Does zepbound (generic name) reduce the efficacy of hormonal birth control methods?

Zepbound Reduces the Efficacy of Oral Hormonal Contraceptives

Zepbound (tirzepatide) does reduce the efficacy of oral hormonal contraceptives, and patients should switch to a non-oral contraceptive method or add a barrier method for 4 weeks after starting Zepbound and for 4 weeks after each dose escalation. 1

Mechanism and Evidence

The FDA-approved drug label for Zepbound explicitly states that tirzepatide may reduce the efficacy of oral hormonal contraceptives due to delayed gastric emptying 1. This effect is:

• Most significant after the first dose
• Diminishes over time but remains clinically relevant
• Occurs with each dose escalation of Zepbound

The drug's mechanism of action as a GIP receptor and GLP-1 receptor agonist affects gastrointestinal motility, which can interfere with the absorption of oral medications, including hormonal contraceptives 1.

Recommended Contraceptive Management

For women taking Zepbound who use oral hormonal contraceptives, the FDA recommends the following approach:

1. Switch to a non-oral contraceptive method (such as IUDs, implants, or injections) OR
2. Add a barrier method of contraception (such as condoms)

These precautions should be maintained:

• For 4 weeks after initial Zepbound initiation
• For 4 weeks after each dose escalation 1

Alternative Contraceptive Options

When considering alternative contraceptive methods for patients on Zepbound, the following options are not affected by the medication:

• Depot medroxyprogesterone acetate (DMPA) injections: Not affected by medications that alter gastric emptying 2
• Intrauterine devices (IUDs): Both hormonal and non-hormonal options remain effective
• Contraceptive implants: Subdermal implants are not affected by gastrointestinal changes
• Barrier methods: Condoms provide both contraception and STI protection

Important Clinical Considerations

• Timing matters: The interaction is most significant after starting Zepbound or increasing the dose
• Patient education: Clearly inform patients about this interaction before starting Zepbound
• Documentation: Record discussions about contraceptive management in the medical record
• Follow-up: Verify that patients have implemented appropriate contraceptive changes

Common Pitfalls to Avoid

1. Assuming all hormonal contraceptives are affected equally: The interaction primarily affects oral formulations due to the gastric emptying mechanism

2. Failing to counsel about the interaction: Many providers may not discuss this interaction, leaving patients vulnerable to unintended pregnancy 3

3. Not addressing the interaction with each dose escalation: Remember that the precautions need to be repeated with each increase in Zepbound dosage

4. Overlooking non-contraceptive benefits of hormonal methods: When switching methods, consider that some patients use hormonal contraceptives for benefits beyond pregnancy prevention, such as management of dysmenorrhea or acne 4

By following these recommendations, healthcare providers can help ensure that patients on Zepbound maintain effective contraception while receiving treatment for obesity or obstructive sleep apnea.