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Zepbound ® (tirzepatide) injection
2.5 mg/ 5 mg/ 7.5 mg/ 10 mg/ 12.5 mg/ 15 mg
This information is provided in response to your request. Resources may contain information about doses, uses, formulations and populations different from product labeling. See Prescribing Information above, if applicable.
Is there a risk for nonarteritic anterior ischemic optic neuropathy (NAION) with Zepbound® (tirzepatide) treatment?
Eli Lilly and Company is aware of publications on the potential risk of nonarteritic anterior ischemic optic neuropathy (NAION) in patients prescribed semaglutide, tirzepatide, dulaglutide, or liraglutide and notes their findings.
See important safety information, including boxed warning, in the attached prescribing information.
Eli Lilly and Company is aware of publications on the potential risk of nonarteritic anterior ischemic optic neuropathy (NAION) in patients prescribed semaglutide, tirzepatide, dulaglutide, or liraglutide and notes their findings.1-23
This is not intended to be a full list of publications available on this topic. There have been numerous studies, commentaries, and other articles published on the topic, and additional literature is being published regularly. Publications on this topic in scientific literature may employ different research methodologies and may be subject to varying scientific rigor and interpretations. We encourage the prescribing healthcare provider to exercise clinical judgement to obtain and evaluate external literature for sound scientific merit, clinical relevance, and generalizability.
Patient safety is Lilly’s top priority, and we review safety data from clinical trials and postmarketing experience for all our medicines on an ongoing basis. Lilly will continue to monitor the tirzepatide development program for all indications to evaluate any new safety signals. If a potential new risk is identified for the product or the class, the local labeling will be assessed in consultation with regulatory authorities.
Enclosed Prescribing Information
ZEPBOUND® (tirzepatide) Injection, for subcutaneous use, Lilly
References
The published references below are available by contacting 1-800-LillyRx (1-800-545-5979).
- Hathaway JT, Shah MP, Hathaway DB, et al. Risk of nonarteritic anterior ischemic optic neuropathy in patients prescribed semaglutide. JAMA Ophthalmol. 2024;142(8):732-739. https://doi.org/10.1001/jamaophthalmol.2024.2296
- Chou CC, Pan SY, Sheen YJ, et al. Association between semaglutide and nonarteritic anterior ischemic optic neuropathy: a multinational population-based study. Ophthalmology. 2025;132(4):381-388. https://doi.org/10.1016/j.ophtha.2024.10.030
- Grauslund J, Taha AA, Molander LD, et al. Once-weekly semaglutide doubles the five-year risk of nonarteritic anterior ischemic optic neuropathy in a Danish cohort of 424,152 persons with type 2 diabetes. Int J Retina Vitreous. 2024;10(1):97. https://doi.org/10.1186/s40942-024-00620-x
- Klonoff DC, Hui G, Gombar S. Real-world evidence assessment of the risk of nonarteritic anterior ischemic optic neuropathy in patients prescribed semaglutide. J Diabetes Sci Technol. 2024;18(6):1517-1518. https://doi.org/10.1177/19322968241268050
- Katz BJ, Lee MS, Lincoff NS, et al. Ophthalmic complications associated with the antidiabetic drugs semaglutide and tirzepatide. JAMA Ophthalmol. 2025;143(3):215-220. https://doi.org/10.1001/jamaophthalmol.2024.6058
- Wang L, Volkow ND, Kaelber DC, and Xu R. Semaglutide or tirzepatide and optic nerve and visual pathway disorders in type 2 diabetes. JAMA Network Open. 2025;8;(8):e2526327. https://doi.org/10.1001/jamanetworkopen.2025.26327
- Cai CX, Hribar M, Baxter S, et al. Semaglutide and nonarteritic anterior ischemic optic neuropathy. JAMA Ophthalmol. 2025;143;(4):304-314. https://doi.org/10.1001/jamaophthalmol.2024.6555
- Goldenberg RM, Aronson R, Trinacty J. Glucagon-like peptide-1 receptor agonists and the risk of nonarteritic anterior ischaemic optic neuropathy: a systematic review and meta-analysis of observational studies. Diabetes Obes Metab. 2025:27(11):6753-6757. https://doi.org/10.1111/dom.70013
- Ramsey DJ, Makwana B, Dani SS, et al. GLP-1 receptor agonists and sight-threatening ophthalmic complications in patients with type 2 diabetes. JAMA Network Open. 2025;8;(8):e2526321. https://doi.org/10.1001/jamanetworkopen.2025.26321
- Lakhani M, Kwan ATH, Mihalache A, et al. Association of glucagon-like peptide-1 receptor agonists with optic nerve and retinal adverse events: a population-based observational study across 180 countries. Am J Ophthalmol. 2025:277;148-168. https://doi.org/10.1016/j.ajo.2025.05.007
- Abbass NJ, Nahlawi R, Shaia JK, et al. The effect of semaglutide and GLP-1 RAs on risk of non-arteritic anterior ischemic optic neuropathy. Am J Ophthalmol. 2025;274:24-31. https://doi.org/10.1016/j.ajo.2025.02.025
- Lieberman RA, Korona-Bailey J, Banaag A, et al. Semaglutide decreases risk of non-arteritic anterior ischemic optic neuropathy in type 2 diabetic patients. Mil Med. 2026;191(5-6):e1020-e1025. https://doi.org/10.1093/milmed/usaf522
- Nagdeve P, Griffin R. GLP-1RA exposure and nonarteritic anterior ischemic optic neuropathy prevalence by diabetes status. JAMA Ophthalmol. 2025;143(9):792-795. https://doi.org/10.1001/jamaophthalmol.2025.2332
- Tesfaye H, Paik JM, Wexler DJ, et al. GLP-1RA and the risk of non-arteritic anterior ischaemic optic neuropathy in patients with type 2 diabetes: a population-based study. Diabetes Obes Metab. 2025;28(2):1517-1528. https://doi.org/10.1111/dom.70200
- Hong AT, Lin F, Keenan JD, Stewart JM. Ocular outcomes with tirzepatide versus glucagon-like peptide-1 receptor agonists in type 2 diabetes. Ophthalmol Retin. 2026;10(6):625-632. https://doi.org/10.1016/j.oret.2026.02.002
- Reynolds KR, O’Malley KM, Roy JA, Dave CV. Glucagon-like peptide-1 receptor agonists and risk for ischemic optic neuropathy. Ann Intern Med. 2026;179(9):1244-1253. https://doi.org/10.7326/annals-25-00860
- Abdelaal A, Serhan HA, Alsaadi M, et al. Semaglutide and the risk of nonarteritic ischemic optic neuropathy: a systematic review and certainty of evidence meta-analysis. Ophthalmology. 2026;133(6):799-810. https://doi.org/10.1016/j.ophtha.2026.02.013
- Vilsbøll T, Kumar DA, Aiello LP, et al. Non-arteritic anterior ischaemic optic neuropathy incidence in placebo-controlled clinical trials of liraglutide or semaglutide. Br J Ophthalmol. Published online April 28, 2026. https://doi.org/10.1136/bjo-2025-328729
- Danesh-Meyer HV, Rizzo JF. Is there a causal link between GLP-1 receptor agonists and non-arteritic anterior ischaemic optic neuropathy? A critique of the clinical evidence. Clin Exp Ophthalmol. 2026;54(4):554-564. https://doi.org/10.1111/ceo.70096
- DeParis SW, Oke I, Gaier ED, et al. Glucagon-like peptide-1 receptor agonists and the risk of non-arteritic anterior ischemic optic neuropathy a consensus statement by the North American neuro-ophthalmology society and the American academy of ophthalmology. Ophthalmology. 2026;133(8):1029-1035. https://doi.org/10.1016/j.ophtha.2026.04.008
- Sun H, Xin X, Yan J, Huang T. Comparative risk of nonarteritic anterior ischemic optic neuropathy among glucagon-like peptide-1 receptor agonists: an integrated safety and mechanistic analysis. Diabetes Obes Metab. Published online September 21, 2026. https://doi.org/10.1111/dom.71358
- Kupersmith MJ. Nonarteritic anterior ischemic optic neuropathy and glucagon-like peptide-1 agonist therapies: an important rare issue, lacking adequate data. Ophthalmology. Published online September 18, 2026. https://doi.org/10.1016/j.ophtha.2026.08.024
- Grossman SN, Biousse V, Newman NJ. GLP-1 receptor agonists and NAION: a risk worth taking? Neurology. 2026;106:e218088. https://doi.org/10.1212/wnl.0000000000218088
Date of Last Review: September 29, 2026