What precautions should be taken when using contraceptives with Zepbound (generic name) and what are the safest options?

Zepbound and Contraceptive Precautions

Critical Issue: No Evidence Found for Zepbound-Contraceptive Interactions

The provided evidence does not contain any information about Zepbound (tirzepatide) or its interactions with contraceptives. The evidence exclusively addresses general contraceptive management, bleeding irregularities, and drug interactions with other medications—but not tirzepatide specifically.

What We Know About GLP-1 Receptor Agonists and Contraception

Based on general medical knowledge of GLP-1 receptor agonists (the drug class to which Zepbound/tirzepatide belongs):

Key Precaution: Delayed Gastric Emptying

• GLP-1 receptor agonists delay gastric emptying, which can theoretically reduce absorption of oral medications, including oral contraceptives.
• This mechanism raises concern for decreased contraceptive efficacy, particularly with oral contraceptive pills (OCPs).

Recommended Precautions

For patients starting Zepbound who use oral contraceptives:

• Consider switching to non-oral contraceptive methods (intrauterine devices, implants, injections, or barrier methods) to eliminate absorption concerns entirely.
• If continuing oral contraceptives, counsel patients about:
  • Using backup barrier contraception (condoms) for at least the first month of Zepbound therapy
  • Watching for breakthrough bleeding, which may signal reduced contraceptive effectiveness 1
  • The importance of consistent pill timing and adherence 1

Safest Contraceptive Options During Zepbound Use

Long-acting reversible contraceptives (LARCs) are the safest choice:

• Levonorgestrel-releasing intrauterine devices (LNG-IUDs) - failure rates <1% per year, no absorption concerns 2, 3
• Copper intrauterine devices (Cu-IUDs) - failure rates <1% per year, non-hormonal, no drug interactions 2, 3
• Etonogestrel subdermal implants - failure rates <1% per year, systemic absorption unaffected by gastric emptying 2, 3

Alternative hormonal options with reduced interaction risk:

• Depot medroxyprogesterone acetate (DMPA) injections - administered every 13 weeks, bypasses gastrointestinal absorption 3
• Contraceptive vaginal ring - releases hormones locally, minimal first-pass metabolism 4
• Transdermal contraceptive patch - avoids gastrointestinal absorption entirely 5

Monitoring Recommendations

• Assess for breakthrough bleeding or spotting, which may indicate reduced contraceptive effectiveness 1
• If breakthrough bleeding occurs with oral contraceptives, consider switching to a LARC method rather than attempting to manage bleeding 1
• Counsel patients that unscheduled bleeding with hormonal contraceptives warrants evaluation for pregnancy and potential contraceptive failure 1

Important Caveat

This recommendation is based on the known pharmacology of GLP-1 receptor agonists and general principles of drug interactions, not on specific clinical trial data for Zepbound and contraceptives. The manufacturer's prescribing information for tirzepatide should be consulted for any specific warnings or precautions regarding contraceptive use.