Zepbound (Tirzepatide) During Breastfeeding
Zepbound should not be used while breastfeeding due to complete absence of safety data in lactating women and the theoretical risks associated with GLP-1/GIP receptor agonists in nursing infants.
Evidence Assessment
The provided evidence contains no specific information about tirzepatide (Zepbound) use during breastfeeding. The guidelines focus on cardiovascular medications 1, respiratory medications 1, and other drug classes 2, 3, 4, none of which address GLP-1/GIP receptor agonists.
Clinical Reasoning
Why Zepbound Should Be Avoided
- No human lactation data exists for tirzepatide, placing it in a category where the risk to the nursing infant cannot be adequately assessed 5, 6
- Large molecular weight proteins like tirzepatide (a peptide medication) have unknown transfer rates into breast milk, and their effects on infant development are unstudied 7, 8
- The indication for Zepbound (weight management/type 2 diabetes) is not life-threatening and safer alternatives exist for managing these conditions during lactation 5
General Principles Applied to This Case
- When prescribing medications during breastfeeding, those with the lowest risk and best-studied safety profiles should be selected 5
- Drugs should only be used when limited information exists if the maternal benefit clearly outweighs potential infant risk 6, 7
- Few drugs are absolutely contraindicated during breastfeeding, but novel medications without lactation data require extreme caution 6, 9
Alternative Management Strategies
For Type 2 Diabetes
- Insulin, metformin, and second-generation sulfonylureas are generally preferred and compatible with breastfeeding 5
- These agents have established safety profiles in lactating women 5
For Weight Management
- Lifestyle modifications including diet and exercise should be prioritized during the breastfeeding period
- Delay pharmacologic weight management until after weaning when possible
Critical Caveat
The decision to discontinue breastfeeding or avoid Zepbound must weigh the significant health benefits of breastfeeding for both mother and infant against the maternal need for this specific medication 8. If glycemic control or weight management is essential, switching to well-studied alternatives compatible with breastfeeding is strongly preferred over using an unstudied agent 5, 6.