What it is
Tirzepatide is a lab-made short chain of amino acids (a peptide). It copies two gut hormones at once, called GIP and GLP-1. The body releases both after a meal. Both tell the pancreas to make insulin. GLP-1 also slows the stomach and lowers hunger.
A similar drug, semaglutide, copies only GLP-1. Tirzepatide copies both. This seems to be why it led to more weight loss when the two drugs were compared directly.
Eli Lilly sells it under two names. Mounjaro is for type 2 diabetes. Zepbound is for weight control and sleep apnoea (breathing that stops and starts during sleep). Both boxes hold the same drug. It is a shot given once a week.
Tirzepatide is a 39-residue synthetic peptide built on the GIP backbone, with Aib substitutions at positions 2 and 13 for DPP-4 resistance and a C20 fatty diacid on Lys20 via a γGlu-2xOEG linker for albumin binding. It is a full agonist at the GIP receptor and a biased partial agonist at the GLP-1 receptor, with lower β-arrestin recruitment than native GLP-1. Plasma half-life is about 5 days.
The pharmacological rationale is that GIP receptor agonism adds to GLP-1-driven weight loss through effects on adipose tissue insulin sensitivity and central appetite circuits, and may partly offset GLP-1 nausea. Whether the GIP component acts as an agonist or effectively as a desensitiser in vivo remains debated in the literature.
Who made it and when
Lilly scientists, including Tamer Coskun, designed it in the mid-2010s. Its code name was LY3298176. The first full report came out in 2018.
The FDA approved it for diabetes in May 2022. It approved it for weight control in November 2023. Sleep apnoea followed in December 2024. In December 2025, the diabetes approval grew to cover children 10 and older. In August 2026, Mounjaro was also approved to lower heart risk. Lilly holds the patents into the 2030s.
Coskun and colleagues reported the compound in Molecular Metabolism in 2018, describing its balanced GIP/GLP-1 receptor pharmacology and rodent efficacy. The core compound patent, US 9,474,780 (priority January 2015), is assigned to Eli Lilly. Approval history: Mounjaro (NDA 215866) 2022-05-13; Zepbound (NDA 217806) 2023-11-08; OSA indication 2024-12-20; Mounjaro pediatric type 2 diabetes (10 years and older, maximum 10 mg weekly) 2025-12-19; Mounjaro cardiovascular risk reduction in type 2 diabetes, based on SURPASS-CVOT, 2026-08-27. SURPASS-CVOT data were added to the Zepbound label on 2026-08-26 without a new Zepbound indication.
What the data say
People with obesity but no diabetes took part in one large study. On the highest dose, they lost about 21% of their body weight over 72 weeks. People on a dummy treatment (placebo) lost about 3%.
In a head-to-head study, tirzepatide beat semaglutide by about 6 percentage points of weight loss. In diabetes, it lowered blood sugar more than semaglutide 1 mg.
It also cut the number of sleep apnoea events. In people with obesity, it lowered heart failure problems. In one large study, it did about as well as dulaglutide, an older diabetes drug. That study looked at heart attacks, strokes and deaths from heart and blood vessel disease.
SURMOUNT-1 (n=2,539) reported placebo-adjusted weight change of −11.9 to −17.8 percentage points at 72 weeks. SURMOUNT-5 (n=751) reported −20.2% vs −13.7% for semaglutide at maximum tolerated dose, a treatment difference of −6.5 points. SURPASS-2 showed superior HbA1c and weight reduction vs semaglutide 1 mg at all three doses. SURMOUNT-OSA reported AHI reductions of about 25–29 events per hour. SUMMIT reported a hazard ratio of 0.62 for the composite of cardiovascular death or worsening heart failure in HFpEF with obesity. SURPASS-CVOT (n=13,299, median follow-up about 4 years) met non-inferiority vs dulaglutide on 3-point MACE with a hazard ratio of 0.92 (95.3% CI 0.83–1.01); superiority was not shown (Nicholls et al., NEJM 2025).
Regulatory picture
Tirzepatide is fully approved by the FDA under its two brand names. Copies made by anyone else are not approved.
There was a shortage from 2022 to 2024. During that time, special pharmacies (compounding pharmacies) could legally make copies. The FDA said the shortage was over in December 2024. It gave these pharmacies deadlines in February and March 2025 to stop.
Since then, the FDA has sent warning letters to sellers of “compounded” or “research” tirzepatide. In February 2026, it said it would take steps to limit the raw ingredient used in mass-marketed copies.
Tirzepatide is a component of FDA-approved products and is not on, and does not need to be on, the 503A bulk drug substances list. Compounding of essentially-copies is permitted only while the product is on the FDA drug shortage list. The FDA removed tirzepatide from the shortage list on 2024-10-02, re-evaluated after litigation by the Outsourcing Facilities Association, and confirmed the decision on 2024-12-19, with enforcement discretion ending 2025-02-18 (503A) and 2025-03-19 (503B). FDA confirmed in April 2026 that tirzepatide is on neither the shortage list nor the 503B bulks list. Personalised compounded formulations that differ materially from the approved product remain a contested area, and FDA’s February 2026 announcement signalled tighter control of GLP-1 active ingredients destined for non-approved compounded drugs.
