23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

2025© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.

Contributor Disclosures

For additional information see "Tirzepatide: Patient drug information"

For abbreviations, symbols, and age group definitions show table

Special Alerts

Glucagon-Like Peptide-1 Receptor Agonists Safety Update January 2024 

The FDA has been evaluating reports of suicidal thoughts or actions in patients
treated with glucagon-like peptide-1 receptor agonists (GLP-1 RAs). A
preliminary evaluation has not found evidence that the use of these medicines
causes suicidal thoughts or actions, but the FDA is continuing to investigate this
issue. Patients should not stop taking GLP-1 RAs without consulting their health
care provider. Health care providers should monitor for and advise patients
using GLP-1 RAs to report new or worsening depression, suicidal thoughts, or
any unusual changes in mood or behavior.

Further information may be found at https://www.fda.gov/drugs/drug-safety-and-

availability/update-fdas-ongoing-evaluation-reports-suicidal-thoughts-or-
actions-patients-taking-certain-type.

ALERT: US Boxed Warning

Risk of thyroid C-cell tumors 

In both male and female rats, tirzepatide causes dose-dependent and treatment-
duration-dependent thyroid C-cell tumors at clinically relevant exposures. It is
unknown whether tirzepatide causes thyroid C-cell tumors, including medullary
thyroid carcinoma (MTC), in humans as human relevance of tirzepatide-induced
rodent thyroid C-cell tumors has not been determined.

Tirzepatide is contraindicated in patients with a personal or family history of MTC or

in patients with multiple endocrine neoplasia syndrome type 2 (MEN 2). Counsel
patients regarding the potential risk for MTC with the use of tirzepatide and

https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 1/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

inform them of symptoms of thyroid tumors (eg, a mass in the neck, dysphagia,
dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or
using thyroid ultrasound is of uncertain value for early detection of MTC in
patients treated with tirzepatide.

Brand Names: US
Mounjaro; Zepbound

Brand Names: Canada

Mounjaro; Mounjaro KwikPen; Zepbound KwikPen

Pharmacologic Category
Glucose-Dependent Insulinotropic Polypeptide (GIP)/Glucagon-Like Peptide (GLP-1)
Receptor Agonist

Dosing: Adult

Dosage guidance:

Clinical considerations: Use is not recommended in patients with severe GI disease

(eg, severe gastroparesis) (has not been studied).
Expand All

Diabetes mellitus, type 2, treatment 

Weight management, chronic 
Weight-related conditions, treatment 

Missed doses:

Single missed dose: Administer missed dose as soon as possible within 4 days, then
resume usual schedule thereafter. If >4 days have elapsed, skip the missed dose
and resume administration at the next scheduled weekly dose.

Multiple missed doses: For patients on the 2.5 mg/week dose, reinitiate at 2.5 mg once
weekly. For patients on doses ≥5 mg/week:

If 2 or fewer doses missed: Reinitiate at the same dose if previously tolerated (Ref).

If 3 or more doses missed: Reinitiate at 5 mg once weekly (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist,

requiring dose/frequency adjustment or avoidance. Consult drug interactions database

https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 2/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

for more information.

Dosing: Kidney Impairment: Adult

No dosage adjustment necessary.

Dosing: Liver Impairment: Adult

No dosage adjustment necessary.

Dosing: Older Adult

Refer to adult dosing.

Adverse Reactions (Significant): Considerations

Expand All

Acute kidney injury 

Diabetic retinopathy 
Gallbladder disease 
Gastrointestinal symptoms 
Hypersensitivity reactions 
Hypoglycemia 
Medullary thyroid carcinoma 
Pancreatitis 

Adverse Reactions
The following adverse drug reactions and incidences are derived from product labeling
unless otherwise specified. Adverse reactions reported in adults.

>10%:

Gastrointestinal: Constipation (6% to 17%) ( table 1), decreased appetite (5% to

11%) ( table 2), diarrhea (12% to 23%) ( table 3), nausea (12% to
29%) ( table 4), vomiting (5% to 13%) ( table 5)

Immunologic: Antibody development (51% to 65%; neutralizing: ≤3%)

1% to 10%:

Cardiovascular: Hypotension (1% to 2%), sinus tachycardia (5% to 10%) ( table 6)

https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 3/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

Dermatologic: Alopecia (4% to 5%; more common in females)

Endocrine & metabolic: Hypoglycemia (0.3% to 4%) ( table 7)

Gastrointestinal: Abdominal distention (3% to 4%), abdominal pain (5% to

10%) ( table 8), dyspepsia (5% to 10%) ( table 9), eructation (3% to 5%),
flatulence (1% to 4%), gallbladder disease (acute; including biliary colic,
cholecystectomy [0.2%] ( table 10), cholecystitis [0.2%] ( table 11),
cholelithiasis [0.6% to 1%] ( table 12)), gastroesophageal reflux disease (2% to
5%)

Hypersensitivity: Hypersensitivity reaction (2% to 5%; including severe hypersensitivity

reaction [<1%]) ( table 13)

Local: Injection-site reaction (3% to 8%)

Nervous system: Dizziness (4% to 5%), fatigue (5% to 7%)

Respiratory: Dry throat (1%)

<1%:

Gastrointestinal: Dysgeusia

Nervous system: Dysesthesia

Frequency not defined: Gastrointestinal: Delayed gastric emptying

Postmarketing:

Endocrine & metabolic: Diabetic retinopathy (Ref)

Gastrointestinal: Acute pancreatitis (including hemorrhagic pancreatitis, necrotizing

pancreatitis) (Ref), gastric outlet obstruction (Ref), increased serum amylase (Ref),
increase serum lipase (Ref), intestinal obstruction

Hepatic: Hepatotoxicity (Ref)

Hypersensitivity: Anaphylaxis, angioedema

Renal: Acute kidney injury (Ref), exacerbation of renal failure

Contraindications

Serious hypersensitivity to tirzepatide or any component of the formulation; serious

hypersensitivity reactions including anaphylaxis and angioedema have been reported;
a personal or family history of medullary thyroid carcinoma or in patients with multiple
endocrine neoplasia syndrome type 2 (MEN 2).
https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 4/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

Canadian labeling: Additional contraindications (not in US labeling): Breastfeeding;

pregnancy.

Warnings/Precautions

Disease-related concerns:

• Bariatric surgery:

- Dehydration: Evaluate, correct, and maintain postsurgical fluid requirements and

volume status prior to initiating therapy, and closely monitor the patient for
the duration of therapy; acute and chronic kidney failure exacerbation may
occur. A majority of cases occurred in patients with nausea, vomiting,
diarrhea, and/or dehydration. Nausea is common and fluid intake may be
more difficult after gastric bypass, sleeve gastrectomy, and gastric band
(Mechanick 2020).

- Excessive glucagon-like peptide-1 exposure: Closely monitor for efficacy and

assess for signs and symptoms of pancreatitis if therapy is initiated after
surgery; gastric bypass and sleeve gastrectomy (but not gastric band)
significantly increase endogenous postprandial GLP-1 concentrations (Korner
2009; Peterli 2012). Administration of exogenous GLP-1 receptor agonists may
be redundant to surgery effects.

Concurrent drug therapy issues:

• Delayed gastric emptying: Tirzepatide slows gastric emptying, which may alter the
absorption of other medications. Monitor narrow therapeutic index medications
for increased or decreased response.

Other warnings/precautions:

• Appropriate use: Diabetes mellitus: Do not use in patients with type 1 diabetes
mellitus or for the treatment of diabetic ketoacidosis; not a substitute for insulin.

• Surgical and endoscopic procedures: Use of glucagon-like peptide-1 receptor agonists

(GLP-1 RAs) has been associated with elevated residual gastric contents, which
may increase the risk for adverse events during anesthesia and deep sedation
(including aspiration) (Kobori 2023; Marroquin-Harris 2023; Silveira 2023). In some
studies, delayed gastric emptying induced by GLP-1 RAs returned to baseline after
8 to 12 weeks of continuous therapy; therefore, risk may be higher in patients who
recently initiated therapy or who use GLP-1 RAs intermittently (Raven 2024; van
Zuylen 2024). Although the American Society of Anesthesiologists has suggested
holding GLP-1 RAs prior to planned procedures requiring general anesthesia, the

https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 5/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

risks and benefits of this approach have not been evaluated (AGA [Hashash 2023];
ASA [Joshi 2023]). For example, in patients using GLP-1 RAs for glycemic control,
holding the medication may result in perioperative hyperglycemia and increase
the risk of adverse postoperative outcomes (AGA [Hashash 2023]; van Zuylen
2024). Individualize the decision to hold the GLP-1 RA based on patient-specific
factors such as the indication (eg, glycemic control vs weight management),
duration and frequency of therapy, presence of adverse GI symptoms, and
concomitant medications that may slow gastric emptying (eg, opioids, proton
pump inhibitors); may consider additional preoperative interventions (eg, clear
liquid diet, full stomach precautions, gastric ultrasound) on a case-by-case basis to
reduce risk (ASA [Hashash 2023]; Marroquin-Harris 2023; Raven 2024; van Zuylen
2024). Refer also to institutional protocols.

Dosage Forms: US
Excipient information presented when available (limited, particularly for generics); consult
specific product labeling.

Solution, Subcutaneous [preservative free]:

Zepbound: 2.5 mg/0.5 mL (0.5 mL); 5 mg/0.5 mL (0.5 mL); 7.5 mg/0.5 mL (0.5 mL); 10
mg/0.5 mL (0.5 mL); 12.5 mg/0.5 mL (0.5 mL); 15 mg/0.5 mL (0.5 mL)

Solution Auto-injector, Subcutaneous [preservative free]:

Mounjaro: 2.5 mg/0.5 mL (0.5 mL); 5 mg/0.5 mL (0.5 mL); 7.5 mg/0.5 mL (0.5 mL); 10
mg/0.5 mL (0.5 mL); 12.5 mg/0.5 mL (0.5 mL); 15 mg/0.5 mL (0.5 mL)

Zepbound: 2.5 mg/0.5 mL (0.5 mL); 5 mg/0.5 mL (0.5 mL); 7.5 mg/0.5 mL (0.5 mL); 10
mg/0.5 mL (0.5 mL); 12.5 mg/0.5 mL (0.5 mL); 15 mg/0.5 mL (0.5 mL)

Generic Equivalent Available: US

No

Pricing: US

Solution (Zepbound Subcutaneous)

2.5 mg/0.5 mL (per 0.5 mL): $104.70

5 mg/0.5 mL (per 0.5 mL): $149.70

7.5 mg/0.5 mL (per 0.5 mL): $179.70

10 mg/0.5 mL (per 0.5 mL): $209.70

https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 6/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

12.5 mg/0.5 mL (per 0.5 mL): $254.70

15 mg/0.5 mL (per 0.5 mL): $314.70

Solution Auto-injector (Mounjaro Subcutaneous)

2.5 mg/0.5 mL (per 0.5 mL): $323.93

5 mg/0.5 mL (per 0.5 mL): $323.93

7.5 mg/0.5 mL (per 0.5 mL): $323.93

10 mg/0.5 mL (per 0.5 mL): $323.93

12.5 mg/0.5 mL (per 0.5 mL): $323.93

15 mg/0.5 mL (per 0.5 mL): $323.93

Solution Auto-injector (Zepbound Subcutaneous)

2.5 mg/0.5 mL (per 0.5 mL): $325.91

5 mg/0.5 mL (per 0.5 mL): $325.91

7.5 mg/0.5 mL (per 0.5 mL): $325.91

10 mg/0.5 mL (per 0.5 mL): $325.91

12.5 mg/0.5 mL (per 0.5 mL): $325.91

15 mg/0.5 mL (per 0.5 mL): $325.91

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is

provided as reference price only. A range is provided when more than one manufacturer's
AWP price is available and uses the low and high price reported by the manufacturers to
determine the range. The pricing data should be used for benchmarking purposes only,
and as such should not be used alone to set or adjudicate any prices for reimbursement or
purchasing functions or considered to be an exact price for a single product and/or
manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether
express or implied, and assumes no liability with respect to accuracy of price or price range
data published in its solutions. In no event shall Medi-Span be liable for special, indirect,
incidental, or consequential damages arising from use of price or price range data. Pricing
data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult
specific product labeling.

https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 7/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

Solution, Subcutaneous:

Mounjaro: 2.5 mg/0.5 mL (0.5 mL); 5 mg/0.5 mL (0.5 mL); 7.5 mg/0.5 mL (0.5 mL); 10
mg/0.5 mL (0.5 mL); 12.5 mg/0.5 mL (0.5 mL); 15 mg/0.5 mL (0.5 mL)

Solution Auto-injector, Subcutaneous:

Mounjaro: 2.5 mg/0.5 mL (0.5 mL); 5 mg/0.5 mL (0.5 mL); 7.5 mg/0.5 mL (0.5 mL); 10
mg/0.5 mL (0.5 mL); 12.5 mg/0.5 mL (0.5 mL); 15 mg/0.5 mL (0.5 mL)

Solution Pen-injector, Subcutaneous:

Mounjaro KwikPen: 2.5 mg/0.6 mL (2.4 mL); 5 mg/0.6 mL (2.4 mL); 7.5 mg/0.6 mL (2.4
mL); 10 mg/0.6 mL (2.4 mL); 12.5 mg/0.6 mL (2.4 mL); 15 mg/0.6 mL (2.4 mL)
[contains benzyl alcohol, phenol]

Zepbound KwikPen: 2.5 mg/0.6 mL (2.4 mL); 5 mg/0.6 mL (2.4 mL); 7.5 mg/0.6 mL (2.4
mL); 10 mg/0.6 mL (2.4 mL); 12.5 mg/0.6 mL (2.4 mL); 15 mg/0.6 mL (2.4 mL)
[contains benzyl alcohol, phenol]

Administration: Adult

SUBQ: Administer by SUBQ injection into the abdomen, thigh, or upper arm at any time of
day on the same day each week, with or without food. If changing the day of
administration is necessary, allow ≥72 hours between 2 doses. Rotate injection sites
with each dose. When using the single-dose vial use a syringe appropriate for dose
administration (eg, a 1 mL syringe for measuring a 0.5 mL dose). Do not mix with other
injectable products (eg, insulin); administer as separate injections. Avoid adjacent
injections if administering other agents in the same area of the body. Solution should
be clear and colorless to slightly yellow; do not use if particulate matter or
discoloration are seen. Do not inject into skin that has lumps or pits or skin that is
bruised, damaged, hard, scaly, scarred, tender, or thickened.

Mounjaro and Zepbound single-dose pens do not require priming before injection. For the
Mounjaro Kwikpen and Zepbound Kwikpen multidose pens (Canadian products), prime
the needle before injecting by turning the dose selector 2 clicks to the prime indicator
and injecting into the air. Use a new needle for each injection. Once injected into the
body, continue to depress the button until the dial has returned to 0 and for an
additional 5 seconds. Then, remove the needle.

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information
and as follows, must be dispensed with this medication:

https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 8/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

Mounjaro:
https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/215866s002s006lb
l.pdf#page=20

Use: Labeled Indications

Type 2 diabetes mellitus, treatment (Mounjaro): As an adjunct to diet and exercise to

improve glycemic control in adults with type 2 diabetes mellitus.

Limitations of use: Has not been studied in patients with a history of pancreatitis; not
indicated for use in patients with type 1 diabetes mellitus.

Obstructive sleep apnea, moderate to severe (Zepbound): Treatment of moderate to

severe obstructive sleep apnea in adults with obesity.

Weight management, chronic (Zepbound): As an adjunct to a reduced-calorie diet and

increased physical activity to reduce excess body weight and maintain weight
reduction long-term in adults with obesity, or in adults with overweight in the presence
of ≥1 weight-related comorbid condition (eg, cardiovascular disease, dyslipidemia,
hypertension, obstructive sleep apnea, type 2 diabetes mellitus).

Use: Off-Label: Adult

Heart failure with preserved ejection fraction, weight management; Metabolic dysfunction–
associated steatohepatitis, weight management

Medication Safety Issues

Sound-alike/look-alike issues: 

Tirzepatide may be confused with teriparatide, tolazamide.

Mounjaro may be confused with Monjuvi.

Metabolism/Transport Effects
None known.

Drug Interactions
(For additional information: Launch drug interactions program)

Note: Interacting drugs may not be individually listed below if they are part of a group
interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a
complete list of drug interactions by individual drug name and detailed management

https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 9/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

recommendations, use the drug interactions program by clicking on the “Launch drug
interactions program” link above.

Alectinib: Glucagon-Like Peptide-1 Agonists may decrease serum concentrations of

Alectinib. Risk C: Monitor

Alpha-Lipoic Acid: May increase hypoglycemic effects of Antidiabetic Agents. Risk C: Monitor

Androgens: May increase hypoglycemic effects of Agents with Blood Glucose Lowering
Effects. Risk C: Monitor

Beta-Blockers (Beta1 Selective): May increase adverse/toxic effects of Antidiabetic Agents.

Specifically, beta-blockers may mask the hypoglycemic symptoms of antidiabetic
agents. Risk C: Monitor

Beta-Blockers (Nonselective): May increase hypoglycemic effects of Antidiabetic Agents.

Beta-Blockers (Nonselective) may increase adverse/toxic effects of Antidiabetic Agents.
Specifically, beta-blockers may mask the hypoglycemic symptoms of antidiabetic
agents. Risk C: Monitor

Bortezomib: May increase therapeutic effects of Antidiabetic Agents. Bortezomib may

decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor

Direct Acting Antiviral Agents (HCV): May increase hypoglycemic effects of Antidiabetic
Agents. Risk C: Monitor

Etilefrine: May decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor

Glucagon-Like Peptide-1 Agonists: Tirzepatide may increase adverse/toxic effects of

Glucagon-Like Peptide-1 Agonists. Risk X: Avoid

Guanethidine: May increase hypoglycemic effects of Antidiabetic Agents. Risk C: Monitor

Hormonal Contraceptives: Tirzepatide may decrease serum concentrations of Hormonal

Contraceptives. Management: Patients using oral hormonal contraceptives should
switch to a non-oral contraceptive method, or add a barrier method of contraception,
for 4 weeks after initiation of tirzepatide and for 4 weeks after each dose escalation of
tirzepatide. Risk D: Consider Therapy Modification

Hyperglycemia-Associated Agents: May decrease therapeutic effects of Antidiabetic Agents.

Risk C: Monitor

Hypoglycemia-Associated Agents: Antidiabetic Agents may increase hypoglycemic effects

of Hypoglycemia-Associated Agents. Risk C: Monitor

https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 10/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

Insulin: Glucagon-Like Peptide-1 Agonists may increase hypoglycemic effects of Insulin.

Management: Consider insulin dose reductions when used in combination with
glucagon-like peptide-1 agonists. Monitor patients for hypoglycemia. Risk D: Consider
Therapy Modification

Liraglutide: May increase adverse/toxic effects of Glucagon-Like Peptide-1 Agonists. Risk X:

Avoid

Maitake: May increase hypoglycemic effects of Agents with Blood Glucose Lowering Effects.
Risk C: Monitor

Meglitinides: Glucagon-Like Peptide-1 Agonists may increase hypoglycemic effects of

Meglitinides. Management: Consider meglitinide dose reductions when used in
combination with glucagon-like peptide-1 agonists, particularly when also used with
basal insulin. Risk D: Consider Therapy Modification

Monoamine Oxidase Inhibitors: May increase hypoglycemic effects of Agents with Blood
Glucose Lowering Effects. Risk C: Monitor

Pegvisomant: May increase hypoglycemic effects of Agents with Blood Glucose Lowering
Effects. Risk C: Monitor

Prothionamide: May increase hypoglycemic effects of Agents with Blood Glucose Lowering
Effects. Risk C: Monitor

Quinolones: May increase hypoglycemic effects of Agents with Blood Glucose Lowering
Effects. Quinolones may decrease therapeutic effects of Agents with Blood Glucose
Lowering Effects. Specifically, if an agent is being used to treat diabetes, loss of blood
sugar control may occur with quinolone use. Risk C: Monitor

Reproterol: May decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor

Ritodrine: May decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor

Salicylates: May increase hypoglycemic effects of Agents with Blood Glucose Lowering
Effects. Risk C: Monitor

Selective Serotonin Reuptake Inhibitor: May increase hypoglycemic effects of Agents with
Blood Glucose Lowering Effects. Risk C: Monitor

Semaglutide: May increase adverse/toxic effects of Glucagon-Like Peptide-1 Agonists. Risk

X: Avoid

Sincalide: Drugs that Affect Gallbladder Function may decrease therapeutic effects of
Sincalide. Management: Consider discontinuing drugs that may affect gallbladder

https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 11/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

motility prior to the use of sincalide to stimulate gallbladder contraction. Risk D:

Consider Therapy Modification

Sulfonylureas: Glucagon-Like Peptide-1 Agonists may increase hypoglycemic effects of

Sulfonylureas. Management: Consider sulfonylurea dose reductions when used in
combination with glucagon-like peptide-1 agonists. Risk D: Consider Therapy
Modification

Thiazide and Thiazide-Like Diuretics: May decrease therapeutic effects of Antidiabetic

Agents. Risk C: Monitor

Warfarin: Tirzepatide may increase serum concentrations of Warfarin. Tirzepatide may

decrease serum concentrations of Warfarin. Risk C: Monitor

Reproductive Considerations

Agents other than tirzepatide are currently recommended for patients with type 2 diabetes
mellitus planning to become pregnant (ADA 2025).

Obesity increases the risk of infertility. Optimal weight control prior to conception improves
pregnancy outcomes; however, medications for weight loss are not recommended prior to
pregnancy due to safety issues and adverse events. Weight loss medications should be
discontinued prior to conception (ACOG 2021; Wharton 2020).

Tirzepatide may decrease the efficacy of oral hormonal contraception due to changes in
gastric emptying; contraceptives administered by a nonoral route are not affected. Because
the changes in gastric emptying are largest following the first dose, patients using an oral
contraceptive should add a barrier method for 4 weeks after starting tirzepatide treatment
and for 4 weeks after each dose increase. Alternately, patients can be switched to nonoral
contraceptive methods.

Consult drug interactions database for more detailed information specific to use of
tirzepatide and specific contraceptives.

Pregnancy Considerations

Based on data from animal reproduction studies, in utero exposure to tirzepatide may
cause fetal harm.

Poorly controlled diabetes during pregnancy can be associated with an increased risk of
adverse maternal and fetal outcomes, including diabetic ketoacidosis, preeclampsia,
spontaneous abortion, preterm delivery, delivery complications, major malformations,
https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 12/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

stillbirth, and macrosomia (ACOG 2018). To prevent adverse outcomes, prior to conception
and throughout pregnancy, maternal blood glucose and HbA1c should be kept as close to
target goals as possible but without causing significant hypoglycemia (ADA 2025).

Agents other than tirzepatide are currently recommended to treat diabetes mellitus in
pregnancy (ADA 2025).

An increased risk of adverse maternal and fetal events is associated with obesity; however,
moderate gestational weight gain based on prepregnancy BMI is required for positive fetal
outcomes in all pregnancies, including patients who are overweight or obese. Therefore,
medications for weight loss therapy are not recommended during pregnancy (ACOG 2021;
Wharton 2020). Patients should discontinue tirzepatide once pregnancy is recognized.

Data collection to monitor pregnancy and infant outcomes following exposure to

tirzepatide is ongoing. Health care providers are encouraged to enroll patients exposed to
Zepbound during pregnancy in the registry (1-800-545-5979); patients may also enroll
themselves.

Breastfeeding Considerations

It is not known if tirzepatide is present in breast milk.

According to the manufacturer, the decision to breastfeed during therapy should consider
the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits
of treatment to the mother.

Monitoring Parameters

Plasma glucose; GI adverse reactions (eg, nausea, vomiting, diarrhea); kidney function (at
baseline and following dose increases in patients with kidney impairment reporting
severe GI adverse reactions); signs/symptoms of pancreatitis (eg, persistent severe
abdominal pain, which may radiate to the back and that may or may not be
accompanied by vomiting); signs/symptoms of gallbladder disease; worsening of
diabetic retinopathy (particularly in those with a prior history of the disease);
emergence of worsening depression, suicidal thoughts/behavior, changes in behavior;
heart rate; body weight (when used for chronic weight management).

HbA1c: Monitor at least twice yearly in patients who have stable glycemic control and
are meeting treatment goals; monitor quarterly in patients in whom treatment
goals have not been met, or with therapy change. Note: In patients prone to
glycemic variability (eg, patients with insulin deficiency), or in patients whose
HbA1c is discordant with serum glucose levels or symptoms, consider evaluating
https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 13/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

HbA1c in combination with blood glucose levels and/or a glucose management

indicator (ADA 2025; KDIGO 2020).

Reference Range

Recommendations for glycemic control in patients with diabetes:

Nonpregnant adults (AACE [Samson 2023], ADA 2025):

HbA1c: <7% (a more aggressive [<6.5%] or less aggressive [<8%] HbA1c goal may be
targeted based on patient-specific characteristics). Note: In patients using a
continuous glucose monitoring system, a goal of time in range >70% with time
below range <4% is recommended and is similar to a goal HbA1c <7%.

Preprandial capillary blood glucose: 80 to 130 mg/dL (SI: 4.4 to 7.2 mmol/L) (more
or less stringent goals may be appropriate based on patient-specific
characteristics).

Peak postprandial capillary blood glucose (~1 to 2 hours after a meal): <180 mg/dL
(SI: <10 mmol/L) (more or less stringent goals may be appropriate based on
patient-specific characteristics).

Older adults (≥65 years of age) (ADA 2025):

Note: Consider less strict targets in patients who are using insulin and/or insulin
secretagogues (sulfonylureas, meglitinides) (ES [LeRoith 2019]).

HbA1c: <7% to 7.5% (healthy); <8% (complex/intermediate health). Note:

Individualization may be appropriate based on patient and caregiver
preferences and/or presence of cognitive impairment. In patients with very
complex or poor health (ie, limited remaining life expectancy), consider
making therapy decisions based on avoidance of hypoglycemia and
symptomatic hyperglycemia rather than HbA1c level.

Preprandial capillary blood glucose: 80 to 130 mg/dL (SI: 4.4 to 7.2 mmol/L)
(healthy); 90 to 150 mg/dL (SI: 5 to 8.3 mmol/L) (complex/intermediate health);
100 to 180 mg/dL (SI: 5.6 to 10 mmol/L) (very complex/poor health).

Bedtime capillary blood glucose: 80 to 180 mg/dL (SI: 4.4 to 10 mmol/L) (healthy);
100 to 180 mg/dL (SI: 5.6 to 10 mmol/L) (complex/intermediate health); 110 to
200 mg/dL (SI: 6.1 to 11.1 mmol/L) (very complex/poor health).

Classification of hypoglycemia (ADA 2025):

Level 1: 54 to 70 mg/dL (SI: 3 to 3.9 mmol/L); hypoglycemia alert value; initiate fast-
acting carbohydrate (eg, glucose) treatment.
https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 14/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

Level 2: <54 mg/dL (SI: <3 mmol/L); threshold for neuroglycopenic symptoms; requires
immediate action.

Level 3: Hypoglycemia associated with a severe event characterized by altered mental

and/or physical status requiring assistance.

Mechanism of Action
Tirzepatide is a glucose-dependent insulinotropic polypeptide (GIP) receptor and glucagon-
like peptide-1 (GLP-1) receptor agonist that increases glucose-dependent insulin secretion,
decreases inappropriate glucagon secretion, slows gastric emptying, and decreases food
intake (likely due to appetite mediation).

Pharmacokinetics (Adult Data Unless Noted)

Distribution: Vdss: ~9.7 to 11.8 L.

Protein binding: 99% to plasma albumin.

Metabolism: By proteolytic cleavage of the peptide backbone, beta-oxidation of the C20

fatty diacid moiety, and amide hydrolysis.

Bioavailability: 80%.

Half-life elimination: ~5 days.

Time to peak: 8 to 72 hours.

Excretion: Urine and feces (as metabolites).

Clearance: 0.056 to 0.061 L/hour.

Brand Names: International

Find brand name(s) by country (for United States and Canada see separate Brand Names sections)

 Enter a Country or Country Code

International Brand Names by Country 

For country code abbreviations ( show table)

(QA) Qatar: Mounjaro | Mounjaro KwikPen

Use of UpToDate is subject to the Terms of Use.

https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 15/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

REFERENCES
1. Aleman Espino A, Aleman Espino E, Aleman Oliva C, Monteagudo H, Frontela O. An incidental finding of a
glucagon-like peptide 1 (GLP-1)-induced acute kidney injury: a case report. Cureus. 2023;15(9):e45261.
doi:10.7759/cureus.45261 [PubMed 37720126]

2. Alves C, Batel-Marques F, Macedo AF. A meta-analysis of serious adverse events reported with exenatide and
liraglutide: acute pancreatitis and cancer. Diabetes Res Clin Pract. 2012;98(2):271-284.
doi:10.1016/j.diabres.2012.09.008 [PubMed 23010561]

3. American College of Obstetricians and Gynecologists (ACOG). ACOG practice bulletin no. 201: pregestational
diabetes mellitus. Obstet Gynecol. 2018;132(6):e228-e248. doi:10.1097/AOG.0000000000002960 [PubMed
30461693]

4. American College of Obstetricians and Gynecologists (ACOG). Obesity in pregnancy: ACOG practice bulletin
no. 230. Obstet Gynecol. 2021;137(6):e128-e144. doi:10.1097/AOG.0000000000004395 [PubMed 34011890]

5. American Diabetes Association (ADA). Standards of care in diabetes–2025. Diabetes Care. 2025;48(suppl
1):S1-S352. https://diabetesjournals.org/care/issue/48/Supplement_1. Accessed February 13, 2025.

6. Besemer F, Verschoor AJ, Diamant M, Hoogma RP. Vesiculopustular dermatosis: an uncommon side-effect of
liraglutide? J Diabetes Complications. 2012;26(5):458-459. doi:10.1016/j.jdiacomp.2012.05.018 [PubMed
22727533]

7. Bjerre Knudsen L, Madsen LW, Andersen S, et al. Glucagon-like Peptide-1 receptor agonists activate rodent
thyroid C-cells causing calcitonin release and C-cell proliferation. Endocrinology. 2010;151(4):1473-1486.
doi:10.1210/en.2009-1272 [PubMed 20203154]

8. Blumenthal KG, Peter JG, Trubiano JA, Phillips EJ. Antibiotic allergy. Lancet. 2019;393(10167):183-198.
doi:10.1016/S0140-6736(18)32218-9 [PubMed 30558872]

9. Carvallo A, Silva C, Gastaminza G, D'Amelio CM. Delayed hypersensitivity reaction to liraglutide: a case
report. J Investig Allergol Clin Immunol. 2020;30(5):367-369. doi:10.18176/jiaci.0521 [PubMed 32301438]

10. Cogen AL, Desai K, Elder D, Rosenbach M. Acute photodistributed exanthematous pustulosis associated with
liraglutide treatment. JAMA Dermatol. 2019;155(10):1198-1200. doi:10.1001/jamadermatol.2019.1893
[PubMed 31389984]

11. Davies MJ, D'Alessio DA, Fradkin J, et al. Management of hyperglycemia in type 2 diabetes, 2018. A
consensus report by the American Diabetes Association (ADA) and the European Association for the Study of
Diabetes (EASD). Diabetes Care. 2018;41(12):2669-2701. doi:10.2337/dci18-0033 [PubMed 30291106]

12. Early worsening of diabetic retinopathy in the Diabetes Control and Complications Trial. Arch Ophthalmol.
1998;116(7):874-886. doi:10.1001/archopht.116.7.874 [PubMed 9682700]

13. Egan AG, Blind E, Dunder K, et al. Pancreatic safety of incretin-based drugs--FDA and EMA assessment. N
Engl J Med. 2014;370(9):794-797. doi:10.1056/NEJMp1314078 [PubMed 24571751]

https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 16/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

14. Elashoff M, Matveyenko AV, Gier B, Elashoff R, Butler PC. Pancreatitis, pancreatic, and thyroid cancer with
glucagon-like peptide-1-based therapies. Gastroenterology. 2011;141(1):150-156.
doi:10.1053/j.gastro.2011.02.018 [PubMed 21334333]

15. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes
(EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO clinical practice guidelines
on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol.
2024;81(3):492-542. doi:10.1016/j.jhep.2024.04.031 [PubMed 38851997]

16. FDA drug safety communication: FDA investigating reports of possible increased risk of pancreatitis and
pre-cancerous findings of the pancreas from incretin mimetic drugs for type 2 diabetes. Food and Drug
Administration. Updated March 14, 2013. Accessed July 20, 2022. https://www.fda.gov/drugs/drug-safety-
and-availability/fda-drug-safety-communication-fda-investigating-reports-possible-increased-risk-
pancreatitis-and-pre

17. Filippatos TD, Panagiotopoulou TV, Elisaf MS. Adverse effects of GLP-1 receptor agonists. Rev Diabet Stud.
2014;11(3-4):202-230. doi:10.1900/RDS.2014.11.202 [PubMed 26177483]

18. Frías JP, Davies MJ, Rosenstock J, et al. Tirzepatide versus semaglutide once weekly in patients with type 2
diabetes. N Engl J Med. 2021;385(6):503-515. doi:10.1056/NEJMoa2107519 [PubMed 34170647]

19. Gastaldelli A, Cusi K, Fernández Landó L, Bray R, Brouwers B, Rodríguez Á. Effect of tirzepatide versus
insulin degludec on liver fat content and abdominal adipose tissue in people with type 2 diabetes
(SURPASS-3 MRI): a substudy of the randomised, open-label, parallel-group, phase 3 SURPASS-3 trial. Lancet
Diabetes Endocrinol. 2022;10(6):393-406. doi:10.1016/S2213-8587(22)00070-5 [PubMed 35468325]

20. Gether IM, Nexøe-Larsen C, Knop FK. New avenues in the regulation of gallbladder motility-implications for
the use of glucagon-like peptide-derived drugs. J Clin Endocrinol Metab. 2019;104(7):2463-2472.
doi:10.1210/jc.2018-01008 [PubMed 30137354]

21. Giorda CB, Nada E, Tartaglino B, Marafetti L, Gnavi R. A systematic review of acute pancreatitis as an
adverse event of type 2 diabetes drugs: from hard facts to a balanced position. Diabetes Obes Metab.
2014;16(11):1041-1047. doi:10.1111/dom.12297 [PubMed 24702687]

22. Grennan K, Borg C, Meneley A, Janitz T, Shuman M, Venegas C. Fatal, fulminant, necrotizing pancreatitis
associated with recent tirzepatide initiation. JCEM Case Rep. 2025;3(6):luaf087. doi:10.1210/jcemcr/luaf087
[PubMed 40270999]

23. Hashash JG, Thompson CC, Wang AY. AGA rapid clinical practice update on the management of patients
taking GLP-1 receptor agonists prior to endoscopy: communication. Clin Gastroenterol Hepatol.
2024;22(4):705-707. doi:10.1016/j.cgh.2023.11.002 [PubMed 37944573]

24. He L, Wang J, Ping F, et al. Association of glucagon-like peptide-1 receptor agonist use with risk of
gallbladder and biliary diseases: a systematic review and meta-analysis of randomized clinical trials. JAMA
Intern Med. 2022;182(5):513-519. doi:10.1001/jamainternmed.2022.0338 [PubMed 35344001]

https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 17/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

25. Htike ZZ, Zaccardi F, Papamargaritis D, Webb DR, Khunti K, Davies MJ. Efficacy and safety of glucagon-like
peptide-1 receptor agonists in type 2 diabetes: a systematic review and mixed-treatment comparison
analysis. Diabetes Obes Metab. 2017;19(4):524-536. doi:10.1111/dom.12849 [PubMed 27981757]

26. Iskander M, Wadhwa M, Kim Y, Singh N, Pathak P. Acute functional gastric outlet obstruction associated
with low-dose tirzepatide. Cureus. 2025;17(1):e78090. doi:10.7759/cureus.78090 [PubMed 40026949]

27. Joshi GP, Abdelmalak BB, Weigel WA, et al; American Society of Anesthesiologists (ASA). American Society of
Anesthesiologists consensus-based guidance on preoperative management of patients (adults and
children) on glucagon-like peptide-1 (GLP-1) receptor agonists. https://www.asahq.org/about-
asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-
on-preoperative. Published June 29, 2023.

28. Kamrul-Hasan ABM, Mondal S, Dutta D, Nagendra L, Kabir MR, Pappachan JM. Pancreatic safety of
tirzepatide and its effects on islet cell function: a systematic review and meta-analysis. Obes Sci Pract.
2024;10(6):e70032. doi:10.1002/osp4.70032 [PubMed 39720158]

29. Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2020 clinical practice
guideline for diabetes management in chronic kidney disease. Kidney Int. 2020;98(suppl 4):S1-S115.
doi:10.1016/j.kint.2020.06.019 [PubMed 32998798]

30. Knapen LM, de Jong RG, Driessen JH, et al. Use of incretin agents and risk of acute and chronic pancreatitis:
a population-based cohort study. Diabetes Obes Metab. 2017;19(3):401-411. doi:10.1111/dom.12833
[PubMed 27883260]

31. Kobori T, Onishi Y, Yoshida Y, et al. Association of glucagon-like peptide-1 receptor agonist treatment with
gastric residue in an esophagogastroduodenoscopy. J Diabetes Investig. 2023;14(6):767-773.
doi:10.1111/jdi.14005 [PubMed 36919944]

32. Korkmaz H, Araz M, Alkan S, Akarsu E. Liraglutide-related cholelithiasis. Aging Clin Exp Res. 2015;27(5):751-
753. doi:10.1007/s40520-015-0335-2 [PubMed 25725635]

33. Korner J, Inabnet W, Febres G, et al. Prospective study of gut hormone and metabolic changes after
adjustable gastric banding and Roux-en-Y gastric bypass. Int J Obes (Lond). 2009;33(7):786-795.
doi:10.1038/ijo.2009.79 [PubMed 19417773]

34. LeRoith D, Biessels GJ, Braithwaite SS, et al. Treatment of diabetes in older adults: an Endocrine Society
clinical practice guideline. J Clin Endocrinol Metab. 2019;104(5):1520-1574. doi:10.1210/jc.2019-00198
[PubMed 30903688]

35. Loomba R, Hartman ML, Lawitz EJ, et al. Tirzepatide for metabolic dysfunction-associated steatohepatitis
with liver fibrosis. N Engl J Med. 2024;391(4):299-310. doi:10.1056/NEJMoa2401943 [PubMed 38856224]

36. Malhotra A, Grunstein RR, Fietze I, et al; SURMOUNT-OSA Investigators. Tirzepatide for the treatment of
obstructive sleep apnea and obesity. N Engl J Med. 2024;391(13):1193-1205. doi:10.1056/NEJMoa2404881
[PubMed 38912654]

https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 18/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

37. Marroquin-Harris M, Olesnicky B. Aspiration risk with glucagon-like peptide 1 (GLP-1) agonists. Anaesthesia.
2023;78(12):1524. doi:10.1111/anae.16099 [PubMed 37443429]

38. Marzioni M, Alpini G, Saccomanno S, et al. Exendin-4, a glucagon-like peptide 1 receptor agonist, protects
cholangiocytes from apoptosis. Gut. 2009;58(7):990-997. doi:10.1136/gut.2008.150870 [PubMed 18829977]

39. Marzioni M, Alpini G, Saccomanno S, et al. Glucagon-like peptide-1 and its receptor agonist exendin-4
modulate cholangiocyte adaptive response to cholestasis. Gastroenterology. 2007;133(1):244-255.
doi:10.1053/j.gastro.2007.04.007 [PubMed 17631146]

40. Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition,
metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update:
cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the
Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and
American Society of Anesthesiologists. Surg Obes Relat Dis. 2020;16(2):175-247.
doi:10.1016/j.soard.2019.10.025 [PubMed 31917200]

41. Mounjaro (tirzepatide) [prescribing information]. Indianapolis, IN: Lilly USA LLC; June 2025.

42. Mounjaro (tirzepatide) [product monograph]. Toronto, Ontario, Canada: Eli Lilly Canada Inc; September
2024.

43. Nauck MA, Muus Ghorbani ML, Kreiner E, Saevereid HA, Buse JB; LEADER Publication Committee on behalf
of the LEADER Trial Investigators. Effects of liraglutide compared with placebo on events of acute
gallbladder or biliary disease in patients with type 2 diabetes at high risk for cardiovascular events in the
LEADER randomized trial. Diabetes Care. 2019;42(10):1912-1920. doi:10.2337/dc19-0415 [PubMed
31399438]

44. Ornelas C, Caiado J, Lopes A, Pereira Dos Santos MC, Pereira Barbosa M. Anaphylaxis to long-acting release
exenatide. J Investig Allergol Clin Immunol. 2018;28(5):332-334. doi:10.18176/jiaci.0274 [PubMed
30350785]

45. Packer M, Zile MR, Kramer CM, et al. Tirzepatide for heart failure with preserved ejection fraction and
obesity. N Engl J Med. 2025;392(5):427-437. doi:10.1056/NEJMoa2410027 [PubMed 39555826]

46. Pérez E, Martínez-Tadeo J, Callero A, Hernández G, Rodríguez-Plata E, García-Robaina JC. A case report of
allergy to exenatide. J Allergy Clin Immunol Pract. 2014;2(6):822-823. doi:10.1016/j.jaip.2014.05.011
[PubMed 25439386]

47. Perreault L, Reid TK. Obesity in adults: drug therapy. Connor RF, ed. UpToDate. Waltham, MA: UpToDate Inc.
https://www.uptodate.com. Accessed April 21, 2025.

48. Peterli R, Steinert RE, Woelnerhanssen B, et al. Metabolic and hormonal changes after laparoscopic Roux-
en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg. 2012;22(5):740-
748. doi:10.1007/s11695-012-0622-3 [PubMed 22354457]

49. Phox M, Thesing J, Kilgore WR 3rd, Alderson J. Tirzepatide-induced liver injury: a rare medication side effect.
ACG Case Rep J. 2025;12(4):e01661. doi:10.14309/crj.0000000000001661 [PubMed 40212859]

https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 19/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

50. Raven LM, Brown C, Greenfield JR. Considerations of delayed gastric emptying with peri-operative use of
glucagon-like peptide-1 receptor agonists. Med J Aust. 2024;220(1):14-16. doi:10.5694/mja2.52170
[PubMed 38009941]

51. Refer to manufacturer's labeling.

52. Rzepka PV, Kaffenberger JA. A case of morbilliform drug eruption to dulaglutide. J Clin Aesthet Dermatol.
2020;13(4):13. [PubMed 33144906]

53. Samson SL, Vellanki P, Blonde L, et al. American Association of Clinical Endocrinology consensus statement:
comprehensive type 2 diabetes management algorithm – 2023 update. Endocr Pract. 2023;29(5):305-340.
doi:10.1016/j.eprac.2023.02.001 [PubMed 37150579]

54. Shamriz O, NaserEddin A, Mosenzon O, Sviri S, Tal Y. Allergic reaction to exenatide and lixisenatide but not
to liraglutide: unveiling anaphylaxis to glucagon-like peptide 1 receptor agonists. Diabetes Care.
2019;42(9):e141-e142. doi:10.2337/dc19-0720 [PubMed 31296642]

55. Shyangdan DS, Royle P, Clar C, Sharma P, Waugh N, Snaith A. Glucagon-like peptide analogues for type 2
diabetes mellitus. Cochrane Database Syst Rev. 2011;2011(10):CD006423.
doi:10.1002/14651858.CD006423.pub2 [PubMed 21975753]

56. Silveira SQ, da Silva LM, de Campos Vieira Abib A, et al. Relationship between perioperative semaglutide use
and residual gastric content: a retrospective analysis of patients undergoing elective upper endoscopy. J
Clin Anesth. 2023;87:111091. doi:10.1016/j.jclinane.2023.111091 [PubMed 36870274]

57. Simó R, Hernández C. GLP-1R as a target for the treatment of diabetic retinopathy: friend or foe? Diabetes.
2017;66(6):1453-1460. doi:10.2337/db16-1364 [PubMed 28533296]

58. Singh S, Chang HY, Richards TM, Weiner JP, Clark JM, Segal JB. Glucagonlike peptide 1-based therapies and
risk of hospitalization for acute pancreatitis in type 2 diabetes mellitus: a population-based matched case-
control study. JAMA Intern Med. 2013;173(7):534-539. doi:10.1001/jamainternmed.2013.2720 [PubMed
23440284]

59. Steveling EH, Winzeler B, Bircher AJ. Systemic allergic reaction to the GLP-1 receptor agonist exenatide. J
Pharm Technol. 2014;30(5):182-186. doi:10.1177/8755122514539462 [PubMed 34860904]

60. Sun F, Chai S, Yu K, et al. Gastrointestinal adverse events of glucagon-like peptide-1 receptor agonists in
patients with type 2 diabetes: a systematic review and network meta-analysis. Diabetes Technol Ther.
2015;17(1):35-42. doi:10.1089/dia.2014.0188 [PubMed 25375397]

61. Thomsen RW, Pedersen L, Møller N, Kahlert J, Beck-Nielsen H, Sørensen HT. Incretin-based therapy and risk
of acute pancreatitis: a nationwide population-based case-control study. Diabetes Care. 2015;38(6):1089-
1098. doi:10.2337/dc13-2983 [PubMed 25633664]

62. Trulicity (dulaglutide) [prescribing information]. Indianapolis, IN: Eli Lilly and Company; December 2021.

https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 20/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

63. van Zuylen ML, Siegelaar SE, Plummer MP, Deane AM, Hermanides J, Hulst AH. Perioperative management
of long-acting glucagon-like peptide-1 (GLP-1) receptor agonists: concerns for delayed gastric emptying
and pulmonary aspiration. Br J Anaesth. 2024;132(4):644-648. doi:10.1016/j.bja.2024.01.001 [PubMed
38290907]

64. Victoza (liraglutide) [prescribing information]. Plainsboro, NJ: Novo Nordisk Inc; December 2021.

65. Vilsbøll T, Bain SC, Leiter LA, et al. Semaglutide, reduction in glycated haemoglobin and the risk of diabetic
retinopathy. Diabetes Obes Metab. 2018;20(4):889-897. doi:10.1111/dom.13172 [PubMed 29178519]

66. Wexler DJ. Initial management of hyperglycemia in adults with type 2 diabetes mellitus. Connor RF, ed.
UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com. Accessed April 21, 2025.

67. Wharton S, Lau DCW, Vallis M, et al. Obesity in adults: a clinical practice guideline. CMAJ.
2020;192(31):E875-E891. doi:10.1503/cmaj.191707 [PubMed 32753461]

68. Whitley HP, Trujillo JM, Neumiller JJ. Special report: potential strategies for addressing GLP-1 and dual GLP-
1/GIP receptor agonist shortages. Clin Diabetes. 2023;41(3):467-473. doi:10.2337/cd23-0023 [PubMed
37456085]

69. Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology.
2013;144(6):1252-1261. doi:10.1053/j.gastro.2013.01.068 [PubMed 23622135]

70. Zepbound (tirzepatide) [prescribing information]. Indianapolis, IN: Lilly USA LLC; April 2025.

71. Zepbound Kwikpen (tirzepatide) [product monograph]. Toronto, Ontario, Canada: Eli Lilly Canada Inc; May
2025.

Topic 138675 Version 151.0

https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 21/22
23/8/25, 13:43 Tirzepatide: Drug information - UpToDate

https://sso.uptodate.com/contents/tirzepatide-drug-information?topicRef=8357&source=see_link 22/22