HealthRX.com · Printable dose-error record
Zepbound dose-error call record
Fill this in while you call Poison Help or the prescribing team: the exact product and device, every possible dose with its time, the medicines and conditions that change the risk, symptoms as they happen, and the advice you were given. Keep it with the pen or vial until the situation is resolved.
The product, the device and the person
Read these from the box or pen label rather than from memory.
Product name and strength printed on the label
Devicesingle-dose pen, single-dose vial, multi-dose vial or KwikPen
Usual dose and usual injection day
Who took it, and their approximate weight
Lot number, if the caller asks
Every possible dose since the last confirmed routine dose
Include the routine dose before the error, so the gap between doses is clear.
| Date | Time | Dose or strength | What happened (complete, leak, unsure, second attempt) | Who gave it |
|---|---|---|---|---|
Tell the caller if any of these apply
- Uses insulin
- Uses a sulfonylurea or another medicine that raises insulin
- Has kidney disease
- Takes a diuretic or has been told to limit fluids
- Is pregnant or could be pregnant
- Has taken other medicines, alcohol or other substances today
- Is already vomiting, has diarrhea or cannot keep fluids down
Symptoms and glucose readings after the error
| Time | Symptom or glucose reading | Better, same or worse | Who you told |
|---|---|---|---|
What the label says
- For an overdose, contact the Poison Help Line (1-800-222-1222) or a medical toxicologist.[1]
- Treatment is supportive and follows the person's signs and symptoms.[1]
- Observation and treatment may be needed for a period, because tirzepatide's half-life is about 5 days.[1]
- Two doses should not be taken within 3 days (72 hours) of each other.[1]
- Multi-dose vials and KwikPens each hold 4 doses, so record the dose that was drawn up or dialed.[1]
- Insulin or a sulfonylurea used with Zepbound can raise the risk of low blood sugar, including severe lows.[1]
Get urgent help now
- Problems breathing or swallowing, or swelling of the face, lips, tongue or throat.[1]
- Confusion, drowsiness or slurred speech in someone using insulin or a sulfonylurea (possible low blood sugar): follow their emergency glucose plan and get help now.[1]
- Abdominal pain that is severe or will not ease, sometimes reaching through to the back, with or without vomiting.[1]
After the call
Time of the call and who you spoke to
Advice given
When to call back, or what would change the plan
Next scheduled dose, and who decides whether it is held or changed
Pen or vial kept until this is resolved?yes / no
Preventing a repeat
- One named person confirms each weekly dose
- A calendar entry is made right after each injection
- The exact strength and device are written next to the schedule
- An uncertain injection is never repeated before speaking to a pharmacist or prescriber
- The current label's missed-dose instruction is written down
- Pens are never shared between people
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
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.