Previous changes

September 2025 — minor update. A typographical error has been corrected.

August 2025 — minor update. Quality standards have been updated in line with the NICE QS 212 Overweight and Obesity Management.

May 2025 — minor update. QOF indicators updated in line with the NHS England Quality and Outcomes Framework guidance for 2025/26.

February 2025 — reviewed. A literature search was conducted in January 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The topic has been updated in line with the National Institute for Health and Care Excellence (NICE) new guideline Overweight and obesity management.

August 2024 — minor update. Added information about endoscopic sleeve gastroplasty as an option for people who may be high risk for bariatric surgery, who decline bariatric surgery because of the associated risk, or where this procedure may prevent progression of obesity and associated comorbidities. Added information about tirzepatide (Mounjaro®) and risks of interaction with oral contraception in individuals who are overweight or obese.

August 2023 — minor update. The 2023 additions and amendments from the NICE clinical guideline Obesity: identification, assessment and management [CG189] have been added to the management section of this topic.

May 2023 — minor update. The recommendation from the NICE technology appraisal Semaglutide for managing overweight and obesity [TA875] has been added to the management section of this topic. It is however, important to note that semaglutide is not currently available. It will be available after launch of the drug in England is confirmed by the manufacturer.

September 2022 — reviewed. The sections on identification and classification, and general principles of care have been updated to align with the updated NICE guideline Obesity: identification, assessment and management.

July 2022 — minor update. The recommendation from the NICE technology appraisal Liraglutide for managing overweight and obesity has been added to the management section of this topic. 

December 2017 — reviewed. A literature search was conducted in November 2017 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of the topic. The recommendations in this CKS topic have been updated in line with the National Institute for Health and Care Excellence (NICE) guideline Obesity: identification, assessment and management, which replaces section 1.2 in the NICE guideline on Obesity Prevention. The topic has also been restructured.

November 2016 — minor update. The 2016 NICE Quality standards on Obesity: clinical assessment and management have been added to this topic.

June 2015 — minor update. Based on an update to the Summary of Product Characteristics (SPC) for Calcichew D3^® chewable tablets, the interaction of orlistat with fat-soluble vitamins has been clarified.

June 2013 — minor update. The 2013 QOF options for local implementation have been added to this topic.

September to October 2012 — reviewed. A literature search was conducted in August 2012 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of this topic. No major changes to recommendations have been made, but recommendations for starting drug treatment have been amended in line with the SPC for orlistat (Xenical^®).

March 2011 — topic structure revised to ensure consistency across CKS topics. No changes to clinical recommendations have been made.

February 2010 — minor update. Advice on interactions between orlistat and levothyroxine and antiepileptic drugs has been added to the Prescribing Information section. 

January 2010 — updated. On 21 January 2010, the European Medicines Agency (EMEA)'s Committee for Medicinal Products for Human Use (CHMP) recommended the suspension of the marketing authorisation for sibutramine (Reductil^®) because the benefits no longer outweigh the risks. This CKS topic has been updated to reflect the EMEA's decision. Recommendations regarding when to consider prescribing sibutramine as well as its prescribing information and prescriptions have been removed.

November 2008 — updated. On 23 October 2008, the EMEA's CMHP recommended the suspension of the marketing authorisation for rimonabant (Acomplia^®) because the benefits no longer outweigh the risks. This CKS topic has been updated to reflect the EMEA's decision. Recommendations regarding when to consider prescribing rimonabant as well as its prescribing information and prescriptions have been removed. 

July 2008 — minor update to incorporate the recommendation from NICE that rimonabant may now be prescribed as an alternative to orlistat or sibutramine. A scenario on prescribing rimonabant has been added.

May 2008 — minor update to text to reflect updated advice from the Medicines and Healthcare products Regulatory Agency (MHRA) regarding rimonabant. Issued June 2008.

June to September 2007 — converted from CKS guidance to CKS topic structure. The evidence base has been reviewed in detail, and recommendations are more clearly justified and transparently linked to the supporting evidence. There have been no major changes to the recommendations. This update incorporates recommendations from the NICE guideline Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children.

July 2006 — minor update. Information regarding orlistat and reduced efficacy of oral contraceptives has been included.

July–September 2005 — reviewed. Validated in December 2005 and issued in February 2006.

March 2002 — reviewed. Validated in June 2002 and issued in July 2002.

June 2001 — updated to incorporate recommendations in the NICE technology appraisal Guidance on the use of orlistat for the treatment of obesity in adults and Statistics on Obesity published by the National Audit Office. Validated in July 2001 and issued in October 2001.

New evidence

Evidence-based guidelines

• MHRA (2025) GLP-1 medicines for weight loss and diabetes: what you need to know. Medicines and Healthcare products Regulatory Agency. https://www.gov.uk [Free Full-text]
• NICE (2025) Overweight and obesity management. National Institute for Health and Care Excellence. https://www.nice.org.uk  [Free Full-text]
• WHO (2025) WHO guideline on the use of glucagon-like peptide-1 (GLP-1) therapies for the treatment of obesity in adults. World Health Organisation. [Free Full-text]

HTAs (Health Technology Assessments)

• NICE (2025) Tirzepatide for managing overweight and obesity. National Institute for Health and Care Excellence. https://www.nice.org.uk [Free Full-text]

Economic appraisals

No new economic appraisals relevant to England since 1 January 2025.

Systematic reviews and meta-analyses

No new systematic reviews or meta-analysis which reach the CKS threshold for inclusion since 1 January 2025.

Primary evidence

No new primary evidence which reaches the CKS threshold for inclusion published since 1 January 2025.

New policies

No new national policies or guidelines since 1 January 2025.

New safety alerts

No new safety alerts since 1 January 2025.

Changes in product availability

• New product Plaobes (liraglutide) 6 mg/ml solution for injection in pre-filled pen. This liraglutide biosimilar is approved for use in the treatment of weight management as an adjunct to a reduced-calorie diet and increased physical activity in adults and adolescents. See more here.

Basis for recommendation

These recommendations are based largely on the National Institute for Health and Care Excellence (NICE) guideline Overweight and obesity management [NICE, 2025c] and the BMJ Best Pracitce guide Obesity in Adults [BMJ Best Practice, 2025].

What are the general principles of managing a person who is living with overweight or obesity?

• Consider the broader determinants and context of overweight and obesity before or during discussions.
• Before discussing overweight, obesity or central adiposity, take into account:
  • Whether it is appropriate to talk about weight in the context of the discussion.
  • That the subject of weight may have been raised before.
  • Your own feelings about weight.
  • That eating disorders can affect people at any weight.
  • Cultural factors.
• Ask permission to discuss overweight, obesity, or central adiposity. Respect the person’s choice to decline the conversation, and either explore the reasons sensitively or wait until an appropriate time.
• Record the outcome of the discussion to make subsequent healthcare professionals aware that the matter has been raised, and to know about the person’s views and any actions already taken.
• Ensure all discussions are conducted in a sensitive, non-judgemental and person-centred manner by:
  
  • Using non-stigmatising language such as 'living with being overweight'.
  • Identifying the person’s preferred terms.
  • Focus on improvements around health and wellbeing rather than simply talking about weight.
  • Staying positive, supportive, and solution-based.
  • Taking into account the person’s thoughts, views and cultural, religious, or spiritual beliefs.
  • Being mindful of the factors that may hinder weight loss.

How should I assess a person who is living with overweight or obesity?

When to take and record measurements

• Avoid attributing all symptoms to overweight or obesity. If the person presents with another health problem or condition, address this first before deciding whether it is appropriate to discuss weight.
• Ask for permission each time before discussing weight and before taking measurements. Ensure all discussions are sensitive and non-judgmental.
• If permission is given, use suitable opportunities to measure and record a person’s height, weight, and waist circumference (in people with body mass index below 35 kg/m²). 
• Ensure that records are kept up to date and shared between providers, if possible, and permission is given for people who have self-referred to overweight and obesity management interventions.

How to take measurements

• Encourage people with body mass index (BMI) below 35 kg/m² to:
  • Measure their own waist-to-height ratio to assess central adiposity.
  • Seek advice and further clinical assessments (such as a cardiometabolic risk factor assessment) from a healthcare professional if the measurement indicates an increased health risk.
• Direct people to resources that provide advice on measuring waist circumference and waist-to-height ratio, such as the video guide on the NHS obesity page.

Measures of overweight, obesity, and central adiposity

• Use BMI with caution, as it is not a direct measure of central adiposity.
• In adults with BMI below 35 kg/m², measure and use their waist-to-height ratio, as well as BMI, as an estimate of central adiposity. These measures should then be used to help assess and predict health risks.
• Do not use bioimpedance as a substitute for BMI as a measure of general adiposity in adults.
• When classifying overweight or obesity in adults, use the scale as seen in the definition section.

Assessing and managing comorbidities

• Following the initial assessment of overweight or obesity, identify any comorbidities and other factors that may affect or be affected by the person's weight. Take into account the timing of the assessment, the degree of overweight or obesity, and the results of previous assessments.
• If comorbidities are identified, start managing these straight away. Do not wait for weight loss.

Specific advice for people from ethnic minority backgrounds

• Be aware that people from some ethnic minority backgrounds are prone to central adiposity, and so are at an increased risk of chronic weight-related health conditions at a lower BMI.
• Ensure people from ethnic minority backgrounds are aware they are prone to central adiposity, and so are at increased risk of chronic weight-related conditions at a lower BMI. Explain these risks in an inclusive and non-stigmatising manner.

How should I manage a behavioural intervention with someone who is living with overweight or obesity?

• Discuss with the individual about any concerns or barriers that might impact their attendance and participation in the intervention. This includes discussing personal circumstances, cultural barriers, physical health needs, or any neurodevelopmental or psychological factors. It is important to consider how these issues might affect their ability to make changes and their progress toward achieving their goals. Repeat these discussions during the intervention if needed and acknowledge:
  • Progress the person has made.
  • Any positive or negative experiences with the intervention.
  • Any cultural and social context or assumptions about health and diet and the impact of deviating from these to improve health.
• If the person is facing difficulties with attendance and participation in the intervention.
  • Discuss whether the programme is suitable for them.
  • Agree on what should happen next (for example, referral to another service, leave the intervention at an agreed time, or think about re-referral at a later date).
• Discuss the importance of support from other members of their network, such as friends, family, and other participants in group interventions (if applicable). With their permission, discuss with relevant members.
• Regularly review the person’s health and progress that they have made towards meeting their goals.

What advice should I give on diet?

• Use a flexible and individualised approach to tailor dietary interventions to achieve nutritional balance while reducing energy intake. Take into account:
  • Food preferences (including cultural preferences).
  • Personal circumstances.
  • Comorbidities (such as eating disorders or disordered eating, type 1 diabetes, inflammatory bowel disease, or non-alcoholic fatty liver disease).
  • Restrictions in the range of foods they eat (for example, because of neurodiversity, sensory problems, or coeliac disease).
  • That in many cases weight regain may happen.
• Encourage people to improve their dietary intake, even if it does not result in them losing weight, as there may be other health benefits (for example, improved lipid profile and reduced risk of other comorbidities).
• Ensure that dietary approaches for adults to support overweight and obesity management keep the person's total energy intake below their energy expenditure (also called an energy deficit or calorie deficit). This could be done by lowering specific macronutrient content (for example, low-fat or low-carbohydrate diets) or using other methods to limit overall energy intake.
• Ensure that dietary approaches that maintain an energy deficit are offered with support by an appropriately trained healthcare professional and follow up to help maintain weight loss.
• Encourage people to eat a nutritionally balanced diet long term. See the NHS Eat well guide for more information. 
• Advise people not to use restrictive diets that are nutritionally unbalanced, as they are ineffective in the long term and can be harmful.

Low-energy and very-low-energy diets for adults

• Consider low-energy diets (800–1200 kilocalories per day, also known as low-calorie diets) only as part of a multicomponent overweight and obesity management strategy with long-term support within a specialist overweight and obesity management service (or other services for the management of long-term conditions such as type 2 diabetes) for people:
  • Living with obesity (with or without diabetes).
  • Living with overweight and type 2 diabetes.
• Consider very-low-energy diets (800 kilocalories per day) only as part of a multicomponent strategy within a specialist overweight and obesity management service, for people who are both living with obesity and have a clinically assessed need to lose weight rapidly (for example, to make surgery safer).
• Do not use these diets as a long-term strategy.
• Ensure that these diets:
  • Are nutritionally complete.
  • Last no more than 12 weeks.
  • Include ongoing clinical support and supervision, with access to support from an appropriately trained professional, and advice on reintroducing a wider range of foods.
• Before starting someone on a low-energy or very-low-energy diet as part of a multicomponent overweight and obesity management strategy:
  • Explain that this is a restrictive diet with a specific health goal (such as improvement in diabetes) and risks (such as weight cycling, weight regain and potential adverse events, and for very-low-energy diets, also the risk of constipation, fatigue and hair loss).
  • Explain that this is not a long-term overweight and obesity management strategy in its own right, as it must be followed by lifelong dietary energy intake control and appropriate physical activity levels.
• Discuss:
  • Weight gain is likely to happen, and if it does it does not mean failure.
  • Reintroducing a wider range of foods after the diet.
  • The options for long-term weight loss maintenance support or therapies.
• Offer assessment and counselling if the person has eating disorders or other mental health issues, to ensure the diet is appropriate.
• Review any medication they are taking and discuss any changed that may need to be made. 

What advice should I give on physical activity?

• Encourage adults to increase their physical activity, even if they do not lose weight as a result, due to the other health benefits it can bring. Encourage them to meet the recommendations in the UK Chief Medical Officers’ physical activity guidelines for weekly activity:
  • Each week, adults should accumulate at least 150 minutes (2 1/2 hours) of moderate intensity activity (such as brisk walking or cycling); or 75 minutes of vigorous intensity activity (such as running); or even shorter durations of very vigorous intensity activity (such as sprinting or stair climbing); or a combination of moderate, vigorous and very vigorous intensity activity.
• To prevent obesity, most people may need to do 45–60 minutes of moderate-intensity physical activity a day, particularly if they do not reduce their energy intake. Advise people who have lived with obesity and have lost weight that they may need to do 60–90 minutes of activity a day to avoid regaining weight. 
• Encourage people to build up to the recommended activity levels for weight maintenance, using a managed approach with agreed goals. Recommend:
  • Activities as part of daily life, such as walking, gardening, or cycling.
  • Supervised exercise programmes.
  • Other activities such as swimming, walking step targets, or stair climbing.
• Consider the person's current physical fitness and ability when recommending activities.
• Encourage people to reduce the amount of time they spend inactive.

What do I need to know about drug treatment for people who are living with overweight or obesity?

• After dietary, exercise and behavioural approaches have been started and evaluated in adults living with overweight or obesity, consider a weight management medicine. For more information, see the section on prescribing information.
  • Liraglutide (Saxenda®) is indicated for adults with an initial BMI of 35 kg/m² or more and non-diabetic hyperglycaemia and a high risk of cardiovascular disease.
    • Liraglutide is prescribed in secondary care by a specialist overweight and obesity management service.
  • Semaglutide (Wegovy®) is indicated for adults with at least 1 weight-related comorbidity and an initial BMI of 35 kg/m² or more, or an initial BMI of 30–34.9 kg/m² and who meet the criteria for referral to specialist overweight and obesity management services.
    • Semaglutide is prescribed in a specialist overweight and obesity management service.
  • Tirzepatide (Mounjaro®) is indicated for adults with an initial BMI of at least 35 kg/m² and at least 1 weight-related comorbidity.
    • Tirzepatide is prescribed in primary care or a specialist overweight and obesity management service.
    • If less than 5% of the initial weight has been lost after 6 months on the highest tolerated dose, decide whether to continue treatment, taking into account the benefits and risks of treatment for the person.
  • Orlistat is indicated for adults with a BMI of 30 kg/m² or more, or a BMI of 28 kg/m² or more and associated risk factors.
    • Orlistat is prescribed in all settings and is available at a lower dose in pharmacies.
    • Stop after 12 weeks if at least 5% of the initial body weight has not been lost.
• All medicines for weight management should be used alongside a reduced-calorie diet and increased physical activity.
• Make the decision to start medicines after discussing them with the person, and discussing the potential impact on their motivation. Arrange information, support and counselling on additional diet, physical activity and behavioural strategies when medicines are prescribed, and give information on patient support programmes.

Continued prescribing and withdrawal for adults

• If there is concern about micronutrient intake adequacy, consider a supplement providing the reference nutrient intake for all vitamins and minerals, particularly for older people (who may be at risk of malnutrition) and young people (who need vitamins and minerals for growth and development). 
• Offer support to help maintain weight loss to people who are stopping weight management medicines.

Monitoring weight management medicines

• Monitor the effect of medicines and reinforce behavioural advice and adherence through regular review.
• When agreeing goals with someone with type 2 diabetes, take into account that their weight loss may be slower than that of people without the condition. Review their goals regularly.

What do I need to know about bariatric surgery?

• Offer adults a referral for a comprehensive assessment by specialist weight management services providing multidisciplinary obesity management to see whether bariatric surgery is suitable for them if:
  • The person has a body mass index (BMI) of 40 kg/m² or more, or between 35–40 kg/m² with a significant health condition that could be improved if they lost weight (for example type 2 diabetes, hypertension, or severe mobility problems).
  • The person agrees to the necessary long-term follow-up after surgery (for example, life-long reviews).
• Consider referral for people of South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family background using a lower BMI threshold (reduced by 2.5 kg/m²).
  
  • This accounts for the fact that these groups are prone to central adiposity and their cardiometabolic risk occurs at a lower BMI.
• For people with recent-onset type 2 diabetes (diagnosed within a 10-year time frame):
  • Offer an expedited assessment for people with a BMI of 35 kg/m² or more as long as they are receiving, or will receive, assessment in a specialist weight management service.
  • Consider an expedited assessment for people with a BMI of 30–34.9 kg/m² if they are also receiving, or will receive, assessment in a specialist weight management service. 
  • Consider an expedited assessment for people of South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family backgrounds with recent-onset type 2 diabetes using a lower BMI threshold (reduced by 2.5 kg/m²), as these groups are prone to central adiposity and their cardiometabolic risk occurs at a lower BMI.

When should I consider referring people who are living with overweight or obesity?

Discussing results

• Give adults information about the severity of their overweight or obesity and central adiposity and the impact this has on their risk of developing other long-term conditions (such as type 2 diabetes, cardiovascular disease, hypertension, dyslipidaemia, certain cancers; and respiratory, musculoskeletal, and other metabolic conditions such as non-alcoholic fatty liver disease).
• Offer advice and discuss the possibility of referral to an overweight and obesity management service with the person, taking into account their individual needs and preferences.
• Address the causes of overweight and obesity if possible.
• Discuss and agree on realistic, personalised health goals. Include the importance and wider benefits of making sustainable, long-term changes to dietary behaviours and increasing physical activity levels.

Referring to specialist services

• Offer a higher level of intervention to people with weight-related comorbidities. Adjust the approach depending on the person's clinical needs, for example, for people with a BMI over 35 kg/m² who have recently developed diabetes, or for people with a BMI of 50kg/m² or over. 
• Consider referral to specialist services if:
  • The underlying causes of overweight or obesity need to be assessed.
  • The person has complex disease states or needs that cannot be managed adequately in behavioural overweight and obesity management services (for example, the extra support needs of people with learning disabilities).
  • Less intensive management has been unsuccessful.
  • Specialist interventions (such as a very-low-calorie diet) may be needed.
  • Surgery or certain medicines are being considered.
• If the person declines a referral to an intervention:
  • Acknowledge and respect their choice.
  • Either explore the reason sensitively or delay discussion until an appropriate time.
  • Ensure they have the opportunity to discuss referral again in the future.
  • Give information about other ways to make sustainable changes to their dietary behaviours and physical activity levels.
  • Give the opportunity for re-referral, as needed.

Dose

• Prescribe 120 mg to be taken with each of the three main meals per day. 
  • It can be taken immediately before, during, or up to 1 hour after a meal.
• Orlistat should not be prescribed to children.

[EMC, 2023]

What are the contraindications and cautions for orlistat?

• Do not prescribe orlistat to:
  • People with chronic malabsorption syndrome or cholestasis — dietary absorption of fat is already impaired in these people.
  • Breastfeeding women — it is not known whether orlistat is secreted into human milk.
• Prescribe orlistat with caution to people with:
  • Chronic kidney disease () and/or volume depletion — the use of orlistat may be associated with hyperoxaluria and oxalate nephropathy leading sometimes to renal failure. This risk is increased in people with underlying CKD and/or volume depletion.

[EMC, 2023]

What adverse effects are associated with orlistat?

• Very common and common adverse effects include:
  • Gastrointestinal adverse effects, for example, oily spotting, abdominal discomfort, abdominal pain, flatulence, faecal urgency, faecal incontinence, and fatty stools. These usually reduce with continued use of orlistat and can often be reduced by limiting fat intake.
  • Headache.
  • Respiratory infections.
  • Urinary tract infection.
  • Hypoglycaemia.
  • Anxiety.
  • Gingival and tooth disorders.
  • Fatigue.
  • Menstrual disturbances.
• Absorption of fat-soluble vitamins (A, D, E, K, and beta-carotene) may be impaired in people taking orlistat. However, in most people levels remain within the normal range.
  • Advise people to have a diet that is rich in fruit and vegetables and consider the use of a multivitamin supplement.
  • Multivitamin supplements should be taken at least 2 hours after taking orlistat.
• Very rarely (less than 1/10,000) hepatitis and cholelithiasis have been reported [MHRA, 2014].
  • The European Medicines Agency (EMA) reviewed the safety of orlistat following concerns about the possible risk of hepatic injury and concluded that the benefits of orlistat outweigh the risks [EMA, 2012].
  • Advise the person to stop taking orlistat and seek medical assistance if they develop symptoms of hepatitis (yellowing skin and eyes, itching, dark-coloured urine, stomach pain, and liver tenderness).
• Bullous eruptions, diverticulitis, hypothyroidism, oxalate nephropathy, cholelithiasis, hepatitis, and rectal bleeding may also occur, but the frequency is unknown.

[EMC, 2023; BNF, 2025]

What key drug interactions are associated with orlistat?

• Drug interactions associated with orlistat include:
  • Ciclosporin — a decrease in ciclosporin plasma levels has been observed and reported in several cases when orlistat was administered concomitantly. This can lead to a decrease in immunosuppressive efficacy.
  • Acarbose — in the absence of pharmacokinetic interaction studies, the concomitant administration of orlistat with acarbose should be avoided.
  • Oral anticoagulants — when warfarin or other anticoagulants are given in combination with orlistat, international normalised ratio (INR) values should be monitored. 
  • Fat soluble vitamins — may potentially impair the absorption of fat-soluble vitamins (A, D, E, and K).
  • Amiodarone — a slight decrease in plasma levels of amiodarone, when given as a single dose, has been observed in a limited number of healthy volunteers who received orlistat concomitantly. The clinical relevance of this is unknown, but may become clinically relevant in some cases. In patients receiving concomitant amiodarone treatment, reinforcement of clinical and ECG monitoring is warranted.
  • Antiepileptic drugs — convulsions have been reported in patients treated concomitantly with orlistat and antiepileptic drugs (for example, valproate and lamotrigine).

[EMC, 2023]

Pregnancy and breastfeeding

• Orlistat is not recommended during pregnancy.
• The manufacturer advises that, as it is not known whether orlistat is secreted into human milk, orlistat is contra-indicated during breastfeeding.

[EMC, 2023]

Dose

• Tirzepatide is administered via subcutaneous injection.
• The standard dose escalation scale for tirzepatide is:
  • Weeks 1–4 — 2.5 mg once weekly.
  • Weeks 5–8 — 5 mg once weekly.
  • Weeks 9–12 — 7.5 mg once weekly.
  • Weeks 13–16 — 10 mg once weekly.
  • Weeks 17–20 — 12.5 mg once weekly.
  • Weeks 21–24 — 15 mg once weekly.

[NICE, 2024a; EMC, 2025]

Contraindications and cautions

• Do not prescribe tirzepatide to people with:
  • Hypersensitivity to the active substance.
  • Hypersensitivity to any of the following:
    • Sodium phosphate dibasic heptahydrate.
    • Sodium chloride.
    • Concentrated hydrochloric acid, and sodium hydroxide (for pH adjustment).
    • Glycerol.
    • Phenol.
    • Benzyl Alcohol.
    • Water for injections.
• Prescribe tirzepatide with caution to people with:
  • Acute pancreatitis.
  • Hypoglycaemia in patients with type 2 diabetes mellitus.
  • Severe gastrointestinal disease.
  • Diabetic retinopathy.
  • Aspiration in association with general anaesthesia or deep sedation.
  • Old age (over 85 years).

[NICE, 2024a; EMC, 2025]

Adverse effects

• Immune system — hypersensitivity reactions (common); anaphylactic reaction and angioedema (rare)
• Metabolism and nutrition disorders —hypoglycaemia when used with sulphonyl ureas or insulin (very common) and hypoglycaemia when used with metformin and SGLT2 inhibitors. 
• Nervous system disorders — dizziness (common) and dysgeusia (uncommon).
• Vascular disorders — hypotension-related events (common).
• Gastrointestinal disorders — nausea, diarrhoea, vomiting, constipation, and abdominal pain (very common); dyspepsia, flatulence, gastroesophageal reflux disease, cholelithiasis, acute pancreatitis, and cholecystitis (uncommon).
• Skin and subcutaneous tissue disorders — hair loss (common).
• General disorders and administration site conditions — fatigue and injection site reactions (common) and injection site pain (uncommon).
• Investigations — blood calcitonin increased, lipase increased, and amylase increased (common).

[EMC, 2025]

Drug interactions

• Drug interactions for tirzepatide include:
  • Paracetamol —  the effect on the absorption of paracetamol is dose and time-dependent. At low doses, only a minor change in paracetamol exposure is seen. After 4 weekly doses, no effect on paracetamol absorption is seen.
  • Oral contraceptives — there is limited information about the effect of tirzepatide on the pharmacokinetics and efficacy of oral contraceptives in women living with obesity or overweight. Since reduced efficacy of oral contraceptives cannot be excluded, it is advised to switch to a non-oral contraceptive method, or add a barrier method of contraception upon initiating tirzepatide therapy (for 4 weeks), or after each dose escalation (for 4 weeks).

[EMC, 2025]

Pregnancy

Pregnancy

• There are no, or a limited amount of, data on the use of tirzepatide in pregnant women.
• If a patient wishes to become pregnant, tirzepatide should be discontinued at least 1 month before a planned pregnancy due to the long half-life of tirzepatide. Tirzepatide should not be used during pregnancy.

Breastfeeding

• It is unknown whether tirzepatide is excreted in human milk. A risk to the newborn/infant cannot be excluded.
• A decision must be made whether to discontinue breastfeeding or to discontinue/abstain from tirzepatide therapy, taking into account the benefit of breastfeeding for the child and the benefit of therapy for the woman.

[EMC, 2025]