Can a person stop taking Zepbound (tirzepatide) cold turkey?

Stopping Zepbound (Tirzepatide): Recommendations for Discontinuation

Zepbound (tirzepatide) can be safely stopped "cold turkey" without a tapering protocol, as there are no established withdrawal symptoms or rebound effects that require gradual discontinuation.

Understanding Tirzepatide Discontinuation

Tirzepatide (Zepbound) is a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist that is FDA-approved for weight management and type 2 diabetes management. Unlike medications that require tapering (such as benzodiazepines or antipsychotics), tirzepatide does not have documented withdrawal syndromes or rebound effects that necessitate gradual discontinuation.

Key Considerations When Stopping Zepbound

1. No Physiological Dependence

   • Unlike medications such as benzodiazepines which require gradual tapering to prevent withdrawal symptoms 1, tirzepatide does not create physiological dependence
   • There are no documented withdrawal syndromes associated with abrupt discontinuation of GLP-1 receptor agonists or dual GIP/GLP-1 receptor agonists

2. Metabolic Effects

   • Be aware that weight regain is likely after discontinuation
   • Blood glucose levels may increase in patients with diabetes after stopping
   • These are not withdrawal effects but rather the removal of the medication's therapeutic effects

3. Monitoring After Discontinuation

   • For patients with diabetes: monitor blood glucose more frequently after stopping 1
   • For patients using for weight management: expect gradual weight regain without continued lifestyle modifications

Special Populations and Situations

• Patients with Diabetes: If the patient has diabetes and is using Zepbound for glycemic control, they should consult with their healthcare provider before stopping to adjust other diabetes medications as needed 1

• Pregnancy Planning: Women planning pregnancy should discontinue tirzepatide and can do so immediately rather than tapering 1

• Surgical Procedures: For elective procedures, stopping tirzepatide 1-2 weeks before surgery may be recommended to reduce risk of gastrointestinal effects during anesthesia, but this is not due to withdrawal concerns

Common Pitfalls to Avoid

1. Confusing Rebound Weight Gain with Withdrawal

   • Weight regain after stopping is not a withdrawal symptom but an expected physiological response
   • This differs from medications like benzodiazepines where tapering is required to prevent serious withdrawal symptoms 1

2. Misinterpreting Gastrointestinal Changes

   • Some patients may experience changes in gastrointestinal function after stopping, but these are not dangerous withdrawal symptoms
   • These represent a return to pre-treatment digestive patterns

3. Failing to Plan for Post-Discontinuation Management

   • For patients with diabetes, have a plan for glycemic control after stopping
   • For weight management patients, have a maintenance strategy in place

Conclusion

While some medications require careful tapering protocols to prevent withdrawal symptoms (as detailed in guidelines for benzodiazepines 1), Zepbound (tirzepatide) does not fall into this category. It can be discontinued abruptly without tapering, though patients should be prepared for the loss of therapeutic effects. The most important considerations are planning for alternative management strategies for the condition being treated, rather than concerns about withdrawal symptoms.