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HealthRX.com · Printable lab tracker

Liver disease on Zepbound: liver test, dose and symptom record

Record your liver diagnosis and starting liver tests, then log each repeat result with your Zepbound dose and any days of vomiting or poor intake. Gallbladder and pancreas warning signs from the label are printed alongside, because both need a prompt call.

Companion to “Zepbound for Fatty Liver: Dosing in Hepatic Impairment” · healthrx.com/zepbound/hepatic-impairment · Facts checked 2026-10-19

Your liver diagnosis

Diagnosisfor example MASLD, MASH, cirrhosis, viral or alcohol-related liver disease
Child-Pugh class, if your clinician has given one
Latest fibrosis assessment: test, result and datebiopsy stage, elastography or a blood-based score
Ascites, varices or past encephalopathy?
Hepatologist or liver clinic contact

Liver tests and doses

DateZepbound dose (mg)ALTASTBilirubinAlbuminINRWeightDays of vomiting or poor intake since last test

What the label and the studies show

  • The Zepbound label recommends no dose adjustment for hepatic impairment.[1]
  • After one 5 mg dose, tirzepatide levels were similar in 6 people with mild, 6 with moderate and 7 with severe liver impairment compared with 13 with normal liver function.[2]
  • SYNERGY-NASH (phase 2, 52 weeks, MASH with F2 or F3 fibrosis): MASH resolved without worse fibrosis in 44% to 62% on tirzepatide 5 to 15 mg, against 10% on placebo.[3]
  • In the label's weight trials, gallstones were reported in 1.1% on Zepbound and 1% on placebo, and gallbladder inflammation in 0.7% and 0.2%.[1]
  • Diarrhea, nausea and vomiting can cause fluid loss that may lead to kidney problems.[1]

Call promptly

  • Pain in the upper stomach, fever, yellowing of the skin or eyes, or clay-colored stools (possible gallbladder problem): tell your healthcare provider right away.[1]
  • Severe stomach pain 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]

For the prescriber or hepatologist

  1. Which liver tests should be repeated, and how often, while my dose is going up?
  2. With my stage of liver disease, should the time between dose increases be longer?
  3. If I have ascites, where should I inject?
  4. What should I do if vomiting or poor intake lasts more than a day?
  5. Which result would make us pause or change the plan?
Sources for the facts on this sheet
  1. 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
  2. Urva S, Quinlan T, Landry J, et al. Effects of Hepatic Impairment on the Pharmacokinetics of the Dual GIP and GLP-1 Receptor Agonist Tirzepatide. Clin Pharmacokinet 2022. PMID 35674880. https://pubmed.ncbi.nlm.nih.gov/35674880/
  3. Loomba R, Hartman ML, Lawitz EJ, et al. Tirzepatide for Metabolic Dysfunction-Associated Steatohepatitis with Liver Fibrosis. N Engl J Med 2024. PMID 38856224. https://pubmed.ncbi.nlm.nih.gov/38856224/

This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.