Zepbound Side Effects

The side effects of Zepbound range from minor effects like abdominal pain, vomiting and constipation to severe effects like stomach paralysis, bowel obstruction and cancer. Zepbound (tirzepatide) is an FDA-approved weight-loss drug manufactured by Eli Lilly. It is similar to semaglutide and tirzepatide medications like Ozempic, Wegovy and Mounjaro. 

Zepbound is the first tirzepatide injection drug approved specifically for weight loss, unlike earlier drugs that were developed to treat Type 2 diabetes. Zepbound acts on two intestinal hormones, GIP and GLP-1. These hormones are believed to work together to reduce glucose production, increase insulin and slow digestion.

Zepbound is meant for people with long-term weight management problems. It isn’t meant for people who only need to lose a few pounds or who don’t want to take medication for the rest of their lives. Some physicians believe this isn’t being stressed enough when Zepbound is prescribed. 

Like all long-term medications, Zepbound has some serious side effects. Doctors and patients should know the side effects of drugs before prescribing or taking them.

Unexpected Zepbound side effects lead to lawsuits

Manufacturers need to disclose drug side effects to doctors and patients. Drug manufacturers must provide medication inserts for all drugs, and they are required to update them when new side effects or drug interactions are discovered.

When a side effect isn’t listed on the insert, doctors and patients won’t know about it until an adverse reaction occurs. Users of Ozempic and similarly classed drugs (Wegovy, Rybelsus and Mounjaro) have experienced serious gastrointestinal conditions that weren’t listed on the label. Many users endured long-term hospitalizations because of this alleged oversight.

Multidistrict litigation (MDL) is underway in the Eastern District of Pennsylvania. Numerous lawsuits were filed against the makers of Wegovy, Ozempic, Mounjaro, Rybelsus and other diabetes or weight loss drugs. More than 1,300 cases are currently consolidated in this MDL as of January 2025.

Learn more about Zepbound lawsuits here.

Most medications have side effects. These side effects are disclosed in the prescribing information and the package insert. Unfortunately, Zepbound has several side effects that are either not listed in the prescribing information or allegedly aren’t described thoroughly enough. This leaves doctors and patients without sufficient warning about the potential signs of serious conditions.

Anyone taking any GLP-1 RA medication should contact their doctor if they notice any new side effects or if existing conditions worsen. Some of the more severe side effects of Zepbound that may not be fully listed or described are detailed below.

Bowel or intestinal obstruction

An intestinal obstruction is any blockage that prevents food from moving through the small or large intestine. Intestinal obstructions can come from many causes, including scar tissue from surgery, impacted (dry) feces, inflammation due to disease, and some medications. One of Zepbound’s effects is delayed gastric emptying, which can also lead to an obstruction. 

Intestinal obstruction can be serious if not treated right away. Blocked portions of the intestines can become permanently scarred or die, which would require surgery to repair. Blocked intestines can become infected, leading to peritonitis, a potentially fatal infection of the abdomen.

Symptoms of intestinal obstruction include:

• Abdominal pain and cramping
• Bloating
• Constipation
• Loss of Appetite
• Vomiting

The prescribing information for Zepbound doesn’t mention intestinal obstruction. It lists the symptoms as a cluster of possible side effects that only happen when the dose is increased (dose escalation).

Chronic vomiting

One listed side effect of Zepbound is vomiting. Chronic or cyclic vomiting is a syndrome characterized by periods of vomiting lasting hours or days. Causes can range from allergies to hormone imbalances. Digestive problems and some medications have also been implicated.

Untreated chronic vomiting can quickly lead to dangerous and possibly life-threatening conditions, such as:

• Dehydration: Continual vomiting causes the body to lose water faster than it can be replaced. Extensive vomiting spells may need to be treated in a hospital.
• Erosion of the stomach and esophagus (food tube): Stomach acid is highly corrosive and can cause blisters and ulcers of the esophagus and upper stomach.
• Tooth decay: Long-term vomiting results in corrosion of tooth enamel. It can also damage vocal cords and sinuses.

The prescribing information for Zepbound mentions vomiting as a cluster of possible side effects that happen only when the dosage increases.

Deep vein thrombosis (DVT)

Deep vein thrombosis (DVT) is a potentially life-threatening condition that occurs when a blood clot (a “thrombus”) develops in one of the large veins that lie deep in the body, often in the legs. 

DVT may have no symptoms until the clot breaks loose and travels to the lungs where it stays and blocks normal blood flow. This blockage is called a pulmonary embolism (PE). PE is a life-threatening situation.

DVT has many risk factors. The more you have, the higher your risk of developing DVT. Some of the risk factors include:

• Being over the age of 60
• Cancer
• Genetics or family history
• Heart disease
• Injury
• Obesity
• Prolonged lack of movement
• Surgery

For reasons that are not clear, Ozempic (semaglutide) appears to raise the risk of DVT by 266%. Ozempic and Zepbound are the same class of drug and affect the same category of hormones.

Zepbound’s prescribing information doesn’t mention the side effects of DVT or PE. Claims of deep vein thrombosis (DVT) are not being handled in the current GLP-1 RA MDL. If you or a loved one experienced this side effect after taking Zepbound, contact Sara Couch at 843.216.9385.

Ileus

Ileus, or paralytic ileus, occurs when the muscles of the intestines no longer move food through the intestines. Food and waste move through the intestines in a series of muscular contractions called peristalsis. Ileus occurs when these contractions stop, temporarily or permanently. Food and waste remain where they are and gas and other products build up in the gut.

Ileus can be caused by inflammation of the abdominal cavity or lining. Appendicitis or peritonitis are two of the most common causes of ileus. Some medications, electrolyte imbalance, diabetes-related conditions and hormonal imbalance can also slow or halt intestinal movement.

The symptoms of ileus are those of general abdominal distress and include:

• Abdominal bloating and distention
• Constipation
• Dehydration
• Gas
• Nausea
• Vomiting

Ozempic and its sister medications, like Zepbound, have been connected with paralytic ileus. A warning was added to the prescribing information for Ozempic in 2023. No such warning has been added to the FDA prescribing information for Zepbound, although it is essentially the same medication.

Intraoperative pulmonary aspiration

The term “intraoperative pulmonary aspiration” refers to a patient inhaling vomited food during surgery. Doctors recommend fasting for at least six to nine hours before surgery to reduce the risk of vomiting and the danger of food entering the lungs. 

The risks of inhaling food during surgery range from minor to life-threatening. If not noticed and corrected immediately, it can lead to respiratory failure, hypoxia and even death. Patients who inhale a small amount of food into their lungs can develop aspiration pneumonia, even after surgery.

Since semaglutide and tirzepatide cause delayed gastric emptying, the recommended nine-hour fast before surgery may not be enough. Recent reports indicate that a patient on semaglutide who fasts for 10 to 12 hours before surgery can still have a full stomach. This suggests that users of Ozempic and Zepbound, along with their doctors, should use extra caution when scheduling surgery. 

No warning appears in the prescribing information for Zepbound about not using the drug before surgery.

Malnutrition-related disorders

Malnutrition is a general term for an imbalance between the vitamins and minerals the body needs and the nutritional value of what a person eats. Malnutrition can occur when someone is starving but can also happen when someone is eating too much of one kind of food (such as starch) and not enough of another (such as foods with vitamins and minerals). 

Malnutrition affects all parts of the body. Malnutrition can even occur when someone eats too much but does not eat enough of the right foods. Someone can be overweight and still be malnourished if they’re not getting enough of the necessary micronutrients (vitamins and minerals) necessary for good health. Micronutrient malnutrition can result in anemia, fatigue, vision loss and cardiac disease.

Zepbound and Mounjaro (tirzepatide) have been implicated in malnutrition-related disorders because they slow digestion and passage of food from the stomach. This can lead to feelings of fullness and result in the user eating less. Zepbound’s known side effects include vomiting and diarrhea, which can lead to dehydration and electrolyte imbalance.

Malnutrition-related disorders are not immediately dangerous or life-threatening, but they can lead to other more serious conditions. The prescribing information does not mention malnutrition as a possible consequence of using Zepbound.

Pancreatic cancer

Pancreatic cancer is an aggressive cancer that begins in the pancreas, an organ lying behind the stomach.  Pancreatic cancer is rarely found in its early stages because symptoms don’t develop until the cancer has spread to other organs.

The pancreas secretes enzymes that help digest food. The most common form of pancreatic cancer forms in the duct that transports digestive enzymes. This helps spread the cancer throughout the body. Symptoms of pancreatic cancer include:

• Abdominal pain
• Blood clots in the arms or legs
• Diabetes or difficulty controlling existing diabetes
• Fatigue
• Jaundice
• Loss of appetite

Pancreatic cancer is a life-threatening condition with a poor prognosis. Risk factors include obesity, type-2 diabetes, pancreatitis and family history.

The Zepbound prescribing information contains a black box warning for a type of cancer but doesn’t mention pancreatic cancer.

Stomach paralysis/gastroparesis

Gastroparesis means “paralysis of the stomach.” It is a condition that affects the nerves and muscles of the stomach and upper digestive system, causing food to remain in the stomach and upper intestines rather than being processed.

The symptoms of gastroparesis are unpleasant and can become life-threatening. Symptoms can include:

• Abdominal bloating
• Constipation
• Loss of appetite
• Nausea
• Vomiting

Gastroparesis may result in malnutrition and further complications of diabetes.

Zepbound and tirzepatide act by slowing the movement of food out of the stomach. This delayed gastric emptying can become permanent and result in gastroparesis.

The prescribing information for Zepbound mentions gastroparesis twice and only in the context of a pre-existing condition where Zepbound should not be prescribed. It doesn’t mention gastroparesis as a possible side effect or outcome of using Zepbound.

Vision loss or changes

Vision loss is a known risk for people with type-1 or type-2 diabetes. Diabetic retinopathy is one of the most common forms of vision loss known in diabetic individuals. Despite this, no study has been made of the possible effects of Zepbound in patients with this condition.

In 2024, a study was published in JAMA Ophthalmology linking semaglutide drugs such as Ozempic to a common eye problem known as “non-arteritic anterior ischemic optic neuropathy” (NAION). NAION is a sudden loss of vision in one eye, caused by loss of blood flow to the optic nerve. Often patients wake up with cloudy or reduced vision. There is no effective treatment because the damage is to the nerve.

It isn’t clear how semaglutide drugs are related to this serious vision loss. The NAION study is very recent and urgently recommends additional follow up. The Zepbound prescribing information has no warnings beyond the mention of diabetic retinopathy.

All medications have side effects, but some are more severe than others. The prescribing information for Zepbound lists adverse reactions that can be serious and minor side effects that may disappear over time. Below is an abbreviated list of the side effects described in the Zepbound prescribing information and package insert.

• Acute gallbladder disease: Inflammation of the gallbladder can result in gallstones, cholecystitis (chronic inflammation of the gallbladder), biliary colic, jaundice and pancreatitis.
• Acute kidney injury (AKI): AKI refers to a sudden failure of the kidneys that prevents them from filtering waste and urine from the body. AKIs may be caused by dehydration, infection, low blood pressure or the effects of some medications.
• Acute pancreatitis: Acute pancreatitis is a sudden inflammation of the pancreas, possibly resulting from gallbladder disease or gallstones. Pancreatitis can cause extreme pain, nausea, vomiting and require surgery.
• Hypoglycemia: Commonly known as low blood sugar, hypoglycemia may be caused by excessive insulin in the bloodstream or not eating enough food. Symptoms include paleness, dizziness, confusion, hunger, thirst and fatigue.
• Risk of thyroid C-cell tumors: This effect has only been observed in rats. People with thyroid disease should be alert to any changes in their thyroid functions and notify their doctors immediately if their functions change.
• Severe gastrointestinal diseases: These disorders can range from gastric reflux disease, irritable bowel syndrome, ulcerative colitis and hiatal hernia.

Notify your doctor immediately if you experience any of these symptoms while taking Zepbound, or if you notice existing symptoms of a chronic condition getting worse. Never stop taking medication for any reason unless instructed to do so by your doctor.

How long do Zepbound side effects last?

Certain Zepbound side effects can last a few days to a few weeks. The most common side effects are nausea, vomiting, diarrhea and stomach pain. These are most frequent when increasing your dosage. You should notify your healthcare provider if they don’t go away within a few months. Plaintiffs allege Zepbound may cause additional severe, life-altering effects that aren’t warned about on the drug’s label.

Is fatigue a side effect of Zepbound?

Fatigue is a known side effect of Zepbound. You may feel tired when using Zepbound for the first time, or when increasing your dose. This feeling should go away within a few days to a few weeks. Contact your healthcare provider immediately if the fatigue persists for more than a few weeks.

Does Zepbound have fewer side effects than Wegovy?

It seems that Zepbound has slightly fewer side effects than Wegovy. It has the same general side effects of nausea, vomiting, constipation, fatigue and abdominal pain and bloating. 

Our medical attorneys have represented thousands of patients seriously hurt by dangerous prescription and over-the-counter drugs. We understand that as a patient or family member, what you know about your or a loved one’s medications may be limited. 

If you think a medication has harmed you or made you sick, our attorneys have the resources needed to thoroughly investigate and:

• Identify potentially harmful medicines
• Investigate if the medicine harmed you
• Review the medicine manufacturer’s compliance with FDA regulations
• Review the adequacy of the manufacturer's warning to you about potential side effects
• Recognize other issues that could affect your potential claim

Learn more about our medical drug experience here.

Do not stop taking a prescribed medication without first consulting with your doctor. Discontinuing a prescribed medication without your doctor's advice can result in injury or death. Zepbound, Ozempic, Wegovy, Mounjaro, Trulicity and Rybelsus remain approved by the U.S. Food and Drug Administration.