HealthRX.com · Printable side-effect diary
Zepbound nausea diary by dose step
Log nausea each day against your dose and the days since your injection, so a call about holding a dose step or trying an anti-nausea medicine starts from a record rather than memory. The timing facts from the label and trials, and the warning signs that need same-day contact, are on the same sheet.
Where you are on the dose schedule
Current weekly dose (mg)
Date of your last dose increase
Usual injection day and time
Weeks at this dose so far
Other medicines, including any anti-nausea medicine
Daily nausea record
Score nausea the same way each day. Note meals that were large or fatty, and the time you took any anti-nausea medicine.
| Date | Days since injection | Nausea: none, mild, moderate, severe | Times vomited | Fluids kept down? | Meals: size and fat | Medicine taken and time |
|---|---|---|---|---|---|---|
What the label and trials say about timing
- Zepbound label: most nausea, vomiting and diarrhea in the trials came during dose escalation and decreased over time.[1]
- Zepbound label: stopping because of stomach side effects was 1.9% on 5 mg, 3.3% on 10 mg and 4.3% on 15 mg versus 0.5% on placebo, mostly in the first few months.[1]
- SURMOUNT-1 to -3: when an anti-nausea medicine was needed, it was most often first used in the first 24 weeks.[2]
- Phase 1 study: the slowing of stomach emptying faded with repeated doses and had diminished by day 23.[3]
- Missed dose: take it within 4 days (96 hours); after that, skip it and take the next dose on your usual day.[1]
Same-day contact, not a wait-and-see week
- Severe pain in the stomach area that will not go away, with or without nausea or vomiting: stop Zepbound and call your healthcare provider right away.[1]
- Nausea, vomiting or diarrhea that does not go away: tell your healthcare provider right away.[1]
- Losing fluids through vomiting or diarrhea can cause dehydration, which can lead to kidney problems.[1]
The page's red flags: tick any that apply today
- Vomiting more than 3 times in 24 hours
- No fluids kept down for 12 hours or more
- Pain high in the abdomen spreading to the back
- Dark or bloody vomit
- Weight loss beyond the target your prescriber set
Questions for your prescriber
- Should I stay at this dose longer before the next increase?
- Is an anti-nausea medicine right for me, and when in the week should I take it?
- Could a lower maintenance dose work for me if nausea keeps returning at each step?
- If nausea continues for weeks at a steady dose, what else should we check?
- Would changing my injection day or time help with my meals and work?
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/lookup.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b
- Rubino DM, Pedersen SD, Connery L, et al. Gastrointestinal tolerability and weight reduction associated with tirzepatide in adults with obesity or overweight with and without type 2 diabetes in the SURMOUNT-1 to -4 trials. Diabetes Obes Metab 2025. PMID 39789843. https://pubmed.ncbi.nlm.nih.gov/39789843/
- Urva S, Coskun T, Loghin C, et al. The novel dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 (GLP-1) receptor agonist tirzepatide transiently delays gastric emptying similarly to selective long-acting GLP-1 receptor agonists. Diabetes Obes Metab 2020. PMID 32519795. https://pubmed.ncbi.nlm.nih.gov/32519795/
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.