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Tirzepatide interaction with oral contraception — DFSRH MCQ

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EasyPharmacyTirzepatide interaction with oral contraceptionDFSRH

A 36-year-old woman with obesity uses a levonorgestrel-containing combined oral contraceptive consistently. She has been receiving subcutaneous semaglutide but is due to switch to tirzepatide for weight management. The planned regimen is tirzepatide 2.5 mg once weekly for 4 weeks, then 5 mg once weekly for 4 weeks, followed by 7.5 mg once weekly as maintenance. She has no vomiting or diarrhoea. She declines switching contraceptive method but is willing to use condoms temporarily. Pregnancy is reasonably excluded. Which is the most appropriate contraceptive advice?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Use condoms continuously from the first tirzepatide dose until 4 weeks after the final planned dose increase

Explanation lettering: D = shown as A · E = shown as C · C = shown as D · A = shown as E

Tirzepatide delays gastric emptying and has reduced the exposure and peak concentrations of oral contraceptive components in pharmacokinetic studies. FSRH therefore advises users of oral contraception either to switch to a non-oral method or to add a barrier method for 4 weeks after tirzepatide initiation and for 4 weeks after every dose increase. Here, dose escalation occurs at 4-week intervals. Each new 4-week precaution period starts as the preceding period ends, so condom use should be uninterrupted from the first injection until 4 weeks after the increase to 7.5 mg. A is incorrect because the absence of an additional-precaution requirement with semaglutide does not extend to tirzepatide. B applies an inadequate 7-day interval, likely extrapolated from rules for initiating combined hormonal contraception. C accounts for initiation but overlooks the renewed precaution period after each escalation. D recognises that precautions must cover the escalation phase but stops them when the final dose is introduced, rather than 4 weeks afterwards. Vomiting and diarrhoea would require additional application of missed-pill guidance, but their absence does not remove the tirzepatide-specific recommendation. The supporting evidence is pharmacokinetic rather than based on observed pregnancy rates, but FSRH and the UK product information give concordant precautionary advice.

Reference: FSRH statement: Glucagon-like peptide-1 (GLP-1) agonists and oral contraception (January 2025) — https://www.fsrh.org/Common/Uploaded%20files/documents/CEU-statement-GLP-1-agonists-and-contraception.pdf Mounjaro KwikPen solution for injection in pre-filled pen — Summary of Product Characteristics (9 April 2026) — https://www.medicines.org.uk/emc/product/15482/smpc