Questions to ask before starting a GLP-1

Both labels list the same two contraindications. Do not use Zepbound or Wegovy if you or anyone in your family has ever had medullary thyroid carcinoma (MTC), or if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), or if you have had a serious allergic reaction to the active ingredient or any ingredient in the product (Zepbound Medication Guide, January 2026; Wegovy Medication Guide, February 2026).

Both carry a boxed warning behind the first one. In rodent studies, these medicines caused thyroid tumors, including cancer, and it is not known whether they cause thyroid tumors or MTC in people (Zepbound Medication Guide, January 2026; Wegovy Prescribing Information, February 2026). Neither should be combined with another GLP-1 medicine or, for Zepbound, another tirzepatide product (Zepbound and Wegovy Medication Guides).

The Medication Guides list both as prescription medicines used with a reduced-calorie diet and increased physical activity. Zepbound's uses are weight loss and moderate to severe obstructive sleep apnea with obesity (Zepbound Medication Guide, January 2026). Wegovy's are weight loss, cardiovascular risk reduction in adults with known heart disease, and a liver condition called MASH with moderate to advanced fibrosis, and Wegovy now comes as a daily tablet as well as a weekly injection (Wegovy Medication Guide, February 2026).

The two lists overlap and differ, so here they are side by side.

• Zepbound. Tell your provider if you have or have had problems with your pancreas; severe stomach problems such as gastroparesis or trouble digesting food; a history of diabetic retinopathy; surgery or a procedure with anesthesia or deep sedation coming up; a pregnancy or plans for one; or breastfeeding or plans to (Zepbound Medication Guide, January 2026). MedlinePlus adds kidney disease to its tirzepatide list (MedlinePlus, tirzepatide, February 15, 2026).
• Wegovy. Tell your provider if you have or have had problems with your pancreas or kidneys; type 2 diabetes with a history of diabetic retinopathy; surgery or a procedure with anesthesia or deep sedation coming up; a pregnancy or plans for one; or breastfeeding or plans to (Wegovy Medication Guide, February 2026). MedlinePlus adds gallbladder disease, slowed stomach emptying, and recent diarrhea, nausea, or vomiting, or being unable to drink liquids (MedlinePlus, semaglutide, May 15, 2026).
• Heart rate. The Wegovy label says to monitor heart rate at regular intervals (Wegovy Prescribing Information, February 2026). In the Zepbound trials, heart rate rose a mean of 1 to 3 beats per minute (Zepbound Prescribing Information, January 2026).
• Mood. The Zepbound label says to monitor for depression or suicidal thoughts (Zepbound Prescribing Information, January 2026). The Wegovy label records its suicidal behavior and ideation section as removed in February 2026 (Wegovy Prescribing Information, February 2026).

NIDDK lists your family's medical history, your current health issues and other medications, and cost among the factors to weigh with your health care professional (NIDDK, last reviewed June 2024).

• Every medicine you take. Tell your provider about all prescription and over-the-counter medicines, vitamins, and herbal supplements, and keep a list to show your provider and pharmacist (Zepbound and Wegovy Medication Guides). Wegovy slows stomach emptying and can affect medicines that need to pass through the stomach quickly (Wegovy Medication Guide, February 2026).
• Diabetes medicines. Say if you take insulin or a sulfonylurea, because low blood sugar is more likely with those (Zepbound and Wegovy Medication Guides). The Wegovy label says to monitor blood glucose before starting and during treatment in people with diabetes (Wegovy Prescribing Information, February 2026).
• Birth control. The Zepbound guide says birth control pills by mouth may not work as well, and your provider may recommend another type for 4 weeks after you start and for 4 weeks after each dose increase (Zepbound Medication Guide, January 2026). MedlinePlus words it more widely, saying tirzepatide may decrease the effectiveness of hormonal contraceptives, including pills, patches, rings, and injections (MedlinePlus, tirzepatide, February 15, 2026). Ask which reading your prescriber follows.
• Pregnancy. Both labels say the medicine may cause fetal harm and, for weight reduction, to discontinue it when pregnancy is recognized (Zepbound Prescribing Information, January 2026; Wegovy Prescribing Information, February 2026). Wegovy adds that it should be discontinued at least 2 months before a planned pregnancy because of semaglutide's long half-life (Wegovy Prescribing Information, February 2026). NIDDK says you should not take weight-loss medications if you are pregnant or planning to become pregnant, as they may harm the fetus (NIDDK, June 2024).
• Breastfeeding. Breastfeeding is not recommended during treatment with Wegovy tablets, and for the injection the guide says to talk with your provider about the best way to feed your baby (Wegovy Medication Guide, February 2026).

Both guides warn that the medicine may increase the chance of food getting into your lungs during surgery or other procedures that use anesthesia or deep sedation, and both say to tell all your healthcare providers you take it before any scheduled procedure (Zepbound Medication Guide, January 2026; Wegovy Medication Guide, February 2026).

• The schedule. Zepbound starts at 2.5 mg once weekly for 4 weeks and goes up in 2.5 mg steps after at least 4 weeks each (Zepbound Prescribing Information, January 2026). Wegovy injection starts at 0.25 mg and steps up every 4 weeks to a maintenance dose from week 17, and the tablet steps up every 30 days (Wegovy Prescribing Information, February 2026).
• How long. Your provider may advise staying on the medication indefinitely if it improves your health without serious side effects, and you will probably regain some weight after you come off it (NIDDK, June 2024).
• The 12-week mark. If you do not lose at least 5% of your starting weight after 12 weeks on the full dose, your health care professional will probably advise you to discontinue it (NIDDK, June 2024).
• Cost. Some insurance plans cover these medications and some do not, and NIDDK says to contact your insurer (NIDDK, June 2024).
• The product itself. Compounded drugs are not FDA approved, which means the FDA does not review them for safety, effectiveness, or quality before they are marketed, and the FDA has received reports of adverse events, some requiring hospitalization, that may be related to dosing errors with compounded injectable semaglutide (FDA, content current as of September 1, 2026). The FDA says to get a prescription from your doctor and fill it at a state-licensed pharmacy (FDA, September 2026). NIDDK says you should feel comfortable asking whether a medication is approved for treating overweight and obesity (NIDDK, June 2024).

The 2025 joint nutrition advisory lists what a clinician can check before starting: current eating habits, emotional triggers and eating-disorder history, food allergies, food and housing insecurity, physical activity including resistance training, sleep, and muscle strength and function, such as a sit-to-stand or stair-climb test (ACLM, ASN, OMA and TOS joint advisory, 2025). The ADA says to counsel and monitor people losing weight to prevent protein insufficiency and micronutrient deficiencies (ADA Standards of Care, 2026). Both are reasons to ask who on the care team handles food and strength.

The NIA publishes two lists for a new prescription (NIA, content reviewed September 22, 2022).

• For the doctor: what is the name of the medicine and why am I taking it; is there a less expensive alternative; when should I expect it to start working, and how will I know; what side effects might I expect, and what do I do about serious ones; will it cause problems with my other prescriptions, over-the-counter medicines, or supplements; what should I do if I want to come off it; will I need a follow-up appointment or testing before a refill.
• For the pharmacist: should I take it with food; how much do I take and when; what should I do if I forget a dose; is it safe to drive while taking it.

AHRQ's short list covers the same ground: how do you spell the name of that drug, are there any side effects, will it interact with medicines I already take, why do I need this treatment, and are there any alternatives (AHRQ, The 10 Questions You Should Know, reviewed November 2020). AHRQ also says to tell your doctor if you are pregnant, nursing, have had reactions to medicines, or take vitamins or herbal supplements, and to say if you are worried about being able to follow the instructions (AHRQ, reviewed November 2024).

Copy this into a note or print it. The source for each question is in parentheses.

About whether it fits me

1. Does anyone in my family history, or my own, rule this out, including medullary thyroid cancer or MEN 2? (both labels)
2. With my history of pancreas, kidney, gallbladder, stomach, or eye problems, is this medicine still a fit? (Medication Guides, MedlinePlus)
3. Is this the FDA-approved product, and which pharmacy should fill it? (FDA, NIDDK)

About my other medicines

1. Do any of my current medicines, vitamins, or supplements need to change? (Medication Guides, NIA)
2. If I take insulin or a sulfonylurea, what is the plan for low blood sugar? (Medication Guides)
3. Does my birth control still work on this, and for how long after each dose increase? (Zepbound guide, MedlinePlus)
4. If I might become pregnant, when would I come off it? (labels, NIDDK)

About the plan

1. What is my dose schedule, and who decides each step up? (labels)
2. What do I do if I miss a dose? (labels, NIA)
3. Which side effects mean I call you, and which mean I go to the emergency room? (Medication Guides)
4. What result are we looking for at 12 weeks on the full dose, and what happens if we don't see it? (NIDDK)
5. How long do you expect me to stay on it, and what is the plan for keeping weight off after? (NIDDK)
6. Who helps me with protein and strength training, and will you check my muscle strength before I start? (joint advisory, ADA)
7. Before any surgery or procedure with anesthesia or deep sedation, who do I need to tell? (Medication Guides)
8. Will my insurance cover it, and what are my options if it doesn't? (NIDDK)

I never decide whether a GLP-1 is right for you, and I never pick a dose. Your prescriber does. What I do is keep the questions you text me between now and the appointment and send them back the day before in the order you ranked them. Afterward, photograph the Medication Guide or the pharmacy printout and I keep it, so the answers come from your own paperwork. From the first shot on, we put shot day and the step-up weeks on the calendar, and I ask how you feel every day so the follow-up has a real record.

No clinician reviewed this page. It restates the FDA labels and Medication Guides, MedlinePlus, NIDDK, the FDA, the NIA, AHRQ, and the joint advisory linked below, and those are the documents to trust over anything here.