What is the recommended transitional dosage from Zepbound (Viltepso) injection to oral Zepbound (Viltepso) for a patient with a history of gastrointestinal issues?

Zepbound Injection to Oral Transition: No Oral Formulation Exists

There is no oral formulation of Zepbound (tirzepatide) available, making a transitional dosage strategy from injection to oral administration impossible. Zepbound is only manufactured and FDA-approved as a subcutaneous injection for chronic weight management.

Critical Clarification

• Zepbound (tirzepatide) exists exclusively as a subcutaneous injection with no oral equivalent on the market 1
• The question appears to conflate Zepbound with a different medication, as no oral tirzepatide formulation has been developed or approved 1
• If discontinuation of injectable Zepbound is necessary due to gastrointestinal complications, the medication must be stopped entirely rather than transitioned to an oral form 2

Important Safety Consideration for GI Issues

Patients with significant gastrointestinal problems should have Zepbound discontinued rather than continued, as the medication carries risk of severe GI motility complications including functional bowel obstruction 2.

When to Stop Zepbound:

• Gastroparesis or severe delayed gastric emptying - GLP-1/GIP agonists are not recommended for individuals with gastroparesis 1
• Ileus or bowel obstruction - discontinue immediately and provide guidance on surgical procedure preparation 1
• Intractable nausea/vomiting despite dose titration - consider slower titration or discontinuation 1
• Functional small bowel obstruction - even without surgical history, this has been reported with dose escalation 2

Alternative Approach if Weight Management Must Continue

If chronic weight management remains medically necessary after Zepbound discontinuation:

• Consider non-GLP-1 based therapies after GI symptoms fully resolve
• Oral medications for diabetes (if applicable) such as metformin or SGLT2 inhibitors have neutral to modest weight loss effects without the severe GI motility risks 1
• Dietary modifications and mindful eating practices (reduction in meal size, stopping when full, decreasing high-fat/spicy foods) should be implemented regardless 1