# Semaglutide and tirzepatide drug interactions: what the labels say Canonical page: https://bodienvi.com/blog/semaglutide-tirzepatide-drug-interactions Published October 19, 2026. Updated October 19, 2026. By Bodi Envi Clinical Content Team. The interactions the Wegovy® and Zepbound® labels name: insulin and sulfonylureas, oral medications and slower stomach emptying, and the pill on tirzepatide. ## Three interactions, all from the labels The prescribing information for Wegovy® and Zepbound® each carries a short drug interactions section, and the entries are the same kind of thing: not chemical reactions between drugs, but changes in how other medications behave because of what a GLP-1 medication does to blood sugar and to the stomach. This article sets out what the two labels say, and nothing beyond it. Your provider and your pharmacist are the people to review your full medication list. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ## Insulin and sulfonylureas: a lower blood sugar risk Both labels say that using the medication together with insulin or with an insulin secretagogue, which is the class of diabetes tablets that includes sulfonylureas such as glipizide and glimepiride, increases the risk of hypoglycemia, meaning blood sugar that falls too low. Both labels say the risk may be lowered by reducing the dose of the insulin or the secretagogue, and both ask patients on these combinations to be told about the signs of low blood sugar and how to respond. The decision to adjust a diabetes medication is the prescriber's, and anyone on insulin or a sulfonylurea should say so before starting. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ## Oral medications: slower stomach emptying Semaglutide and tirzepatide both delay gastric emptying, which is part of how they reduce appetite. Both labels note that this has the potential to change the absorption of medications taken by mouth at the same time. The Zepbound® label adds that the effect is largest after the first dose and when the dose is increased, and lessens over time. Neither label lists specific tablets to avoid. The practical point is that medications with a narrow margin between a dose that works and one that causes harm, which the labels describe as narrow therapeutic index drugs, deserve closer monitoring when a GLP-1 medication starts or steps up. Levothyroxine, warfarin and some seizure medications are the examples providers most often raise, and a provider may choose to check levels or timing. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ## Oral contraceptives: a tirzepatide specific warning The Zepbound® label carries an interaction the Wegovy® label does not. Tirzepatide reduced the exposure of oral hormonal contraceptives in a clinical study, and the label advises patients who use them to switch to a non-oral method, or to add a barrier method, for four weeks after starting tirzepatide and for four weeks after each dose increase. This is one of the clearest action items in either label and it belongs in the first conversation with a provider for anyone who relies on the pill. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ## What is not in the label, and what else to mention Neither label lists an interaction with alcohol, caffeine or common over the counter pain relievers. The absence of an entry is not a statement of safety, only that no interaction was identified in the studies the label reports. Separately, professional anesthesia guidance asks patients to tell a surgical or endoscopy team that they take a weekly GLP-1 medication, because slower stomach emptying matters for sedation, and the team decides whether to hold a dose. The same slower emptying is why both labels warn about dehydration from vomiting or diarrhea, which has led to kidney injury in reported cases, and why keeping fluids up matters during dose changes. This is general information and not medical advice. The labels describe Wegovy® and Zepbound®, the branded products. Personalized compounded semaglutide and tirzepatide, which Bodi Envi's programs may include, are not FDA-approved, were not studied and are not equivalent to the branded products. Bring a complete list of prescriptions, supplements and over the counter products to your provider, and ask your pharmacist about any new medication added while on treatment. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ## Frequently asked questions ### Can I take semaglutide or tirzepatide with metformin? The labels do not list metformin as an interaction. Metformin is not an insulin secretagogue, so it does not carry the hypoglycemia warning that sulfonylureas and insulin do. Tell your provider you take it. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ### Does the birth control warning apply to semaglutide? The Wegovy® label does not carry it. The Zepbound® label does, for tirzepatide, for four weeks after starting and after each dose increase. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ### Will my thyroid medication still work? The labels say slower stomach emptying can affect the absorption of oral medications and single out narrow therapeutic index drugs for monitoring. Levothyroxine is one providers commonly watch. Do not change the dose yourself. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ### What about antidepressants or blood pressure tablets? Neither label names them. Any oral medication can in principle be affected by slower emptying, which is why the full list goes to your provider and pharmacist. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ### Should I stop before surgery? Tell the surgical team you take a weekly GLP-1 medication. Professional guidance exists on holding doses before procedures and the team decides for you. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ### Is alcohol an interaction? It is not listed in either label. The site's guide on alcohol and semaglutide covers what is and is not known. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ## Sources - Wegovy® (semaglutide) injection prescribing information, section 7, Drug Interactions, DailyMed: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b (checked October 2026) - Zepbound® (tirzepatide) injection prescribing information, section 7, Drug Interactions, DailyMed: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b (checked October 2026) - American Society of Anesthesiologists, consensus based guidance on preoperative management of patients on GLP-1 receptor agonists: https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative (checked October 2026)