Before You Start
Important Safety Information For GLP-1 Medications
GLP-1 receptor agonists such as semaglutide (Wegovy®) and tirzepatide (Zepbound®) are prescription medications for chronic weight management. They can be effective alongside diet and exercise, and they carry real risks.
This page covers who should not take them, the boxed warning, the serious risks, the common side effects, and what compounded means. Read it properly, and bring any questions to your provider.
How To Read This Page
Not on a weekly injection? The risks and warnings on this page apply to GLP-1 medications as a class, whichever form you take. For the pills, sublinguals and daily injections we prescribe — and the timing rules that differ between them — see Other Forms Of GLP-1 Medication.
Who Should Not Use These Medications
Applies to semaglutide, tirzepatide and Foundayo™
Do not use these medications if you or any family member has ever had medullary thyroid carcinoma (MTC), or if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN2). These are absolute contraindications because of the thyroid tumor risk described in the boxed warning below, and they apply to semaglutide, tirzepatide and Foundayo™ (orforglipron) alike.
Pregnancy And Nursing
- Pregnancy
- Do not use GLP-1 medications if you are pregnant or planning to become pregnant in the near future. Wegovy®'s labeling warns it may harm an unborn baby, and you should stop the medication at least 2 months before a planned pregnancy. Weight loss offers no benefit during pregnancy, and these drugs have not been adequately studied in pregnant women. If you become pregnant while on treatment, inform your provider immediately.
- Breastfeeding
- It is not known if these medications pass into breast milk. If you are nursing, discuss with your provider whether you should use them.
Allergies
- Previous Serious Reaction
- Do not use if you have had a serious allergic reaction to semaglutide, tirzepatide, or any of their ingredients.
- What A Serious Reaction Looks Like
- Swelling of the face or throat, difficulty breathing, rash, rapid heartbeat, or dizziness.
Call 911 or go to the nearest emergency room for any of those symptoms. Do not message us and wait.
If you use birth control pills, check which medication you are on — this applies to two of the three. Both tirzepatide and Foundayo™ can reduce how well oral contraceptives are absorbed, because they slow how quickly the stomach empties. Their labeling instructs patients to switch to a non-oral method, or add a barrier method such as condoms:
- Tirzepatide — for 4 weeks after starting, and for 4 weeks after each dose increase.
- Foundayo™ (orforglipron) — for 30 days after starting, and for 30 days after each dose increase.
- Semaglutide — its labeling carries no equivalent instruction.
If you are not certain which medication you are on, check your Rx summary or ask your provider before relying on an oral contraceptive.
Conditions To Tell Your Provider About
Inform your provider about all medical conditions before starting treatment. In particular, tell them if you:
- Have or have had problems with your pancreas or kidneys. It is not known if these drugs are safe in those with a history of pancreatitis, and kidney issues can be worsened by dehydration from side effects.
- Have severe digestive problems such as gastroparesis (slowed stomach emptying) or trouble swallowing. GLP-1 agonists have been associated with gastrointestinal reactions, sometimes severe, and have not been studied in patients with serious GI diseases, so they are not recommended in such cases.
- Have type 1 diabetes. GLP-1 medications are not a substitute for insulin in type 1 diabetes and are not indicated for this condition.
- Have type 2 diabetes with diabetic eye disease (diabetic retinopathy). Semaglutide in diabetics has been associated with diabetic retinopathy complications, so extra monitoring may be needed.
- Have a history of depression, suicidal thoughts, or other mental health issues. Weight-loss trials with these drugs have reported rare instances of suicidal ideation; you and your provider should monitor for mood changes.
- Are scheduled for surgery or sedation. Because these medicines delay stomach emptying, there is an increased risk of food or liquid getting into your lungs while under anesthesia or deep sedation. Tell your surgeon and anesthesiologist well before the procedure, and give them three things: the medication name, your dose, and the date of your last dose. They may ask you to stop it for a period beforehand — that decision belongs to the team performing your procedure.
Always discuss your full medical history with your provider so they can determine whether a GLP-1 medication is safe and appropriate for you. These medications are not right for everyone and are used only after careful screening.
Boxed Warning: Thyroid C-Cell Tumors
The FDA's strongest warning category
Wegovy® (semaglutide), Zepbound® (tirzepatide) and Foundayo™ (orforglipron) all carry a boxed warning — the FDA's strongest warning — about a risk of thyroid C-cell tumors. It is unknown whether any of them cause thyroid tumors in humans, and out of caution, patients with a personal or family history of MTC or MEN2 must not use them.
The basis of the warning is not identical across the three. For semaglutide and tirzepatide it comes from animal studies in which the drugs caused thyroid C-cell tumors, including medullary thyroid carcinoma, in rodents. Foundayo™ is different: orforglipron is not pharmacologically active in rodents and did not produce tumors in them, but it is active at the human GLP-1 receptor, so the same warning is applied and the human relevance is unknown.
What This Means For You
Thyroid cancer from these medications has not been seen in human studies. You should still know the symptoms to watch for.
Tell your provider right away if you notice a lump or swelling in your neck, hoarseness, difficulty swallowing, or shortness of breath. These can be signs of thyroid cancer and should be evaluated — a lump or swelling that is growing, or any difficulty breathing, should be seen in person rather than waited on.
Your provider will also counsel you on this risk and the symptoms to watch for. This risk is very rare, and it is taken seriously. It is why every patient is given the official FDA Medication Guides for Zepbound (tirzepatide) and Wegovy (semaglutide), which set out this warning in plain language.
Other Serious Risks And Warnings
Summarized from the FDA-approved labels
Beyond the thyroid tumor warning, GLP-1 medications carry other serious potential side effects. It is important to understand these before starting therapy.
Severe abdominal pain that does not go away — especially if it radiates to your back, with or without vomiting — needs to be evaluated in person. Stop the medication and go to an urgent care or emergency room. This can be pancreatitis, which is potentially life-threatening. Call 911 if the pain is severe.
Because we are a remote practice, we cannot provide emergency or same-day in-person care, and a message to us could sit unanswered while symptoms progress. Get seen first, then message your provider so it is on your record.
Pancreatitis
GLP-1 agonists like semaglutide and tirzepatide have been linked to pancreatitis in some patients. These drugs have not been studied in those with a history of pancreatitis, so caution is warranted.
Gallbladder Problems
Rapid weight loss and these medications themselves can increase the risk of gallbladder issues, including gallstones and gallbladder inflammation. Some cases have required surgery.
Get evaluated in person for upper stomach pain, fever, yellowing of the skin or eyes (jaundice), or clay-colored stools — these can indicate gallstones or gallbladder inflammation. Tell your provider as well.
Kidney Injury
Severe vomiting, diarrhea, or dehydration from the drug's side effects can lead to acute kidney injury or worsening of kidney disease. If you already have kidney problems, you must be monitored closely when starting treatment. Stay hydrated, especially if you are having GI side effects, to reduce the risk of dehydration-related kidney issues.
Severe Gastrointestinal Reactions
Nausea and stomach upset are common. In some cases stomach problems can be severe and persistent. If you have continuous or worsening nausea, vomiting, or abdominal pain that affects your ability to eat or stay hydrated, tell your provider. If you cannot keep fluids down at all, get seen in person — dehydration is what causes the kidney risk above.
GLP-1 drugs are not recommended in patients with severe GI disorders like gastroparesis.
Low Blood Sugar (Hypoglycemia)
By themselves, Wegovy® and Zepbound® usually do not cause low blood sugar in people without diabetes. However, if you have type 2 diabetes and are also on other blood-sugar-lowering drugs such as insulin or a sulfonylurea, adding a GLP-1 can increase the risk of hypoglycemia. Signs include shakiness, dizziness, sweating, fast heartbeat, hunger, confusion, or feeling faint. Your provider may adjust doses of other medications and will advise you how to watch for and treat low blood sugar.
Increased Heart Rate
Wegovy® in particular has been observed to increase resting heart rate in some patients. Your provider may check your pulse during treatment. Let them know if you feel your heart racing or pounding for an extended period.
Mental Health
A small number of individuals have reported new or worsening depression, mood changes, or suicidal thoughts while taking medications like semaglutide or tirzepatide; this risk has been noted in weight management trials. Pay attention to your mood during therapy, and consider letting family or a close friend know you are starting this medication so they can help observe any changes.
If you are having thoughts of harming yourself, do not wait for a reply from us. Call or text 988 to reach the Suicide & Crisis Lifeline, available 24 hours a day. Call 911 or go to the nearest emergency room if you are in immediate danger.
Our messages are not monitored around the clock and we cannot provide crisis care. Once you are safe, tell your provider so they can factor it into your treatment plan.
Serious Allergic Reactions
Though uncommon, serious hypersensitivity reactions such as anaphylaxis or angioedema have occurred with GLP-1 medications. Do not use the medication again if a serious allergy is confirmed.
Call 911 for a widespread rash, difficulty breathing, swelling of the face or tongue, or dizziness and fainting.
Surgery And Procedure Precautions
Because these medications slow stomach emptying, tell every one of your healthcare providers that you are on semaglutide or tirzepatide if you are planning any surgery or medical procedure requiring sedation or anesthesia. Give the surgical and anesthesia team the medication name, your dose, and the date of your last dose, well before the procedure rather than on the day.
You may be instructed to stop the medication temporarily beforehand to reduce aspiration risk — food or liquid entering the lungs during the procedure. How long to hold it is a decision for the team performing your procedure, not something to work out on your own.
Where to report what. Anything in a red block above goes to 911, a crisis line, or in-person care first. Everything else — side effects that are bothersome, persistent, or new — goes to your provider as a portal message. Do not stop your medication before speaking to your provider unless you suspect a severe reaction like pancreatitis or a serious allergy, in which case stop and seek care as described above.
Common Side Effects
What most patients experience, and when it settles
Like many medications, semaglutide and tirzepatide can cause side effects. Most patients experience some mild-to-moderate effects when starting therapy, especially gastrointestinal ones. These are often worse at the beginning and improve as your body adjusts — which is why providers start at a low dose and increase it gradually.
Reported In At Least 5% Of Patients In Clinical Trials
- Gastrointestinal symptoms. Nausea is by far the most common. You may also experience vomiting, diarrhea, constipation, or general stomach discomfort. Eating smaller, low-fat meals and staying hydrated can help.
- Stomach pain or reflux. Some people get abdominal pain or heartburn.
- Headache or fatigue. You might feel a headache or tiredness when first adjusting. Dizziness has also been noted in some patients.
- Injection site reactions. If you inject, redness, itching, or a lump where you injected. Rotating sites helps prevent this.
- Minor allergic reactions. Mild rash or itching, distinct from the serious reactions described above.
- Others. Belching, gas, or bloating. Hair thinning has been reported in some people taking tirzepatide or semaglutide for weight loss; it is usually temporary and related to rapid weight loss. Make sure your nutrition is adequate, and mention it to your provider if it happens.
Most common side effects are not dangerous and will be monitored by your care team. Still tell us if any are bothersome or do not settle over time — there are often strategies that help, such as anti-nausea remedies, or a dose adjustment. If you are not sure whether a symptom is serious, treat it as serious and get seen.
Using These Medications Safely
Dosing, combinations, lifestyle and monitoring
Follow Your Prescription
- As Prescribed
- Semaglutide and tirzepatide injections are typically once weekly. Oral, sublingual and daily options have their own schedules — follow the one on your Rx summary. Do not change your dose or schedule without guidance.
- If You Miss A Dose
- Check the Rx summary for your specific medication, or message your provider. What to do depends on which medication you are on.
Do Not Combine
- Other Weight-Loss Medications
- Unless directed by your provider, do not use other GLP-1 agonists or weight-loss drugs at the same time as semaglutide or tirzepatide. Combining similar medications can increase side effects and has not been shown to be safe.
- Supplements
- We advise against over-the-counter or herbal weight-loss supplements during GLP-1 therapy, as safety is not established.
Lifestyle Is Still Key
These medications are intended to be used alongside a reduced-calorie diet and increased physical activity. For the best results and to minimize side effects, follow the nutrition and lifestyle plan provided by your care team. Individual results vary, and no specific amount of weight loss is ever guaranteed.
Monitoring
While on treatment you will have periodic check-ins so your provider can monitor your progress and health. Attend your scheduled follow-ups and be honest about any difficulties or side effects. Having side effects does not mean you cannot continue — but your provider has to know in order to advise you properly.
Children
Wegovy® is approved for certain adolescents aged 12 and over with obesity; Zepbound® (tirzepatide) is not approved for pediatric use. We treat only patients aged 18 and over. Keep all medications out of reach of children.
Other Forms Of GLP-1 Medication
Pills, sublinguals and daily injections
Not every GLP-1 is a weekly injection. Alongside semaglutide and tirzepatide injections, we prescribe oral and sublingual options taken daily, and liraglutide, which is injected daily rather than weekly.
Everything above still applies to you. The contraindications, the boxed warning, and the serious risks in this guide are risks of GLP-1 receptor agonists as a class — they do not go away because the medication is a pill or a liquid instead of an injection. What changes by form is how and when you take it, and that is what this section covers.
Wegovy® Pills (Oral Semaglutide)
Taken once daily. The timing rules on this one are strict, and they are what patients most often get wrong — absorption depends on taking it correctly.
- First thing, on an empty stomach. Before any food, any other drink, and any other oral medication.
- No more than 4 oz of plain water to swallow it. Not coffee, not juice, not more water than that.
- Swallow the tablet whole. Do not split, crush or chew it.
- Then wait at least 30 minutes before food, any other drink, or any other oral medication — including your other prescriptions.
- If you miss a day, skip that dose and take the next one at your usual time the following day. Do not double up.
Available in 1.5mg, 4mg, 9mg and 25mg strengths. Your Rx summary states which one you are on.
Foundayo™ (Orforglipron)
Also a once-daily pill, and the one with no timing rules at all. Foundayo™ is a small molecule rather than a peptide, which is precisely why it does not carry the food, water and timing restrictions that oral semaglutide does. You can take it with or without food, at any time of day, with a normal drink. Swallow the tablet whole — do not break, crush or chew it.
Approved by the FDA on 1 April 2026, in six strengths: 0.8mg, 2.5mg, 5.5mg, 9.0mg, 14.5mg and 17.2mg.
Two things on Foundayo™ that catch people out. It carries the same thyroid C-cell boxed warning and the same MTC and MEN2 contraindication as the injectables — being a pill does not change that. And if you use birth control pills, see the contraception instruction above: Foundayo™ has one, for 30 days after starting and after each dose increase.
Compounded Sublingual And Dissolving Options
Taken daily rather than weekly. Two different things sit under this heading, and they are used differently:
Sublingual Liquids
- What They Are
- Compounded sublingual tirzepatide and sublingual semaglutide. These are liquids, not tablets — they are held under the tongue, not swallowed.
- Supply
- Sold as a 60-day supply rather than on the weekly-injectable tier ladder.
Dissolving Tablets
- What They Are
- Compounded tirzepatide ODT — orally disintegrating tablets, which dissolve in the mouth rather than being swallowed with water.
- Supply
- Also sold as a 60-day supply.
These are compounded medications, so everything in the compounded section below applies to them — they have not been evaluated or approved by the FDA, and they carry the same risks and side effects as the commercially manufactured versions. Store and handle them exactly as instructed on your Rx summary; storage requirements for a sublingual liquid are not the same as for an injection.
Liraglutide
A GLP-1 injected daily, not weekly. It is an older medication than semaglutide and tirzepatide. Because the schedule is daily, a missed dose does not work the same way it does on a weekly injectable — check your Rx summary rather than applying what you may have read about weekly dosing. Plans are sold as a 2-month supply rather than as tiers.
Your Rx summary is the authority for your medication. Every medication and dose we offer has its own summary covering dosing, administration, storage, side effects and what to do about a missed dose. If what you read anywhere else disagrees with your Rx summary, follow the summary and ask your provider.
About Compounded GLP-1 Medications
What compounded means, and what still applies
Alongside FDA-approved Wegovy® and Zepbound®, your provider may prescribe compounded semaglutide or tirzepatide. Compounded means the medication is custom-prepared for you by a licensed compounding pharmacy rather than manufactured by a pharmaceutical company. You may hear terms like "tirzepatide + B12" or "semaglutide with glycine and B12" — these are compounded formulations where more than one ingredient is combined.
When Compounded Is Used
Compounding allows doses that are not commercially made, and it is an option when you are sensitive to an ingredient in the commercial formulation. Your provider talks through which option fits you.
Compounded drugs have not been evaluated or approved by the FDA. The FDA does not verify their safety, effectiveness, or quality before they are used. Quality standards depend on each individual compounding pharmacy and are governed by their state pharmacy boards. We only submit prescriptions to certified and licensed compounding pharmacies to minimize that risk, but it is important that you understand the distinction.
Every Risk In This Guide Still Applies
Compounded semaglutide and tirzepatide carry the same risks and side effects described earlier, including the boxed warning and all precautions. A compounded semaglutide injection can cause nausea and carries a similar risk of pancreatitis, thyroid tumors and gallbladder problems as the brand-name version.
Do not let the word "compounded" give a false sense of safety. It is not gentler, and it does not work differently in your body. Additives contained in a compounded medication do not remove the possibility of any side effect described above.
Quality And Variability
Licensed compounding pharmacies operate on a smaller scale than commercial manufacturers and create custom formulations, so more variability in production is possible. Quality control measures and batch testing are performed to prevent significant variation.
- Store and handle compounded medication exactly as instructed. Compounded GLP-1 injections should be refrigerated and protected from light.
- Never use a compounded medication past its beyond-use date, or if it has been stored improperly.
- Do not use any medication, compounded or otherwise, if you notice anything unusual about its appearance — particles in the vial, an unusual color, or cloudiness.
Our Position
We offer compounded GLP-1 options to improve access for patients with a clinical need for an alternative to commercial medications, and we approach their use carefully. We will always be transparent with you when you are being prescribed a compounded drug. We retain the right not to prescribe a particular compounded medication, or not to use a particular compounding pharmacy, in the interest of patient safety. If you ever have questions about the source or formulation of your medication, ask us.
In Summary, And Where To Read More
Official labels and your own Rx summaries
Semaglutide (Wegovy®) and tirzepatide (Zepbound®) are promising tools for weight loss and health improvement, and they come with real responsibilities for safe use. We are committed to prescribing them responsibly and monitoring you throughout. They must be used under the supervision of a qualified provider, and they are not right for everyone. This information is here so you can make an informed decision.
Always feel free to discuss any concerns or experiences with your provider. Weight management is a journey, and we are your partners in navigating it safely.
Official Information
- Zepbound (tirzepatide) — Medication Guide Lilly's patient Medication Guide, written in plain language. Open the Zepbound Medication Guide (PDF) →
- Zepbound (tirzepatide) — Full Prescribing Information The complete FDA label, including the Medication Guide. Technical, intended for healthcare professionals. Open the Zepbound label (PDF) →
- Wegovy (semaglutide) — Full Prescribing Information The complete FDA label, including the Medication Guide. Technical, intended for healthcare professionals. Open the Wegovy label (PDF) →
- Your Rx Summaries Summaries for tirzepatide, semaglutide, liraglutide, oral weight-loss medications, B vitamin boosters, amino acid boosters, glutathione, NAD+, sermorelin and lipotropic medications. Browse the Rx summaries →
This guide does not replace talking with your healthcare provider. Use it as a reference alongside your consultations — your provider will give you personalized advice and explain how these risks apply to your specific situation. In an emergency, call 911 or go to the nearest emergency department. Lavender Sky Health is not an urgent or emergency care provider, and our email, messages, text and social channels are not monitored for emergencies.