# The Zepbound side effects worth knowing about

> Zepbound side effects from the label: nausea, constipation, hair loss and burping rates vs placebo, when they ease, red flags, and an easy way to track yours.

Canonical page: https://handlehealth.co/zepbound-side-effects · Category: Side effects · Last checked against sources: 2026-09-23

Zepbound side effects are mostly digestive, with nausea, diarrhea, vomiting and constipation at the top of the list, and they are most common while the dose is being stepped up. Here is the full picture from the label and its trials, including hair loss, burping and tiredness, what may help, the red flags that need urgent help, and how to keep a record for your prescriber.

## In short

- The most common Zepbound (tirzepatide) side effects are nausea, diarrhea, vomiting and constipation; in the 72-week weight-management trials behind the label, nausea affected 25–29% of people on Zepbound against 8% on placebo.[1]
- Most nausea, vomiting and diarrhea happened while the dose was being stepped up and decreased over time; 4.8–6.7% of people stopped Zepbound because of side effects, against 3.4% on placebo, most of them in the first few months.[1]
- Less talked-about effects include injection-site reactions (6–8% vs 2% on placebo), tiredness (5–7% vs 3%), burping (4–5% vs 1%) and hair loss (4–5% vs 1%), which was reported by 7.1% of women and 0.5% of men.[1]
- The label's serious warnings include pancreatitis, gallbladder problems, kidney problems from dehydration, severe stomach problems and serious allergic reactions, plus a boxed warning about thyroid C-cell tumors seen in rats.[1]
- Handle's free daily check-in keeps a simple record of how you feel that you can show your prescriber, and it never suggests a dose.

## The most common Zepbound side effects

Zepbound's label pools two 72-week, placebo-controlled trials: SURMOUNT-1, in adults with obesity or overweight and no diabetes, and SURMOUNT-2, in adults with type 2 diabetes. In all, 2,519 adults took Zepbound.[1] The table lists every side effect reported by at least 2% of them and more often than on placebo.

| Side effect | Placebo | 5 mg | 10 mg | 15 mg |
|---|---|---|---|---|
| Nausea | 8% | 25% | 29% | 28% |
| Diarrhea | 8% | 19% | 21% | 23% |
| Vomiting | 2% | 8% | 11% | 13% |
| Constipation | 5% | 17% | 14% | 11% |
| Stomach pain | 5% | 9% | 9% | 10% |
| Indigestion | 4% | 9% | 9% | 10% |
| Injection-site reactions | 2% | 6% | 8% | 8% |
| Tiredness (fatigue) | 3% | 5% | 6% | 7% |
| Allergic reactions | 3% | 5% | 5% | 5% |
| Burping | 1% | 4% | 5% | 5% |
| Hair loss | 1% | 5% | 4% | 5% |
| Heartburn or reflux (GERD) | 2% | 4% | 4% | 5% |
| Gas | 2% | 3% | 3% | 4% |
| Bloating | 2% | 3% | 3% | 4% |
| Dizziness | 2% | 4% | 5% | 4% |
| Low blood pressure | 0% | 1% | 1% | 2% |

*Source: Zepbound prescribing information, Table 1.[1] The dose columns are trial groups; your prescriber decides your dose. The label notes that side-effect rates from different medicines' trials can't be compared directly.[1]*

In the same two trials:

- **56%** — had at least one stomach side effect on each Zepbound dose, against 30% on placebo[1]
- **4.8–6.7%** — stopped Zepbound because of side effects, against 3.4% on placebo[1]
- **1.9–4.3%** — stopped because of stomach side effects, against 0.5% on placebo[1]

*Most people who stopped because of side effects did so in the first few months, mainly because of stomach effects.[1]*

## When Zepbound side effects start, and when they ease

The label gives no week-by-week timeline, so nobody can tell you what your first week will be like. It does describe a pattern.

- **During dose escalation — When most reports came.** Zepbound is started low and stepped up gradually, with your prescriber setting the steps. The label says most nausea, vomiting and diarrhea happened during this dose escalation.[1]
- **After each change — The weeks to write down.** Because that is when most reports came, the weeks after a change are the ones most worth recording: symptoms, food and fluids.
- **The months that follow — Usually easing.** Those effects decreased over time.[1] In SURMOUNT-5, most stomach side effects on tirzepatide were mild to moderate.[3]
- **Whenever it doesn't settle — Tell your care team.** The Medication Guide asks you to tell your healthcare provider about stomach problems that are severe or won't go away, and to tell them right away about nausea, vomiting or diarrhea that doesn't go away.[1]

## What may help, and when to call

General, non-drug measures only, from the Medication Guide and the NHS.[1][10] Your care team knows your health and can advise on anything more.

| Side effect | What may help | Call your care team if |
|---|---|---|
| Nausea | Drinking fluids, which the Medication Guide says helps lower your chance of dehydration;[1] avoiding alcohol, which the NHS says can increase nausea;[10] ask your care team whether changing what or how much you eat might help | It stops you eating or drinking, or doesn't go away |
| Diarrhea | Keep drinking: the Medication Guide says fluids help lower your chance of dehydration[1] | It doesn't go away (tell them right away)[1] |
| Constipation | Ask your care team whether more fiber and fluids would suit you | It's severe or won't go away; severe constipation and bowel blockage have been reported with tirzepatide since approval[1] |
| Vomiting | Avoiding alcohol, which the NHS says can increase vomiting;[10] ask your care team how best to keep fluids up | It doesn't go away (tell them right away),[1] or you can't keep fluids down |
| Indigestion, heartburn, burping | Ask your care team whether changes to your meals might help | It's severe or won't go away |
| Stomach pain, gas, bloating | Ask your care team whether changes to your meals might help | It's severe or won't go away; severe, lasting pain is a red flag (below) |

*For food and drink on rough days, see our guide to [what to eat on Zepbound and Mounjaro](https://handlehealth.co/what-to-eat-on-mounjaro).*

### A few taps a day instead of trying to remember (in Handle)

Handle's daily check-in asks about nausea every day, plus the symptoms you switch on, such as diarrhea, constipation, vomiting or stomach pain. Add up to six tracked symptoms, like belching, heartburn, headache or fatigue, or one in your own words, and the card still takes seconds.

Handle never diagnoses, and it is not a monitoring or emergency service. If a symptom worries you, contact your care team directly.

- Nausea every day, plus the symptoms you choose
- The same short card, whatever you answer
- Missed a day? Add it later, up to 30 days back

## Less talked-about Zepbound side effects

Beyond the stomach, this is what the label says about the effects people often ask about.

### Hair loss

Hair loss was reported by 4–5% of people on Zepbound against 1% on placebo, and more often by women (7.1%) than men (0.5%); on placebo the figures were 1.3% and 0%.[1] The label links it with weight reduction, and no one taking Zepbound in the trials stopped because of it.[1] It doesn't say how long it lasts, so raise it with your care team if it worries you.

### Burping and "sulfur burps"

Burping (eructation) affected 4–5% against 1%.[1] The label says nothing about smell; "[sulfur burps](https://handlehealth.co/sulfur-burps)" is not a label term. Heartburn or reflux (4–5% vs 2%), gas (3–4% vs 2%) and bloating (3–4% vs 2%) were also more common than on placebo.[1]

### Tiredness and headache

Fatigue was reported by 5–7% against 3%.[1] Headache isn't in Zepbound's table of common side effects; in SURMOUNT-5, 7.2% of people on tirzepatide and 7.2% on semaglutide reported it, according to the trial's registry results.[1][5]

If you also use insulin or a sulfonylurea, weakness, drowsiness and headache can be signs of low blood sugar, so mention them to your care team.[1]

### Injection-site reactions

Reactions where you inject affected 6–8% against 2%, and were more common in people who developed antibodies to tirzepatide.[1] The label asks you to rotate injection sites with each dose; our [tirzepatide injection sites](https://handlehealth.co/mounjaro-injection-sites) guide shows how.

### Dizziness, skin sensitivity and rarer effects

Dizziness affected 4–5% against 2%, and low blood pressure 1.6% against 0.1%.[1] Fewer people reported altered skin sensation (dysesthesia, 0.2–0.4% vs 0.1%), changes in taste (0.4% vs none) or a dry mouth or throat (1% vs 0.1%), and average heart rate rose by 1 to 3 beats per minute.[1]

### Muscle, lean mass and "Ozempic face"

The label says tirzepatide lowers weight with greater fat loss than lean-mass loss.[1] In a SURMOUNT-1 body-scan substudy of 160 people, about 75% of the weight lost was fat and 25% lean mass, in both the tirzepatide and placebo groups; lean mass is not the same thing as muscle.[4]

"Ozempic face" isn't a label term. It's an informal name for loss of fullness in the face with rapid weight loss, which Harvard Health says can follow any GLP-1 medicine or any other cause of rapid weight loss.[6]

## Zepbound side effects in women and men

The only side effect the label breaks down by sex is hair loss: 7.1% of women on Zepbound reported it, against 0.5% of men.[1]

For women, two more points matter. Zepbound can make birth control pills taken by mouth work less well, so the label advises switching to a non-oral method, or adding a barrier method, for 4 weeks after starting and for 4 weeks after each dose increase.[1] The label also says Zepbound may cause harm to an unborn baby, so tell your prescriber if you're pregnant, planning a pregnancy or breastfeeding.[1] Our guide to the [Zepbound and Mounjaro half-life](https://handlehealth.co/mounjaro-half-life) covers what the guidance says about planning a pregnancy.

## Zepbound for sleep apnea: what the OSA trials found

Zepbound is also approved to treat moderate to severe obstructive sleep apnea in adults with obesity; when the FDA approved it in December 2024, it called it the first drug treatment option for certain patients with the condition.[7] In the two 52-week sleep apnea trials, which included 467 adults, side effects were similar to those in the weight-management trials.[1]

One figure is reported separately: confirmed pancreatitis ran at 0.84 people per 100 years of use on Zepbound, against none on placebo.[1] People with type 2 diabetes weren't included, and the trials didn't evaluate whether or when to stop PAP therapy such as CPAP, so keep that decision with your sleep clinician.[1]

## Serious Zepbound side effects

Serious side effects are less common, and each has signs worth knowing. These are the label's main warnings.

- **Pancreatitis.** Confirmed in 0.2% of people on Zepbound and 0.2% on placebo in the weight-management trials.[1] The warning sign is severe stomach pain that won't go away; see the red flags below.
- **Gallbladder problems.** Gallstones in 1.1% against 1%, gallbladder inflammation in 0.7% against 0.2%, and gallbladder removal in 0.2% against 0%.[1]
- **Kidney problems from dehydration.** Acute kidney injury in 0.5% against 0.2%.[1] Nausea, vomiting and diarrhea can cause the fluid loss behind it, which is why fluids matter.[1]
- **Severe stomach problems.** 1.7–3.1% against 1%, and Zepbound is not recommended for people with severe gastroparesis.[1]
- **Low blood sugar.** Mainly with insulin or a sulfonylurea: in SURMOUNT-2, 4.2% of people with type 2 diabetes had a reading below 54 mg/dL against 1.3% on placebo, and 10.3% of those also taking a sulfonylurea did.[1]
- **Serious allergic reactions.** Severe reactions in 0.1% against none on placebo; anaphylaxis and angioedema have been reported with tirzepatide since approval.[1][2]
- **Eye changes in type 2 diabetes.** The label warns about diabetic retinopathy complications in people with type 2 diabetes; report any change in your vision.[1]
- **Food in the lungs under anesthesia.** Rare reports after approval in people taking GLP-1 medicines. Tell every healthcare provider you take Zepbound before surgery or sedation.[1]

> **Red flags: get medical help right away**
> For each of these, the Medication Guide asks you to contact a healthcare provider or get medical help right away. If it feels like an emergency, call your local emergency number.
> - Severe pain in your stomach area that won't go away, with or without nausea or vomiting; you may feel it from your stomach through to your back. The label warns this can be pancreatitis.[1]
> - Swelling of your face, lips, tongue or throat, problems breathing or swallowing, severe rash or itching, fainting or feeling dizzy, or a very rapid heartbeat: signs of a serious allergic reaction.[1]
> - Pain in your upper stomach, fever, yellowing of your skin or eyes, or clay-colored stools, which can be signs of gallbladder problems.[1]
> - Nausea, vomiting or diarrhea that doesn't go away, because losing fluids can lead to kidney problems.[1]

## Who should not take Zepbound

Zepbound has a boxed warning: in rats, tirzepatide caused thyroid C-cell tumors, and it is not known whether it causes these tumors, including medullary thyroid carcinoma (MTC), in people.[1] The label says not to use Zepbound if you or a family member has had MTC, if you have multiple endocrine neoplasia syndrome type 2 (MEN 2), or if you've had a serious allergic reaction to tirzepatide or its ingredients. Tell your provider about a lump or swelling in your neck, hoarseness, trouble swallowing or shortness of breath.[1]

It isn't meant to be combined with other tirzepatide products, such as Mounjaro, or with other GLP-1 medicines, and its safety and effectiveness in children have not been established.[1][2]

## Long-term Zepbound side effects, and stopping

In SURMOUNT-3, which began with an intensive lifestyle program, 10% of people on Zepbound stopped because of side effects over 72 weeks, against 2% on placebo. In SURMOUNT-4, 7% stopped because of side effects during its first 36 weeks.[1]

SURMOUNT-4 then switched some people to placebo: over the next year their weight rose by an average of 14.0%, while those who stayed on Zepbound lost a further 5.5%.[1] Stopping is a decision to make with your prescriber, and regain is a signal worth discussing, not a personal failure.

Zepbound's warning about suicidal thoughts and behavior was removed from its label in February 2026, after an FDA review of 91 placebo-controlled trials with 107,910 people found no increased risk of suicidal thoughts or of depression.[1][8] The FDA still asks you to tell your health care professional about new or worsening depression, suicidal thoughts or unusual changes in mood or behavior.[8]

## Zepbound vs Wegovy side effects: the one head-to-head trial

SURMOUNT-5 compared tirzepatide (Zepbound) with semaglutide (Wegovy) directly: 751 adults with obesity and without type 2 diabetes, 72 weeks, open-label, each on the highest dose they tolerated.[3] It wasn't designed to compare safety, so read these as descriptions, not a verdict.[9]

| Reported in SURMOUNT-5 | Tirzepatide | Semaglutide |
|---|---|---|
| Nausea | 43.6% | 44.4% |
| Constipation | 27.0% | 28.5% |
| Diarrhea | 23.5% | 23.4% |
| Vomiting | 15.0% | 21.3% |
| Injection-site reactions | 8.6% | 0.3% |
| Hair loss | 8.3% | 6.1% |
| Stopped because of adverse events | 6.1% | 8.0% |

*Side-effect rates are the trial's registry results for non-serious events above its 5% reporting threshold; the stopping figures come from Lilly's announcement.[5][9] More in [Zepbound vs Wegovy](https://handlehealth.co/zepbound-vs-wegovy) and [Wegovy side effects](https://handlehealth.co/wegovy-side-effects).*

## Keeping a record your prescriber can use

The most useful record is short: the dose you took and when, how you felt each day, what you ate and drank, and anything that changed. Our [Zepbound tracker](https://handlehealth.co/zepbound-tracker) guide covers logging doses and injection sites, and the [GLP-1 side effect tracker](https://handlehealth.co/glp-1-side-effect-tracker) checklist covers what to note.

### Bring the pattern to your appointment (Handle Premium)

The consultation report, a Premium feature, brings together your Zepbound record including any dose changes, symptom summaries, weight history, nutrition and activity, and an optional note about what you want to discuss, so your clinician can see the pattern quickly. More on [preparing for a GLP-1 doctor appointment](https://handlehealth.co/glp-1-doctor-appointment).

- Shared as a secure link you can revoke at any time
- Your private daily notes are never included
- Your clinician needs no account to read it

## Questions to ask your prescriber

1. Which side effects should I call you about, and which can I manage at home?
2. What should I do if I can't keep fluids down?
3. Do any of my other medicines, including insulin, a sulfonylurea or the contraceptive pill, need a plan while I'm on Zepbound?
4. What should I do if I miss a dose? Zepbound's instructions have their own rule, so it's worth asking rather than guessing.
5. I have surgery or a procedure coming up. Who needs to know that I take Zepbound?

Zepbound and Mounjaro are the same medicine, so our [Mounjaro side effects](https://handlehealth.co/mounjaro-side-effects) page adds the type 2 diabetes figures; see also [Mounjaro vs Zepbound](https://handlehealth.co/mounjaro-vs-zepbound), [Foundayo vs Zepbound](https://handlehealth.co/foundayo-vs-zepbound) and our overview of [GLP-1 side effects](https://handlehealth.co/glp-1-side-effects).

## Questions people ask

### What are the most common side effects of Zepbound?

Nausea, diarrhea, vomiting and constipation, followed by stomach pain and indigestion. In the 72-week trials behind the label, nausea affected 25–29% of people on Zepbound against 8% on placebo, and diarrhea 19–23% against 8%.[1] Most of it happened while the dose was being stepped up and decreased over time.[1]

### How long do Zepbound side effects last?

There's no fixed timeline. The label says most nausea, vomiting and diarrhea happened during dose escalation and decreased over time, and most people who stopped because of side effects did so in the first few months.[1] If a side effect is severe or won't go away, tell your healthcare provider, and tell them right away about nausea, vomiting or diarrhea that doesn't go away.[1]

### Are Zepbound side effects worse in the first week?

Nobody can say for your first week in particular. The label gives no week-by-week breakdown; it says most nausea, vomiting and diarrhea happened during the dose-escalation period and decreased over time.[1] Writing down how you feel from the first dose gives you and your prescriber real information instead of guesses.

### Does Zepbound cause hair loss?

It can. In the trials behind the label, hair loss was reported by 4–5% of people on Zepbound against 1% on placebo, including 7.1% of women and 0.5% of men.[1] The label links it with weight reduction, and no one on Zepbound stopped treatment because of it in those trials.[1] Raise it with your care team if it worries you.

### Does Zepbound make you tired?

Some people report it: fatigue affected 5–7% of people on Zepbound against 3% on placebo.[1] If you also take insulin or a sulfonylurea, weakness or drowsiness can be signs of low blood sugar, which the Medication Guide asks you to discuss with your provider.[1] Mention tiredness that's new or doesn't lift to your care team.

### Is burping a side effect of Zepbound?

Yes. Burping (eructation) was reported by 4–5% of people on Zepbound against 1% on placebo.[1] The label says nothing about smell, so "sulfur burps" is not a label term. Ask your care team what may help, and tell them if it's severe or won't go away.

### Does Zepbound cause constipation or diarrhea?

Both are common. Constipation affected 11–17% of people on Zepbound against 5% on placebo, and diarrhea 19–23% against 8%.[1] Fluids matter with diarrhea because losing fluids can lead to kidney problems; for constipation, ask your care team whether more fiber and fluids would suit you. Tell your care team if either is severe or won't go away.[1]

### Does Zepbound cause headaches?

Headache isn't in Zepbound's table of common side effects.[1] In SURMOUNT-5, 7.2% of people on tirzepatide and 7.2% on semaglutide reported headache, according to the trial's registry results.[5] Headache can also be a sign of low blood sugar, mainly a risk with insulin or a sulfonylurea, so mention it if it's new.[1]

### Can Zepbound affect your mental health?

The warning about suicidal thoughts was removed from Zepbound's label in February 2026, after an FDA review of 91 placebo-controlled trials found no increased risk of suicidal thoughts or depression.[1][8] The FDA still asks you to report new or worsening depression or unusual changes in mood to your health care professional; in the US you can call or text 988.[8]

### Does Zepbound cause thyroid cancer?

It isn't known. In rats, tirzepatide caused thyroid C-cell tumors, which is why Zepbound carries a boxed warning; whether it causes these tumors, including medullary thyroid carcinoma, in people has not been determined.[1] The label says not to use it with a personal or family history of MTC or with MEN 2, and to report a lump in your neck or hoarseness.[1]

## Sources

1. Eli Lilly and Company, via DailyMed (U.S. National Library of Medicine). [Zepbound (tirzepatide) injection — Prescribing Information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b), effective August 28, 2026.
2. Eli Lilly and Company, via DailyMed (U.S. National Library of Medicine). [Mounjaro (tirzepatide) injection — Prescribing Information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d2d7da5d-ad07-4228-955f-cf7e355c8cc0), effective August 27, 2026.
3. The New England Journal of Medicine (Aronne et al.), via PubMed. [Tirzepatide as Compared with Semaglutide for the Treatment of Obesity](https://pubmed.ncbi.nlm.nih.gov/40353578/), 2025.
4. Diabetes, Obesity and Metabolism (Look et al.), via PubMed. [Body composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study of adults with obesity or overweight](https://pubmed.ncbi.nlm.nih.gov/39996356/), 2025.
5. ClinicalTrials.gov (U.S. National Library of Medicine). [A Study of Tirzepatide (LY3298176) in Participants With Obesity or Overweight With Weight Related Comorbidities (SURMOUNT-5)](https://clinicaltrials.gov/study/NCT05822830).
6. Harvard Health Publishing. [GLP-1 diabetes and weight-loss drug side effects: "Ozempic face" and more](https://www.health.harvard.edu/staying-healthy/glp-1-diabetes-and-weight-loss-drug-side-effects-ozempic-face-and-more), February 5, 2024.
7. U.S. Food and Drug Administration. [FDA Approves First Medication for Obstructive Sleep Apnea](https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-obstructive-sleep-apnea), December 20, 2024.
8. U.S. Food and Drug Administration. [FDA Requests Removal of Suicidal Behavior and Ideation Warning from Glucagon-Like Peptide-1 Receptor Agonist (GLP-1 RA) Medications](https://www.fda.gov/drugs/drug-safety-communications/fda-requests-removal-suicidal-behavior-and-ideation-warning-glucagon-peptide-1-receptor-agonist-glp), January 13, 2026.
9. Eli Lilly and Company, via PR Newswire. [Zepbound (tirzepatide) showed superior weight loss over Wegovy (semaglutide) in complete SURMOUNT-5 results published in The New England Journal of Medicine](https://www.prnewswire.com/news-releases/zepbound-tirzepatide-showed-superior-weight-loss-over-wegovy-semaglutide-in-complete-surmount-5-results-published-in-the-new-england-journal-of-medicine-302451241.html), May 11, 2025.
10. NHS. [Tirzepatide: a medicine to manage type 2 diabetes and treat obesity](https://www.nhs.uk/medicines/tirzepatide/), last reviewed May 15, 2026.

## About Handle

Handle is a GLP-1 treatment companion. It keeps your dose record, a short daily check-in, weight, food, drinks and activity in one calm place, and turns them into a summary you can choose to share with your clinician.

Handle supports recording and conversations with your care team. It does not diagnose, and it never tells you to start, change, skip or stop a dose. This page is general information, not medical advice. Always follow your prescriber and your medicine's instructions for use.