HealthRX.com · Printable side-effect diary
Zepbound constipation and fiber or laxative diary
Record your usual bowel pattern, each product you try by ingredient and amount (not just the brand), daily bowel movements, fluids and injection days, then bring it to your prescriber with the questions below. The warning signs from the Zepbound and psyllium labels are on the same page.
Before you change anything
Usual bowel pattern before Zepbound
What changed, and when it started
Zepbound dose and date of your last dose change
Oral medicines you takenote any timing instructions
Kidney problems or other conditions your prescriber should weigh
Products you try
Copy the ingredient amount from the label: grams of psyllium or fiber per dose, or the magnesium compound and its amount. A brand name or scoop size is not enough.
| Product name | Active ingredient | Amount per dose | Doses a day | Date started | Helped? (yes, partly, no) |
|---|---|---|---|---|---|
Daily diary
| Date | Injection day? | Bowel movements | Stool: hard, normal or loose | Product and amount taken | Fluids (glasses) | Pain, bloating or straining |
|---|---|---|---|---|---|---|
What the cited studies and labels report
- Zepbound label trials: constipation in 17% on 5 mg, 14% on 10 mg and 11% on 15 mg, versus 5% on placebo.[1]
- Psyllium vs docusate trial: psyllium 5.1 g twice daily gave more bowel movements than docusate 100 mg twice daily by the second week.[2]
- Prunes vs psyllium trial: 50 g of dried plums twice daily and 11 g of psyllium twice daily each supplied 6 g of fiber a day, and prunes improved complete spontaneous bowel movements more.[3]
- Magnesium oxide trial: 0.5 g of magnesium oxide three times a day for 28 days, against placebo, in women with mild to moderate constipation.[4]
- Psyllium product label: mix each dose with at least 8 ounces (a full glass) of fluid, and take it at least 2 hours before or after prescribed oral medicines.[5]
Stop and get medical advice
- Severe pain in your stomach area that will not go away, with or without nausea or vomiting: stop Zepbound and call your healthcare provider right away.[1]
- Chest pain, vomiting, or trouble swallowing or breathing after a psyllium dose: get medical help immediately.[5]
- Constipation lasting more than 7 days on a fiber laxative, or rectal bleeding: stop it and ask a doctor.[5]
- A sudden change in bowel habits lasting 2 weeks, or abdominal pain, nausea or vomiting: ask a doctor before starting a fiber laxative.[5]
To ask at your next review
- Is this a new problem since Zepbound, or a longstanding one that has changed?
- Which product should I try first, and how will we judge whether it worked?
- Would polyethylene glycol (PEG) be a better next step for me than magnesium?
- Is a magnesium product appropriate with my kidney function?
- How should I space fiber from my other oral medicines?
- At what point would a prescription treatment make sense?
Sources for the facts on this sheet
- Eli Lilly and Company, via DailyMed. Zepbound (tirzepatide) injection, for subcutaneous use: prescribing information and Medication Guide. Effective 2026-08-28. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b
- McRorie JW, Daggy BP, Morel JG, et al. Psyllium is superior to docusate sodium for treatment of chronic constipation. Aliment Pharmacol Ther 1998. PMID 9663731. https://pubmed.ncbi.nlm.nih.gov/9663731/
- Attaluri A, Donahoe R, Valestin J, et al. Randomised clinical trial: dried plums (prunes) vs. psyllium for constipation. Aliment Pharmacol Ther 2011. PMID 21323688. https://pubmed.ncbi.nlm.nih.gov/21323688/
- Mori S, Tomita T, Fujimura K, et al. A Randomized Double-blind Placebo-controlled Trial on the Effect of Magnesium Oxide in Patients With Chronic Constipation. J Neurogastroenterol Motil 2019. PMID 31587548. https://pubmed.ncbi.nlm.nih.gov/31587548/
- Publix Super Markets, Inc., via DailyMed. Publix Fiber Therapy Sugar Free psyllium husk powder, orange flavor: Drug Facts label. Effective 2025-10-28. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ed3dc80a-a243-4013-9886-b148e3e3b662
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.