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From the trial data.
Tirzepatide side effects: what’s common, what’s serious and what helps
By the NexLife Medical Team · Medically reviewed by Adam Kennah, MD · Updated
The most common tirzepatide side effects are nausea, diarrhea, vomiting and constipation; in Zepbound’s trials, nausea affected 25% to 29% of people, versus 8% on placebo. Most nausea, vomiting and diarrhea came while the dose was rising, per the label (read November 2, 2026); compounded tirzepatide wasn’t studied. Serious problems are uncommon but need prompt care.
- Nausea: 25–29% in Zepbound trials, mostly early
- What helps: smaller meals, fluids, slower dose steps
- When to call: severe belly pain, yellow skin, signs of dehydration
Most common, in the Zepbound trials
- Nausea
- 25–29%, vs 8% on placebo
- Diarrhea
- 19–23%, vs 8%
- Constipation
- 11–17%, vs 5%
- Vomiting
- 8–13%, vs 2%
- Stopped for stomach side effects
- 1.9–4.3%, vs 0.5% on placebo
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At a glance
Tirzepatide side effects at a glance
The short answers, from Zepbound’s label and the 2025 nutrition advisory. Each one is explained below.
| Question | Answer |
|---|---|
| What’s most common? | Nausea, diarrhea, vomiting and constipation. |
| How common is nausea? | 25% to 29% of people on Zepbound in its two 72-week trials, versus 8% on placebo. |
| When do they happen? | Most nausea, vomiting and diarrhea came while the dose was rising, and decreased over time. |
| What helps? | Smaller meals, stopping when you feel full, fluids, and less high-fat food and alcohol. |
| When should you call right away? | Severe stomach pain that won’t go away: stop the medicine and call your provider. Swelling of your face or throat, or trouble breathing: call 911. |
| What about compounded tirzepatide? | It wasn’t studied in these trials, and it isn’t FDA-approved. |
These numbers come from trials of FDA-approved Zepbound. Compounded tirzepatide isn’t FDA-approved and wasn’t studied in them.
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Key takeaways
- The most common: nausea, diarrhea, constipation and vomiting. Nausea affected 25% to 29% in Zepbound’s trials, versus 8% on placebo.
- Most come early and fade: most nausea, vomiting and diarrhea came while the dose was rising, and decreased over time.
- Small changes help: smaller meals, stopping when full, sipping fluids, adding fiber slowly, and less high-fat food and alcohol.
- Severe stomach pain that won’t go away? Stop the medicine and call your provider right away; for trouble breathing, call 911.
- These are Zepbound trial numbers. Compounded tirzepatide isn’t FDA-approved and wasn’t studied, so report any side effect to your provider.
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(949) 818-8000 . Compounded tirzepatide is $139 a month on the 12-month plan.
How often
How common is each tirzepatide side effect?
The four stomach side effects lead the list. In SURMOUNT-1, most were mild to moderate.
| 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% |
| Belly pain | 5% | 9% | 9% | 10% |
| Indigestion | 4% | 9% | 9% | 10% |
| Injection-site reactions | 2% | 6% | 8% | 8% |
| Tiredness | 3% | 5% | 6% | 7% |
Zepbound prescribing information (revised August 2026), Table 1. Everyone in the trials, including the placebo group, also had diet and activity advice. These numbers come from trials of FDA-approved Zepbound. Compounded tirzepatide isn’t FDA-approved and wasn’t studied in them.
When they happen
When do tirzepatide side effects happen, and do they go away?
Most nausea, vomiting and diarrhea happened during dose increases, which come every 4 weeks or more.
In the trials, these events decreased over time.
Your provider can hold your dose longer or lower it.
“The majority of nausea, vomiting, and/or diarrhea events occurred during dose escalation and decreased over time.”
Eli Lilly and Company, Zepbound (tirzepatide) prescribing information, revised August 2026
- 56%had a stomach side effect on tirzepatide
- 30%on placebo
- 1.9–4.3%stopped for one
- 0.5%stopped on placebo
From the label’s pooled trials. Across all side effects, 4.8% to 6.7% stopped tirzepatide (by dose), versus 3.4% on placebo; most who stopped did so in the first few months.
Dose and vial math
What does each dose look like in a syringe?
Stomach side effects came mostly while the dose was rising, so it helps to know your dose at each step. From a vial, it depends on the strength; here it is at an example strength of 25 mg per mL.
| Weekly dose | Volume at 25 mg/mL (example) | Units on a U-100 syringe |
|---|---|---|
| 2.5 mg | 0.1 mL | 10 units |
| 5 mg | 0.2 mL | 20 units |
| 7.5 mg | 0.3 mL | 30 units |
| 10 mg | 0.4 mL | 40 units |
| 12.5 mg | 0.5 mL | 50 units |
| 15 mg | 0.6 mL | 60 units |
The math: mL = dose ÷ strength (mg per mL); units = mL × 100. So 7.5 mg ÷ 25 mg/mL = 0.3 mL, or 30 units. 25 mg/mL is an example only: it’s the strength of Zepbound’s 15 mg multi-dose vial on its August 2026 FDA label. Your vial’s label decides the strength, and your prescription sets your dose.
Check before you draw. The FDA has reported dosing errors with compounded semaglutide, and says mix-ups between milliliters, milligrams and units may have contributed. If a number doesn’t match your prescription, ask your provider before you inject. Every dose and strength: our tirzepatide dosage chart.
What helps
What helps common tirzepatide side effects like nausea?
Nausea
Eat smaller meals and stop when you feel full; large meals make vomiting more likely. Go easy on high-fat and fried food, and on alcohol.
Diarrhea
Sip fluids through the day so you don’t get dehydrated. Skip large or high-fat meals until it settles.
Constipation
Add fiber slowly, with fluids: fruit, vegetables, beans, prunes. Ask your provider before adding a laxative or supplement.
Injection-site redness
Rotate spots each week: belly, thigh, or the back of the upper arm if someone else gives it. Tell us if a reaction spreads or doesn’t fade.
Eating tips from the 2025 joint nutrition advisory for people taking
Side effect bothering you?
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Step by step
How do you handle a side effect?
Start with small changes, and know when to call. Five steps, in order.
- Start with small changes. Smaller meals, fluids through the day, and less high-fat food and alcohol.
- Expect it early. In the trials, most nausea, vomiting and diarrhea came while the dose was rising, and decreased over time.
- Not settling? Tell your provider. They can hold your dose longer or lower it.
- Severe stomach pain that won’t go away? Stop the medicine and call your provider right away.
- Swelling or trouble breathing? Call 911: it can be a serious allergic reaction.
The five steps above, in order. Your label and your prescriber’s instructions come first.
Get help
Which side effects need a call right away?
Call 911 or get emergency care for swelling of your face, lips, tongue or throat, trouble breathing or swallowing, or fainting. These can be signs of a serious allergic reaction.
“If hypersensitivity reactions occur, advise patients to promptly seek medical attention and discontinue use of ZEPBOUND.”
Eli Lilly and Company, Zepbound (tirzepatide) prescribing information, revised August 2026
| If you notice… | It can be a sign of | What to do |
|---|---|---|
| Severe stomach pain that won’t go away, sometimes reaching your back, with or without vomiting | Pancreatitis | Stop the medicine and call your provider right away |
| Pain in your upper stomach, fever, yellow skin or eyes, or clay-colored stools | Gallbladder problems | Call your provider |
| Nausea, vomiting or diarrhea that won’t stop, dizziness, or peeing much less | Dehydration, which can affect your kidneys | Drink fluids and call your provider |
| Shakiness, sweating, confusion or a fast heartbeat, if you take insulin or a sulfonylurea | Low blood sugar | Follow your low-blood-sugar plan and call your provider |
| Changes in your vision, if you have type 2 diabetes | Diabetic eye disease getting worse | Call your provider |
| A lump in your neck, hoarseness that lasts, trouble swallowing or shortness of breath | A possible thyroid tumor | Call your provider |
“If pancreatitis is suspected, discontinue ZEPBOUND and initiate appropriate management.”
Eli Lilly and Company, Zepbound (tirzepatide) prescribing information, revised August 2026
Planning surgery or a procedure with anesthesia or deep sedation? Tell the team you take tirzepatide; it slows stomach emptying.
Also reported
What less common side effects were reported?
| Side effect | Tirzepatide vs placebo |
|---|---|
| Allergic reactions (mostly skin) | 5% vs 3% |
| Burping | 4–5% vs 1% |
| Hair loss | 4–5% vs 1% |
| Acid reflux (GERD) | 4–5% vs 2% |
| Dizziness | 4–5% vs 2% |
| Gas | 3–4% vs 2% |
| Bloating | 3–4% vs 2% |
| Low blood pressure | 1–2% vs 0% |
Hair loss was linked to weight loss and reported mostly in women. Tirzepatide hair loss: why it happens.
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Tirzepatide side effects: your questions
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What are the most common side effects of tirzepatide?
Nausea, diarrhea, vomiting and constipation. In the two 72-week trials behind Zepbound, nausea affected 25% to 29% of people depending on dose, versus 8% on placebo, and diarrhea 19% to 23%, versus 8%. Most of these came while the dose was rising. Those trials studied FDA-approved Zepbound; compounded tirzepatide wasn’t studied.
How long do tirzepatide side effects last?
In Zepbound’s trials, most nausea, vomiting and diarrhea came while the dose was going up, and these events decreased over time. Dose steps come every 4 weeks or more. If side effects don’t settle, your provider can hold your dose longer or lower it. Compounded tirzepatide wasn’t studied in these trials.
Do side effects get worse at higher doses?
Some do. In Zepbound’s trials, vomiting rose from 8% at 5 mg to 13% at 15 mg, and diarrhea from 19% to 23%; nausea was 25% to 29% at every dose. Constipation was most common at 5 mg. Compounded tirzepatide wasn’t studied in these trials.
What helps nausea on tirzepatide?
Small eating changes: smaller meals, stopping when you feel full, and going easy on high-fat or fried food and alcohol. Large meals make vomiting more likely. Sip fluids through the day so you don’t get dehydrated. If nausea is severe or won’t go away, call your provider; they can hold or lower your dose.
What are the serious side effects of tirzepatide?
They’re uncommon but include pancreatitis, gallbladder problems, kidney problems from dehydration, serious allergic reactions, low blood sugar with some diabetes medicines, and possible thyroid tumors. Severe stomach pain that won’t go away can be a sign of pancreatitis: stop the medicine and call your provider right away.
Does compounded tirzepatide have the same side effects?
No one knows for sure: compounded tirzepatide hasn’t been studied in clinical trials and isn’t FDA-approved, so the FDA hasn’t reviewed it for safety, effectiveness or quality. The numbers on this page come from trials of FDA-approved Zepbound. Tell your provider about any side effect you notice; NexLife members can call or text 24/7.
Who do I call about a side effect at NexLife?
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Does tirzepatide cause constipation?
It can. In the two 72-week Zepbound trials, constipation affected 11% to 17% of people on tirzepatide, versus 5% on placebo, and it was most common at 5 mg. Adding fiber slowly, with fluids, can help; ask your provider before adding a laxative or supplement.
Does tirzepatide cause hair loss?
It can. In the Zepbound trials, 4% to 5% of people reported hair loss, versus 1% on placebo; it was linked to weight loss and reported mostly in women. Our guide to tirzepatide hair loss covers why it happens and what helps.
Does tirzepatide cause diarrhea?
It can. In the two 72-week trials behind Zepbound, diarrhea affected 19% to 23% of people, versus 8% on placebo, mostly while the dose was rising. Sip fluids through the day so you don’t get dehydrated, and skip large or high-fat meals until it settles.
Can tirzepatide cause low blood sugar?
It’s more likely if you also take insulin or a sulfonylurea. Watch for shakiness, sweating, confusion or a fast heartbeat. If they happen, follow your low-blood-sugar plan and call your provider.
Can tirzepatide make you tired?
Some people report it. In the two 72-week trials, tiredness affected 5% to 7% of people on tirzepatide, by dose, versus 3% on placebo. Tell your provider if it bothers you; NexLife members can call or text (949) 818-8000, 24/7.
Important safety information
Compounded tirzepatide and semaglutide are not FDA-approved, and the FDA hasn’t reviewed them for safety, effectiveness or quality. A provider prescribes them only when they offer a significant difference for you compared with an FDA-approved product. Both medicines may cause thyroid tumors, including cancer: don’t use either if you or a family member has had medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN 2).
Read the full safety information
In studies with rodents, both medicines caused thyroid tumors; it isn’t known whether they cause them in people. Tell your provider if you notice a lump or swelling in your neck, hoarseness, trouble swallowing or shortness of breath. Serious side effects can include inflammation of the pancreas (pancreatitis), gallbladder problems, low blood sugar (especially with insulin or sulfonylureas), kidney problems from dehydration, severe stomach problems, serious allergic reactions, vision changes in people with type 2 diabetes, and a faster heart rate. Tell your care team before any surgery or procedure that uses anesthesia or deep sedation. Don’t combine either medicine with other
Tirzepatide can make birth control pills less effective: switch to a non-oral method, or add a barrier method such as condoms, for 4 weeks after you start and for 4 weeks after each dose increase. Both medicines may harm an unborn baby. Semaglutide should be stopped at least 2 months before a planned pregnancy. Tell your provider right away if you’re pregnant, planning to be, or breastfeeding.
This is a summary, not the complete safety information. Read the full Prescribing Information for FDA-approved tirzepatide (Zepbound) and semaglutide (Wegovy), and talk with your provider. You can report side effects to the FDA at
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Leads the NexLife Medical Team, which writes and medically reviews NexLife’s guides, including this one.
Checked every number against the Zepbound prescribing information (revised August 2026).
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Sources
- Eli Lilly and Company. Zepbound (tirzepatide) prescribing information.
- The New England Journal of Medicine. Tirzepatide once weekly for the treatment of obesity (SURMOUNT-1), 2022.
- Obesity (Silver Spring). Mozaffarian D, et al. Nutritional priorities to support
GLP-1 therapy for obesity: a joint advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association and The Obesity Society (2025). - U.S. Food and Drug Administration. MedWatch: report a problem.
- NexLife. Compounded tirzepatide plans.
- U.S. Food and Drug Administration. FDA’s concerns with unapproved
GLP-1 drugs used for weight loss. - Novo Nordisk. Wegovy (semaglutide) prescribing information.
- LegitScript. LegitScript certification record for NexLife.us.
- NexLife. Compounded semaglutide plans.
- Ro: weight loss program pricing. Checked November 1, 2026.
- Hims: Zepbound KwikPen. Checked November 1, 2026.
- Hims: Wegovy pill and pen, with membership. Checked November 1, 2026.
- Mochi Health: FAQs (membership and medication prices). Checked November 1, 2026.
- Embody: compounded tirzepatide, one-month supply. Checked November 1, 2026.
- Embody: compounded semaglutide, one-month supply. Checked November 1, 2026.
- Eli Lilly and Company, via Drugs@FDA. ZEPBOUND (tirzepatide) injection, for subcutaneous use: prescribing information, revised August 2026. Read November 2, 2026.
- U.S. Food and Drug Administration. FDA alerts health care providers, compounders and patients of dosing errors associated with compounded injectable semaglutide products. July 26, 2024. Read November 2, 2026.
- U.S. Food and Drug Administration. Compounding and the FDA: Questions and Answers. Read November 2, 2026.