Is Zepbound (ozanimod) safe to use in an adult patient with hypomagnesemia?

Zepbound (Tirzepatide) Use in Hypomagnesemia

Critical Clarification

There appears to be confusion in the question: "Zepbound" is the brand name for tirzepatide (a GLP-1/GIP receptor agonist for diabetes and weight management), NOT ozanimod. Ozanimod is marketed as Zeposia and is a sphingosine 1-phosphate receptor modulator used for multiple sclerosis and ulcerative colitis 1, 2. The provided evidence discusses ozanimod, not tirzepatide/Zepbound.

If the Question is About Ozanimod (Zeposia) and Hypomagnesemia:

Ozanimod can be safely used in patients with hypomagnesemia, provided the hypomagnesemia is corrected first and cardiac monitoring is performed, as there are no direct contraindications related to magnesium levels. 2

Pre-Treatment Requirements

• Correct hypomagnesemia before initiating ozanimod because:
  • Hypomagnesemia causes cardiac arrhythmias and QT prolongation 3
  • Ozanimod requires first-dose cardiac monitoring for bradycardia and AV conduction abnormalities 2
  • The combination of uncorrected hypomagnesemia and ozanimod's cardiac effects could be problematic

Magnesium Correction Protocol

For moderate to severe hypomagnesemia (<0.50 mmol/L or <1.2 mg/dL), administer intravenous magnesium sulfate 1-2 g over 5-15 minutes, followed by continuous infusion. 4

• For mild hypomagnesemia (>0.50 mmol/L), oral magnesium oxide 12-24 mmol daily (preferably at night) is reasonable 5, 4
• Always replace magnesium before attempting to correct concurrent hypocalcemia or hypokalemia, as these will be refractory to treatment until magnesium normalizes 4
• Monitor serum magnesium, calcium, and potassium levels during replacement 4

Cardiac Monitoring with Ozanimod

On Day 1 of ozanimod initiation (after magnesium correction), perform:

• Baseline ECG to assess for QT prolongation or conduction abnormalities 2
• Vital signs including heart rate prior to dosing and hourly for at least 6 hours 2
• Repeat ECG at Hour 6 post-dose 2

Safety Data

• In clinical trials, only 1.2-1.4% of patients were excluded from ozanimod due to cardiac disorders 2
• First-dose cardiac events occurred in 0.2% of UC patients and 0.6% of MS patients 2
• The 7-day dose escalation regimen (starting with 0.23 mg) mitigates first-dose cardiac effects 2

Common Pitfalls to Avoid

• Do not start ozanimod with uncorrected hypomagnesemia and concurrent QT-prolonging medications 4
• Do not assume serum magnesium accurately reflects total body stores—less than 1% of magnesium is in blood 3
• Do not give calcium or potassium supplements simultaneously with magnesium—separate by at least 2 hours 4

If the Question is Actually About Tirzepatide (Zepbound):

There is no evidence in the provided literature linking tirzepatide to hypomagnesemia or contraindications related to magnesium levels. Standard practice would be to correct significant hypomagnesemia before initiating any new medication, particularly given the cardiac risks of hypomagnesemia 3, 4.