This guide is designed to help you understand how to use these medications safely, effectively, and with confidence. Obesity is a chronic disease—and these are chronic treatments. Understanding the why, how, and what to expect is key to success.

• Obesity Is a Chronic Disease
• FDA-Approved Indications
• Side Effects & Risks
• Pregnancy, Fertility, and Birth Control
• Preventing Muscle Loss During Weight Loss
• How do I take the medication?
• Storage Recommendations
• Dosing & Minimizing Side Effects
• Special Medical Considerations

Obesity Is a Chronic Disease

Important: These medications are not a short-term fix. Once started, long-term treatment is typically needed. If the medication is stopped, weight regain is likely.

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FDA-Approved Indications

Wegovy® (semaglutide) is approved for:

• Chronic weight management in adults with obesity or overweight with at least one weight-related condition
  • Typically prescribed for patients with a BMI ≥30, or ≥27 with conditions like hypertension, type 2 diabetes, or high cholesterol.
• Reducing the risk of major cardiovascular events (heart attack, stroke, or death) in adults with obesity and established cardiovascular disease

Zepbound™ (tirzepatide) is approved for:

• Chronic weight management in adults with obesity or overweight with at least one weight-related condition
  • Typically prescribed for patients with a BMI ≥30, or ≥27 with conditions like hypertension, type 2 diabetes, or high cholesterol.
• Treatment of moderate-to-severe obstructive sleep apnea (OSA) in adults with obesity

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Side Effects & Risks

Contraindications:

Do not take these medications if you:

• Have a personal/family history of medullary thyroid carcinoma (rare thyroid cancer)
• Have Multiple Endocrine Neoplasia Syndrome Type 2 (MEN2)
• Have a known allergy to semaglutide (Wegovy) or tirzepatide (Zepbound)

Common:

• Nausea, vomiting, diarrhea, constipation
• Fatigue
• Headache
• Abdominal discomfort

Less Common but Important:

• Pancreatitis – sudden severe abdominal pain. If you have a history of pancreatitis it’s not a contraindication but must be discussed with your health care provider in advance of taking the drug. If develop pancreatitis while on drug and the drug is felt to be the cause of the pancreatitis then should not be taken again
• Gallbladder issues – stones or inflammation
• Worsening diabetic retinopathy – especially if blood sugars improve quickly
• Dehydration and kidney issues – especially in patients with renal insufficiency

If you have kidney disease, vomiting or diarrhea could lead to worsening renal function. Let your provider know promptly if symptoms are severe.

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Pregnancy, Fertility, and Birth Control

Weight Loss Increases Fertility

As obesity resolves, estrogen levels drop (since fat tissue makes estrogen), often making it easier to get pregnant—even unintentionally. If you’re of reproductive age, your current birth control strategy may no longer be enough.

Zepbound-Specific Warning

Because Zepbound can interfere with oral birth control, the FDA recommends:

• Adding a barrier method (like condoms) for the first 4 weeks after starting
• Repeat this each time your dose increases

Pregnancy and Breastfeeding

• These medications should not be used during pregnancy. If you suspect pregnancy do not take your next dose until tested and discuss with your health care provider
• Discontinue at least 2 months before conception
• Not recommended during breastfeeding

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Preventing Muscle Loss During Weight Loss

Weight loss can reduce not only fat, but also muscle mass (lean body mass). This occurs with:

• Medications like Wegovy and Zepbound
• Diet and exercise alone
• Bariatric surgery

Why It Matters:

• Muscle loss slows metabolism
• Can reduce physical function, strength, and long-term mobility
• Increases the risk of frailty

How to Protect Your Muscle:

Prioritize Protein

• Aim for a high-protein diet (≥75–100g/day), if medically safe
• Include lean meats, dairy, tofu, legumes, and protein shakes

Exercise Regularly

• Strength training at least 2–3 times per week
• Add walking, swimming, or cycling for heart health

Tip: Focus on active weight loss, not passive. Prioritize strength and function.

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How do I take the medication?

Both Wegovy® and Zepbound™ come in a simple, single-use pen injector. Read the package insert for specific instructions for each medication.

You will give yourself one injection per week — on the same day each week.

Step-by-Step Guide:

Prepare

• Wash your hands with soap and water.
• Take the pen out of the refrigerator.
• If injecting right away, let it sit at room temperature for about 30 minutes — this can make the injection more comfortable.
• Check the pen:
  • Confirm the expiration date.
  • Check that the liquid is clear and colorless — do not use if cloudy or discolored.

• The injection goes just under the skin (subcutaneous).
• Common sites:
  • Front of the thigh
  • Abdomen, at least 2 inches away from the belly button
  • Back of the upper arm (if someone is helping you)
• Rotate sites each week to avoid skin irritation. Do not inject into an area that is tender, bruised, red, or hard.

Avoid injecting into:

• Over a hernia site (such as an umbilical hernia or incisional hernia)
• Scar tissue from surgery or injury
• Areas with active infection (red, warm, painful skin)
• Bruised, tender, hardened, or swollen skin
• Areas with lipodystrophy (fatty lumps or dents under the skin, often from repeated prior injections)

Inject

• Clean the skin with an alcohol swab and let it dry.
• Remove the pen cap.
• Place the pen straight against your skin at the injection site.
• Press and hold the injection button down firmly.
• You will hear a click — keep holding the pen against the skin for the full injection (usually 5-10 seconds depending on pen type).
• Wait until the indicator shows that the dose is complete.
• Remove the pen and dispose of it safely in a sharps container.

After the Injection

Keep track of your injection date and rotate your injection sites.

You may apply light pressure to the injection site with a cotton ball or tissue — do not rub the area.

Store your pen as instructed — used pens are single-use only and should be discarded.

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Storage Recommendations

• Refrigerate: Store in the refrigerator at 36°F to 46°F (2°C to 8°C).
• Do not freeze. If the pen is accidentally frozen, it should be discarded.
• Room temperature: You may store the pen out of the refrigerator at temperatures up to 86°F (30°C) for up to:
  • 28 days for Wegovy®
  • 21 days for Zepbound™
• After 28 days (Wegovy) or 21 days (Zepbound) out of the refrigerator, the pen should be discarded, even if it looks fine.
• Always store pens in the original carton to protect them from light.

Practical Tips

• If traveling, use an insulated cooler to protect the pen from heat.
• If you take the pen out of the fridge, you do not need to return it to the fridge if you will use it within the allowed time window (28 days for Wegovy®, 21 days for Zepbound™).
• Write the date you removed the pen from the refrigerator on the carton to track how long it has been out.
• Do not use the pen if it has been exposed to temperatures above 86°F (hot car, direct sunlight, hot rooms, etc.).
• When ready to inject, it’s often more comfortable if the pen is at room temperature rather than straight from the fridge.

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Dosing & Minimizing Side Effects

Start Slow

• Dosing increases gradually (typically monthly) to help your body adjust

Wegovy® (Semaglutide) Dosing Schedule

Week	Dose	Maintenance?
1–4	0.25 mg once weekly	No
5–8	0.5 mg once weekly	No
9–12	1.0 mg once weekly	No
13–16	1.7 mg once weekly	Yes — Maintenance dose option
17+	2.4 mg once weekly	Yes — Maintenance dose option

The non-maintenance doses are stepping stones to help your body adjust on the way to a maintenance dose. Maintenance doses have been studied for long-term use and are where most people stay once they reach their goal.

Zepbound™ (Tirzepatide) Dosing Schedule

Week	Dose	Maintenance?
1–4	2.5 mg once weekly	No
5–8	5 mg once weekly	Yes — Maintenance dose option
9–12	7.5 mg once weekly	No
13–16	10 mg once weekly	Yes — Maintenance dose option
17+	15 mg once weekly	Yes — Maintenance dose option

The non-maintenance doses are stepping stones to help your body adjust on the way to a maintenance dose. Maintenance doses have been studied for long-term use and are where most people stay once they reach their goal.

Plan Ahead

• Inject on a day with fewer responsibilities (many choose Friday or Saturday).
• Be aware that many patients do not experience side effects on the day of injection, but rather the day after. Factor this into your planning so that any potential nausea, fatigue, or other effects do not interfere with work or family responsibilities.

Eat & Hydrate Smart

• Small, low-fat meals
• More frequent eating
• Hydrate well (aim for >64 oz of water)
• Keep electrolyte drinks on hand

For Constipation:

• Increase fiber or use over the counter stool softeners

For Nausea:

• Ginger tea or lozenges
• Avoid heavy, greasy meals
• Sit upright after eating

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Special Medical Considerations

Condition	Considerations
Diabetic Retinopathy	Rapid glucose improvement may worsen retinopathy – monitor closely
Kidney Disease	Vomiting or diarrhea may worsen kidney function – alert provider early
Pregnancy Planning	Not safe in pregnancy – discuss timing with provider
Other Medications	Discuss interactions, especially with insulin or insulin secretagogues (sulfonylureas and meglitinides. )

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