Zepbound Side Effects: What to Expect
Adverse reactions reported for tirzepatide in its pivotal trial program, plus the boxed warning and serious warnings from the FDA label.
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Most Common Zepbound Side Effects
Adverse reactions reported in the Zepbound FDA label, with the incidence among tirzepatide-treated patients and placebo for comparison. Figures are transcribed from the label's adverse-reactions section (DailyMed SetID 487cd7e7-434c-4925-99fa-aa80b1cc776b).
| Adverse reaction | Incidence (Zepbound vs placebo) |
|---|---|
| Nausea | 25–29% (placebo 8%) |
| Diarrhea | 19–23% (placebo 8%) |
| Vomiting | 8–13% (placebo 2%) |
| Constipation | 11–17% (placebo 5%) |
| Abdominal pain | 9–10% (placebo 5%) |
| Dyspepsia | 9–10% (placebo 4%) |
| Injection-site reactions | 6–8% (placebo 2%) |
| Fatigue | 5–7% (placebo 3%) |
| Hypersensitivity reactions | 5% (placebo 3%) |
| Eructation (burping) | 4–5% (placebo 1%) |
| Hair loss (alopecia) | 4–5% (placebo 1%) |
| Gastroesophageal reflux disease (GERD) | 4–5% (placebo 2%) |
Source: Zepbound FDA prescribing information via DailyMed (SetID 487cd7e7-434c-4925-99fa-aa80b1cc776b), Section 6 Adverse Reactions. Last verified 2026-05-31. This is summary information — read the full label and talk to a prescriber.
Boxed Warning — Thyroid C-Cell Tumors
“In rats, tirzepatide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. It is unknown whether ZEPBOUND causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as the human relevance of tirzepatide-induced rodent thyroid C-cell tumors has not been determined. ZEPBOUND is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).”
Verbatim from the Zepbound FDA label (DailyMed SetID 487cd7e7-434c-4925-99fa-aa80b1cc776b). The boxed warning is the FDA's most serious warning. Do not start Zepbound without discussing your personal and family medical history with a licensed prescriber.
Serious Warnings & Precautions
Beyond the common reactions above, the Zepbound label lists these serious risks (Section 5 Warnings & Precautions). They are less common but can be medically urgent — know the symptoms and when to seek care.
- Risk of thyroid C-cell tumors
- Severe gastrointestinal adverse reactions
- Acute kidney injury due to volume depletion
- Acute gallbladder disease
- Acute pancreatitis
- Hypersensitivity reactions
- Hypoglycemia
- Diabetic retinopathy complications in patients with type 2 diabetes mellitus
- Pulmonary aspiration during general anesthesia or deep sedation
Compare every Zepbound provider
A prescriber screens for the warnings above before prescribing. See current pricing, verification status, form, and states served across every vetted provider in one place.
Related deep-dives
For management steps and the underlying evidence on each symptom, read our dedicated articles:
- Zepbound nausea: causes & management →
- Zepbound constipation: causes & relief →
- Zepbound fatigue: causes & management →
- Zepbound hair loss & telogen effluvium →
- Zepbound headaches: how common? →
- Zepbound & sleep disturbance →
- Can you drink alcohol on Zepbound? →
- Tirzepatide & lean-mass / muscle loss →
- Tirzepatide burping & sulfur burps →
- Zepbound vs Wegovy: side-effect comparison →
- GLP-1 side effects: what the trials showed →
- How long do GLP-1 side effects last? →
- GLP-1 side-effect questions answered →