms) after starting or increasing your dose. 

• Diabetes treatment medications like insulin: Insulin and some oral diabetes medications, such as sulfonylureas, can increase your risk for hypoglycemia when used with tirzepatide. If your provider determines that you are a good candidate for tirzepatide, they may adjust the dosage of your diabetes medication. 

You should also avoid taking tirzepatide in combination with other GLP-1 agonist medications. There is no evidence that taking two of these medications together is more effective for weight loss or blood sugar control, and combining them can increase your risk of severe side effects. 

Lastly, make sure your provider knows that you’re taking tirzepatide before you undergo any surgeries or procedures that require sedation. There have been some reports of pulmonary aspiration (a complication where food from your stomach is inhaled into your lungs) while under general anesthesia or deep sedation in people taking tirzepatide, likely due to delayed stomach emptying. In this case, your provider may recommend a different fasting schedule to prepare for surgery. 

If you are pregnant or plan to become pregnant, you should not use tirzepatide. If you are breastfeeding, talk with your provider to determine if the benefits of tirzepatide outweigh the potential risks. 

If you have a personal or family history of certain health conditions, your provider may recommend a different medication, or they may want to watch you more closely for certain side effects and reactions. 

Tell your provider if you have a current or past history of:

• Diabetic retinopathy

• Pancreas or kidney problems, such as a history of pancreatitis

• Medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome type 2 

• Severe gastrointestinal disease like gastroparesis (delayed gastric emptying that causes nausea, vomiting, bloating)

• Serious allergy to tirzepatide, including anaphylaxis

Tirzepatide is designed to be used with a reduced-calorie diet and regular exercise, which will help you get the most significant benefits for both weight loss and blood sugar control. 

Because tirzepatide reduces appetite and slows digestion, most people who take it eat fewer and smaller meals. As a result, it’s important to eat a balanced diet to ensure you’re getting the nourishment you need. 

Aim for a diet that includes lots of vegetables, fruit, whole grains, legumes, lean proteins, and healthy fats to ensure you get essential nutrients. Many of these foods are also rich in fiber, which can help with bowel regularity—an important benefit when taking a GLP-1, says Charlie Seltzer, MD, a board-certified obesity medicine doctor in Philadelphia. He also recommends eating small, more frequent meals to help mitigate GI discomfort. 

Monitor your blood sugar levels and watch for signs of low blood sugar such as confusion, fatigue, shaking, and heart palpitations. If you have type 2 diabetes, you should always carry a quick source of sugar like fruit juice, candy, or glucose tablets with you in case of a hypoglycemic episode.

“The choice between semaglutide and tirzepatide will come down to cost, insurance coverage, availability, and patient preference,” says Dr. McGowan. 

Insurance coverage makes a huge impact on the affordability of these medications because they are expensive. The list price of Zepbound is $1,059.87 and Mounjaro is $1,069.08, but what you pay will depend on factors like pharmacy price, insurance coverage, and whether or not you’re eligible for coupons or savings programs. 

“Insurance coverage is typically class-wide, meaning that insurance covers both semaglutide and tirzepatide or neither,” says Dr. McGowan, adding that research has found that in 2024, just 18% of large employers that offered health benefits included GLP-1 coverage for weight loss. 

If you have questions about how much tirzepatide will cost, call your insurance company. In some cases, your insurer may require prior authorization. 

If you do not have insurance coverage, there are other ways to save. You may be eligible for savings cards from the manufacturer—with Mounjaro’s savings program, you may pay as little as $25 for a one- or three-month supply. 

There are also cash options available. Zepbound has a cash payment option that costs $399 (2.5 mg) to $549 (5 mg) per month when you pay without insurance or a savings card.

Access has been a real issue for injectable GLP-1 medications due to high demand. However, that is changing. Currently, both Mounjaro and Zepbound are available at all doses and have been removed from the U.S. Food & Drug Administration’s shortage list. 

• Tirzepatide is a prescription GLP-1/GIP medication. It mimics a naturally occurring hormone that helps to reduce blood sugar, suppress hunger cues, and slow digestion. 

• The most common side effects of tirzepatide are nausea, vomiting, constipation, and diarrhea. Side effects tend to go away the longer you are on tirzepatide but may flare up when you increase your dose. 

• Staying hydrated, taking anti-nausea medications, and slowly increasing your dose over time can help you manage side effects. 

• Serious side effects may include pancreatitis, kidney injury, allergic reactions, and vision changes, although these are rare. 

When combined with lifestyle interventions like a reduced-calorie diet and regular exercise, both Zepbound and Mounjaro are effective in promoting weight loss and blood sugar control, respectively.  While both medications are FDA-approved and considered safe, they do come with mild side effects and potentially serious health risks for certain people. 

Talk to your provider about all potential health risks before you start a new medication. This discussion should include any medications, supplements, and herbs you currently take, your complete health history, your family health history, and your weight loss goals. This information will help you and your provider better understand your risk factors so you can weigh them against the potential health benefits of tirzepatide. 

Ro has helped over 80,000 members lose weight with GLP-1s. Connect with one of our medical experts today to learn more. 

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Current version

November 21, 2024

Written by

Jessica Migala

Fact checked by

Dr. Nesochi Okeke-Igbokwe, MD, MS

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About the medical reviewer

Nesochi Okeke-Igbokwe, MD, MS

Nesochi Okeke-Igbokwe, MD, MS, is a physician, health expert, media contributor, and health writer based in the New York City area. She’s a practicing internist as well as a civil surgeon designated by the United States Department of Homeland Security and the United States Citizenship and Immigration Services.