Zepbound (tirzepatide) is a prescription drug that’s used for weight loss and weight management. This drug can interact with other medications. For example, Zepbound can interact with oral birth control and insulin.

Zepbound is prescribed for weight loss and weight management in adults with either:

Zepbound comes as a liquid solution that you inject under your skin.

An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.

Keep reading to learn about Zepbound’s possible interactions. And for more information about Zepbound, including details about its uses, see this article.

Before you start Zepbound, tell your doctor and pharmacist about any prescription, over-the-counter (OTC), or other drugs you take. Sharing this information with them may help prevent possible interactions. (Learn whether Zepbound interacts with herbs or vitamins or supplements. See the “Are there other interactions with Zepbound?” section below.)

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

The table below lists drugs that may interact with Zepbound. Keep in mind that this table does not include all drugs that may interact with Zepbound. For more information about some of these interactions, see the “Drug interactions explained” section below.

Drug group or drug nameDrug examplesWhat can happen
oral birth control• ethinyl estradiol/norgestimate (Sprintec, Tri-Sprintec, others)
• ethinyl estradiol/drospirenone (Yasmin, Yaz, others)
• ethinyl estradiol/norethindrone (Aurovela, Junel, others)
can make oral birth control less effective
sulfonylureas• glyburide (Diabeta, Glynase)
• glimepiride (Amaryl)
glipizide (Glucotrol XL)
can increase the risk of low blood sugar
insulin• insulin detemir (Levemir)
• insulin lispro (Humalog, others)
• insulin lispro-aabc (Lyumjev)
• insulin glargine (Lantus, Toujeo, others)
can increase the risk of low blood sugar
meglitinides• nateglinide
• repaglinide
can increase the risk of low blood sugar
any oral prescription or OTC drug• warfarin (Jantoven)
• cyclosporine (Gengraf, Neoral, Sandimmune)
• theophylline (Elixophyllin, Theo-24)
can make any oral prescription or OTC drug less effective

Certain health conditions or other factors could raise your risk of harm if you have treatment with Zepbound. In such cases, your doctor may not prescribe Zepbound for you. These are known as contraindications. The list below includes contraindications of Zepbound.

If you have multiple endocrine neoplasia type 2 (MEN 2): If you have a rare inherited condition called MEN 2, your doctor likely won’t prescribe Zepbound for you. This is because having MEN 2 may increase your risk of thyroid cancer* if you have treatment with Zepbound. Your doctor can suggest other treatments that are safer options for you.

If you or a family member has had medullary thyroid carcinoma (MTC): If you have a family or personal history of MTC, your doctor likely won’t prescribe Zepbound for you. This is because having MTC may increase your risk of thyroid cancer* if you have treatment with Zepbound. Your doctor can suggest other treatments that are safer options for you.

If you’ve had an allergic reaction: If you’ve had an allergic reaction to Zepbound or any of its ingredients, your doctor likely won’t prescribe Zepbound for you. This is because treatment with the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.

Before you start Zepbound, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Zepbound is safe for you.

* Zepbound has a boxed warning about the risk of thyroid cancer. A boxed warning is the most serious warning from the FDA. To learn more, see the boxed warning at the top of this article.

Zepbound is not known to interact with alcohol. But Zepbound and alcohol both can cause some similar side effects, such as nausea and vomiting. So you may be more likely to have these side effects if you drink alcohol during Zepbound treatment.

If you have questions about consuming alcohol during Zepbound treatment, talk with your doctor or pharmacist.

Learn more about certain drug interactions that can occur with Zepbound.

Interaction with oral birth control

Zepbound can interact with oral birth control, which is taken to help prevent pregnancy. Examples of oral birth control drugs include:

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

What could happen

Having Zepbound treatment while taking oral birth control can make oral birth control less effective. This is because Zepbound may affect your body’s ability to absorb oral birth control medication. In turn, this can lead to a lower level of the birth control medication in your body. As a result, the birth control medication could be less effective at helping prevent pregnancy.

The risk of this effect is highest at certain times during Zepbound treatment. These are when you first start treatment with Zepbound and after your doctor increases your Zepbound dosage.

What you can do

If you take oral birth control, talk with your doctor about it when starting Zepbound treatment. They may advise you to take the oral birth control and use backup contraception for 4 weeks. They may also suggest using backup contraception for at least 4 weeks after they increase your Zepbound dosage. Examples of backup birth control methods include a diaphragm or condom.

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

Interaction with insulin

Zepbound can interact with insulin, which is prescribed to help manage blood sugar levels. Examples of insulins include:

What could happen

Zepbound and insulin both can cause low blood sugar. Having both of these drugs in your body at once can raise your risk of this side effect.

What you can do

If you have treatment with both Zepbound and insulin, your doctor may prescribe a dosage of insulin that’s lower than usual. This will reduce your risk of low blood sugar when these medications are injected together.

If you have treatment with Zepbound and insulin together, tell your doctor right away if you have symptoms of low blood sugar. These may include shaking, dizziness, and sweating. Your doctor can advise you on ways to increase your blood sugar level. This may include consuming at least 15 grams (g) of carbohydrates, such as from fruit juices and hard candies.

Severely low blood sugar is a medical emergency and may cause you to lose consciousness. If your symptoms seem severe or life threatening, call 911 or a local emergency number right away. You may need a bystander to call for you.

If you have questions about treatment with Zepbound and insulin, talk with your doctor or pharmacist.

Interaction with any oral prescription or OTC drug

Zepbound can interact with any oral prescription or OTC drug. This includes any tablet, capsule, or liquid that you take by mouth.

Examples of oral prescription drugs include:

  • warfarin (Jantoven)
  • cyclosporine (Gengraf, Neoral, Sandimmune)
  • theophylline (Elixophyllin, Theo-24)

What could happen

Zepbound may affect your body’s ability to absorb oral medication. This can lead to a lower level of an oral drug in your body, which can make the oral drug less effective.

The risk of this effect is highest at certain times during Zepbound treatment. These are when you first start treatment with Zepbound and after your doctor increases your Zepbound dosage.

What you can do

If you take any oral medication, talk with your doctor. They may watch closely for the effects of the oral drug during your treatment with Zepbound.

For questions about Zepbound treatment together with any oral prescription or OTC drug, talk with your doctor or pharmacist.

Zepbound may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Zepbound.

Does Zepbound interact with supplements?

Before you start Zepbound, talk with your doctor and pharmacist about herbs or vitamins or supplements you take. Sharing this information with them may help you avoid possible interactions.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Zepbound and herbs

Zepbound currently has no reports of interacting with herbs. But this doesn’t mean that interactions with herbs won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products during Zepbound treatment.

Zepbound and vitamins

Zepbound currently has no reports of interacting with vitamins. But this doesn’t mean that interactions with vitamins won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products during Zepbound treatment.

Does Zepbound interact with food?

Zepbound currently has no reports of interacting with food. If you have questions about eating certain foods during your treatment with Zepbound, talk with your doctor.

Does Zepbound interact with vaccines?

Zepbound currently has no reports of interacting with vaccines. If you have questions about getting certain vaccines during your treatment with Zepbound, talk with your doctor.

Does Zepbound interact with lab tests?

Zepbound currently has no reports of interacting with lab tests. If you have questions about having certain lab tests during your treatment with Zepbound, talk with the healthcare professional ordering the test.

Does Zepbound interact with cannabis or CBD?

Zepbound currently has no reports of interactions with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). But as with any drug or supplement, talk with your doctor before using cannabis with Zepbound.

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

Certain medical conditions or other health factors may raise the risk of interactions with Zepbound. Before starting Zepbound, talk with your doctor about your health history. They’ll determine whether Zepbound is right for you.

Health conditions or other factors that might interact with Zepbound include:

Mood disorders, including depression: Medications prescribed for weight management, such as Zepbound, may lead to suicidal thoughts or behaviors. Your risk may be higher if you have a mood disorder such as depression. Your doctor can determine whether Zepbound is right for you.

Pancreatitis: Before starting Zepbound, tell your doctor if you’ve had pancreatitis (inflammation of your pancreas) in the past. Zepbound may cause pancreatitis as a side effect. It isn’t known for certain whether the drug is safe for people who’ve had this condition. Your doctor can recommend whether Zepbound is the right treatment option for you.

Diabetic retinopathy and type 2 diabetes: If you have diabetic retinopathy related to type 2 diabetes, talk with your doctor before starting Zepbound treatment. The drug may cause temporary vision changes in people with this condition. Your doctor can recommend whether Zepbound is the right treatment option for you.

Kidney problems: If you have a kidney problem, such as kidney failure, tell your doctor before starting Zepbound. The drug may cause severe digestive problems that lead to dehydration (low fluid level). In turn, this can worsen your kidney condition. If you have a kidney problem, your doctor can recommend whether it’s safe to start Zepbound.

Digestive system conditions: Before starting Zepbound, tell your doctor if you have a digestive system condition. An example is slow stomach emptying. The drug can cause severe digestive problems that may not be safe for people with these conditions. Your doctor can recommend whether Zepbound is the right treatment option for you.

Pregnancy: It’s not known whether Zepbound is safe to inject during pregnancy. If you’re pregnant or planning a pregnancy, talk with your doctor before injecting Zepbound.

If you do inject Zepbound while pregnant, consider enrolling in the drug’s pregnancy registry. This registry collects details about pregnancy issues reported with Zepbound. To learn more, call 800-545-5979 or talk with your doctor.

Breastfeeding: It’s not known whether it’s safe to inject Zepbound while breastfeeding. Researchers don’t know whether the drug passes into breast milk. Also, it’s not known what effect it may have on a child who’s breastfed. If you’re breastfeeding or planning to breastfeed, talk with your doctor about your options.

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

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you are not in the same household, stay on the phone with them until help arrives.

Was this helpful?

Taking certain steps can help you avoid interactions with Zepbound. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:

  • Whether you drink alcohol or use cannabis.
  • Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a medication list.
  • What to do if you start taking a new drug during your Zepbound treatment.

It’s also important to understand Zepbound’s label and other paperwork that may come with the drug. Colored stickers that describe interactions may be on the label. And the paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions. (If you did not get paperwork with Zepbound, ask your pharmacist to print a copy for you.)

If you have difficulty reading or understanding this information, your doctor or pharmacist can help.

Injecting Zepbound exactly as prescribed can also help prevent interactions.

If you still have questions about Zepbound and its possible interactions, talk with your doctor.

Questions you may want to ask your doctor include:

  • Do I need to tell you if I start taking another medication or supplement during my Zepbound treatment?
  • How do Zepbound’s interactions compare with those of other weight management products?
  • Can I still have Zepbound even if it interacts with a health condition I have?

To learn more about Zepbound, see this article: All About Zepbound.

To get information on different conditions and tips for improving your health, subscribe to any of Healthline’s newsletters. You may also want to check out the online communities at Bezzy. It’s a place where people with certain conditions can find support and connect with others.

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