Zepbound (tirzepatide) is a brand-name subcutaneous injection pen. It’s prescribed for weight loss and weight management. Zepbound has interactions with some other drugs. Examples include sulfonylureas and oral birth control.

An interaction occurs when one substance causes another substance to have a different effect than expected.

To learn more about Zepbound’s interactions, keep reading. For additional information about Zepbound, including details about its uses, see this article.

Before you start treatment with Zepbound, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Zepbound interacts with supplements, herbs, or vitamins, see the “Zepbound and other interactions” section below.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Zepbound. Keep in mind that this table doesn’t include all drugs that may interact with Zepbound. Some of these interactions are described in detail just below in “Drug interactions in depth.”

Drug class or drug nameDrug examplesInteraction result with Zepbound
meglitinides• repaglinide
• nateglinide
may increase the risk of low blood sugar as a side effect of Zepbound* and meglitinides
insulin• insulin aspart (Fiasp, NovoLog)
insulin detemir (Levemir)
insulin glargine (Lantus, Toujeo, others)
may increase the risk of low blood sugar as a side effect of Zepbound* and insulin
sulfonylureas†glipizide (Glucotrol XL)
glyburide (Diabeta, Glynase)
glimepiride (Amaryl)
may increase the risk of low blood sugar as a side effect of Zepbound* and sulfonylureas
oral birth control• ethinyl estradiol/norethindrone (Aurovela, Junel, others)
• ethinyl estradiol/drospirenone (Yasmin, Yaz, others)
• ethinyl estradiol/norgestimate (Sprintec, Tri-Sprintec, others)
may make oral birth control less effective
any oral medication†cyclosporine (Gengraf, Neoral, Sandimmune)
warfarin (Jantoven)
may make any oral medication less effective

* For details about Zepbound’s side effects, see this article.
For details about this interaction, see the “Drug interactions in depth” section below.

In some cases, factors or conditions could prevent your doctor from prescribing Zepbound due to a risk of harm. These are known as contraindications. The contraindications of Zepbound include:

Having medullary thyroid cancer or MEN2

Doctors typically will not prescribe Zepbound for people with certain conditions that increase the risk of thyroid cancer. This is because Zepbound has a boxed warning about the risk of thyroid cancer. This is the most serious warning from the FDA.

Specifically, doctors will likely not prescribe Zepbound for people with either:

  • a personal or family history of medullary thyroid cancer, which is a rare type of thyroid cancer
  • a personal history of MEN2, which is a rare genetic (inherited) condition

For more details, see the boxed warning section at the beginning of this article.

Having had an allergic reaction to Zepbound or any of its ingredients

If you’ve had an allergic reaction to Zepbound or any of its ingredients, your doctor will likely not prescribe Zepbound. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Note: Before you start treatment with Zepbound, it’s important to tell your doctor if these contraindications apply to you. They can determine whether to prescribe Zepbound.

There aren’t any known interactions between Zepbound and alcohol. However, your doctor may advise you to avoid or limit alcohol consumption during Zepbound treatment.

This is because drinking alcohol while taking the drug may worsen some of Zepbound’s side effects. For example, you may experience worsened nausea or vomiting. For information about side effects of Zepbound, see this article.

If you have questions about drinking alcohol during Zepbound treatment, talk with your doctor.

Here’s a closer look at certain drug interactions of Zepbound.

Sulfonylureas

Sulfonylureas are prescribed to help manage blood sugar levels in people with type 2 diabetes.

Interaction result: Taking sulfonylureas during Zepbound treatment may increase the risk of low blood sugar as a side effect of either drug.

Interaction explained: Sulfonylureas are prescribed to decrease blood sugar levels. Zepbound may cause low blood sugar. This risk may be higher in people with type 2 diabetes who are taking other diabetes medications, including sulfonylureas.

Examples of sulfonylurea drugs: Here are some sulfonylureas that may interact with Zepbound:

Steps you or your doctor may take: If your doctor prescribes Zepbound with a sulfonylurea, they may prescribe a lower dosage of the sulfonylurea. Doing so can help reduce your risk of low blood sugar when taking these drugs in combination.

If you’re prescribed Zepbound with a sulfonylurea, watch for symptoms of low blood sugar. These may include headache, dizziness, sweating, and shaking. Talk with your doctor about how to manage these symptoms. For example, they may recommend eating at least 15 grams (g) of carbohydrates to increase your blood sugar level. Sources of carbohydrates include hard candies, fruit juice, and glucose tablets.

You may lose consciousness if your blood sugar becomes severely low. For this or other severe symptoms, you or a bystander should call 911 or a local emergency number right away.

If you have other questions about Zepbound and sulfonylureas, talk with your doctor or pharmacist.

Oral birth control

Oral birth control refers to forms of birth control that are swallowed. Oral birth control is prescribed to help prevent pregnancy.

Interaction result: Taking oral birth control during Zepbound treatment could make the oral birth control less effective.

Interaction explained: Zepbound may affect your body’s ability to absorb oral birth control. As a result, you may have a lower level of the oral birth control in your system. Having a lower level of the drug could make it less effective at helping prevent pregnancy.

Examples of oral birth control drugs: Here are some examples of oral birth control that may interact with Zepbound:

  • ethinyl estradiol/norethindrone (Aurovela, Junel, others)
  • ethinyl estradiol/drospirenone (Yasmin, Yaz, others)
  • ethinyl estradiol/norgestimate (Sprintec, Tri-Sprintec, others)

Steps you or your doctor may take: Before starting Zepbound, be sure your doctor knows if you’re taking oral birth control. They may recommend other birth control options that do not interact with Zepbound. An example is an intrauterine device (IUD) such as levonorgestrel (Kyleena, Mirena, others).

If you take oral birth control with Zepbound, your doctor may suggest certain precautions. This may include using a backup method of birth control. Your doctor may recommend doing so for at least 4 weeks after starting Zepbound and after increasing your Zepbound dosage. Examples of backup birth control methods include condoms and diaphragms.

If you have other questions about Zepbound and oral birth control, talk with your doctor or pharmacist.

Any oral medication

Oral medication refers to any drug that is swallowed. This may include both prescription and over-the-counter drugs.

Interaction result: Taking an oral medication during Zepbound treatment could make the oral medication less effective.

Interaction explained: Zepbound could affect your body’s ability to absorb any oral medication. As a result, you may have a lower level of the oral drug in your system. Having a low level of the oral drug in your system could make it less effective.

Examples of oral medications: Here are some oral medications that may interact with Zepbound:

Steps you or your doctor may take: Before starting Zepbound, tell your doctor about all oral medications you take. They can recommend whether it’s safe to have Zepbound while taking these drugs.

Zepbound may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Zepbound.

Zepbound and supplements

It’s possible for drugs to interact with supplements, such as vitamins and herbs.

Zepbound and herbs

There are no specific reports of herbs interacting with Zepbound. However, that doesn’t mean herbal interactions won’t occur or be recognized in the future. Because of this, it’s important to check with your doctor or pharmacist before taking any of these products during Zepbound treatment.

Zepbound and vitamins

There are no specific reports of vitamins interacting with Zepbound. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Zepbound.

Zepbound and food

There were no reports of food interactions with Zepbound. If you’d like to learn more about eating certain foods during treatment with Zepbound, talk with your doctor.

Zepbound and vaccines

There aren’t any known interactions between Zepbound and vaccines. Talk with your doctor or pharmacist to find out whether you’re due for any vaccines.

Zepbound and lab tests

Zepbound isn’t known to interact with any lab tests. If you have concerns about this medication interacting with lab tests, talk with your doctor.

ZEPBOUND AND CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Zepbound. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Zepbound. The effects of cannabis may affect how well you stick to your Zepbound treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Zepbound. Before you take this drug, be sure to talk with your doctor about your health history. Zepbound may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Zepbound include:

Type 2 diabetes and diabetic retinopathy: If you have both type 2 diabetes and diabetic retinopathy, talk with your doctor before starting Zepbound treatment. People with this condition may have temporary vision changes from Zepbound. Your doctor can recommend whether Zepbound is a safe treatment option for you.

Kidney problems: Zepbound may cause severe digestive problems that lead to dehydration. These problems can worsen kidney conditions. If you have a kidney problem, such as kidney failure, be sure to tell your doctor before starting Zepbound. They can recommend whether Zepbound is the right treatment option for you.

Digestive system problems: Zepbound may cause severe digestive problems. This side effect may be unsafe for people who already have a digestive system problem. An example is stomach paralysis. If you have a digestive system problem, talk with your doctor before starting Zepbound. They can recommend whether this drug is a safe treatment option for you.

Pancreatitis: Zepbound may cause pancreatitis as a side effect. It isn’t known for certain whether the drug is safe for people who’ve had this condition in the past. If you’ve had pancreatitis, talk with your doctor before starting Zepbound. They can recommend whether this drug is the right treatment option for you.

Mood conditions, including depression: Zepbound is prescribed for weight management in certain people. Medications for this purpose may lead to suicidal thoughts or behaviors. This risk may be higher for people with mood disorders, such as depression. Your doctor can recommend whether Zepbound is right for you.

Allergic reaction: If you’ve had an allergic reaction to Zepbound or any of its ingredients, your doctor will likely not prescribe Zepbound. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Breastfeeding: It’s not known whether it’s safe to have Zepbound while breastfeeding. There isn’t enough information to determine whether the drug passes into breast milk or what effects Zepbound may have on a child who is breastfed. If you’re breastfeeding or planning to, talk with your doctor before starting Zepbound. They can talk with you about treatment options and ways to feed your child.

Pregnancy: There haven’t been enough clinical trials to determine whether Zepbound is safe to have while pregnant. Animal studies show that the drug may cause congenital anomalies (commonly known as birth defects). However, it’s important to note that animal studies don’t always indicate what may happen in humans. If you’re pregnant or planning to become pregnant, tell your doctor before starting Zepbound. They can advise you on the right treatment plan for you.

If you are prescribed Zepbound during pregnancy, consider enrolling in the drug’s pregnancy registry. This registry collects information about any pregnancy issues that may be reported with Zepbound. To learn more, talk with your doctor or call 800-545-5979.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

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To learn more about Zepbound’s side effects, view this article.

You can take certain steps to help prevent interactions with Zepbound. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

  • Let them know if you drink alcohol or use cannabis.
  • Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
  • Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Zepbound label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Zepbound doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Zepbound by injecting it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Zepbound. These resources might help:

  • Overview of Zepbound: For a general overview of Zepbound, you can see this article.
  • Side effects: If you’re interested in the side effects of Zepbound, see this article. Another option is to refer to the Zepbound prescribing information.
  • Dosage specifics: To learn about the dosage of Zepbound, see this article.
  • Facts about weight loss: To learn more about weight management, see our weight management hub.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.