Wegovy, Zepbound, Saxenda, Qsymia and pregnancy or breastfeeding: what the labels say

This is one of the questions I see asked most often and answered worst. So I did the boring thing: I read the FDA label for all seven approved weight loss drugs and pulled out exactly what each one says about pregnancy, breastfeeding and contraception.

Nothing below is my interpretation. Every statement is what the manufacturer’s own FDA-approved prescribing information says, with the label revision date attached, and links to each one in the sources at the bottom. Labels are the most conservative and most binding statements that exist about a drug — they are what the FDA has agreed the company may claim.

One thing this guide is not: advice about your own situation. If any of this applies to you, the conversation belongs with your prescriber, who can see the rest of your history. This is here so you can walk into that conversation knowing what the paperwork actually says.

The sentence almost every label shares

Read the pregnancy sections back to back and one line keeps reappearing, nearly word for word. Zepbound’s label (revised 8/2026) puts it as: “Weight loss offers no benefit to a pregnant patient and may cause fetal harm. Advise pregnant patients that weight loss is not recommended during pregnancy and to discontinue ZEPBOUND when a pregnancy is recognized.”

Foundayo (revised 7/2026) says: “Weight loss offers no benefit to a pregnant patient and may cause fetal harm. When a pregnancy is recognized, advise the pregnant patient of the risk to a fetus and discontinue FOUNDAYO.” Contrave (revised 11/2025) opens its risk summary with the same first sentence. Saxenda (revised 6/2026) uses it too, and adds that the drug “should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus”.

The logic behind the shared wording is stated plainly by the labels themselves: these drugs are approved to cause weight loss, and pregnancy is a state in which weight gain is expected. Xenical’s label (revised 7/2024) spells it out — “A minimum weight gain, and no weight loss, is currently recommended for all pregnant women, including those who are already overweight or obese, due to the obligatory weight gain that occurs in maternal tissues during pregnancy.”

Wegovy: the two-month rule, and a split on breastfeeding

Wegovy (semaglutide) is the only one of the seven with a stated waiting period before a planned pregnancy. Section 8.3 says: “Because of the potential for fetal harm, discontinue WEGOVY in patients at least 2 months before they plan to become pregnant to account for the long half-life of semaglutide.” That is a pharmacology point, not a caution about the pregnancy itself — semaglutide stays in the body a long time after the last dose.

On pregnancy, section 8.1 says: “When a pregnancy is recognized, advise the pregnant patient of the risk to a fetus. Discontinue WEGOVY in pregnant patients who are using it for weight reduction.” The label also notes a pregnancy exposure registry that “monitors pregnancy outcomes in women exposed to WEGOVY during pregnancy”, run by Novo Nordisk.

Breastfeeding is where the injection and the pill part company, and it is worth knowing because the two are often discussed as one drug. For the tablets, the label says: “advise patients that breastfeeding is not recommended during treatment with WEGOVY tablets.” The reason given is the absorption enhancer in the tablet, SNAC, and the possibility of accumulation in infants. For the injection, the label simply records an absence of data — “There are no data on the presence of subcutaneously administered semaglutide or its metabolites in human milk” — and notes that it “does not contain the SNAC metabolites”. The section then closes, for both formulations, with the standard formula: benefits of breastfeeding weighed against “the mother’s clinical need for WEGOVY”. If you are weighing the pill against the injection, this is a real difference between them.

Zepbound: the birth control interaction

Zepbound (tirzepatide) carries the contraception point that surprises people most. Section 8.3 states: “Use of ZEPBOUND may reduce the efficacy of oral hormonal contraceptives due to delayed gastric emptying. This delay is largest after the first dose and diminishes over time. Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after initiation with ZEPBOUND and for 4 weeks after each dose escalation.”

Section 7.2 adds the reassuring half of that: “Hormonal contraceptives that are not administered orally should not be affected.” So the concern is specifically the pill, and specifically in the weeks after starting and after each dose increase — which, on a standard titration, is a lot of weeks.

On lactation, the Zepbound label reports a measurement rather than a blanket statement: “In a single-dose clinical lactation study, the concentration of tirzepatide in breast milk was found to be either undetectable or low compared to the maternal administered dose.” It then applies the usual benefits-versus-need framing. Lilly also runs a pregnancy exposure registry for the drug.

Foundayo: 30 days, and a clear line on nursing

Foundayo (orforglipron) gives the same contraceptive advice as Zepbound but with a longer window and an honest caveat about why. Section 8.3: “The effect of FOUNDAYO on the absorption of oral contraceptives has not been evaluated in a clinical trial. Because delayed gastric emptying may affect the absorption of oral medications, advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method, or add a barrier method of contraception for 30 days after initiation with FOUNDAYO and for 30 days after each dose escalation.” The same section advises “women of childbearing potential to use effective contraception during treatment”.

On breastfeeding, Foundayo is more direct than the injectables: “FOUNDAYO is not recommended for nursing women.” The label explains that orforglipron “was present in the milk of lactating rats” and that “when a drug is present in animal milk, it is likely that the drug will be present in human milk”.

Saxenda: the older label, the older format

Saxenda (liraglutide) has no section 8.3 at all, so there is no washout period and no contraceptive advice anywhere in the label. Section 8.1 says the drug “should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus” and that “when a pregnancy is recognized, advise the pregnant patient of the risk to a fetus, and discontinue SAXENDA”.

Lactation is a blank: “There are no data on the presence of liraglutide in human milk, the effects on the breastfed infant, or effects on milk production.” The label notes that in rats, liraglutide appeared in milk at roughly half the concentration found in maternal plasma.

Qsymia: the strictest label of the seven

Qsymia (phentermine/topiramate) is in a different category. Its section 4 lists patients “who are pregnant” first among the contraindications — not a caution, an outright bar.

Section 5.1 explains why: “QSYMIA can cause fetal harm. Data from pregnancy registries and epidemiologic studies indicate that a fetus exposed to topiramate in the first trimester of pregnancy has an increased risk of major congenital malformations, including but not limited to cleft lip and/or cleft palate (oral clefts), and of being small for gestational age (SGA).” It goes on: “A negative pregnancy test is recommended before initiating QSYMIA treatment in patients who can become pregnant and monthly during QSYMIA therapy.” Section 8.3 repeats the monthly testing point and advises effective contraception throughout.

That risk also drives how the drug is distributed. The label states: “Because of the teratogenic risk associated with QSYMIA therapy, QSYMIA is available through a limited program under the REMS. Under the QSYMIA REMS, only certified pharmacies may distribute QSYMIA.” A REMS is a Risk Evaluation and Mitigation Strategy — an FDA-mandated safety programme that restricts how a drug reaches patients. Of the seven approved drugs, this is the only one with one attached for pregnancy risk.

On breastfeeding, the label says to “advise patients that breastfeeding is not recommended during QSYMIA therapy”. And on birth control specifically, the label notes that in patients taking combined oral contraceptives, Qsymia “may cause irregular bleeding”, adding: “Advise patients not to discontinue taking their COC and to contact their health care provider.” Spotting is not a sign the contraceptive has stopped working. There is more on that in the Qsymia interactions page.

Contrave and orlistat

Contrave (naltrexone/bupropion) follows the standard formula on pregnancy — discontinue when a pregnancy is recognised — and notes that available data with its individual components “have not demonstrated a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes”. On lactation, the label is specific: “Data from published literature report the presence of bupropion and its metabolites in human milk”, and “Naltrexone and its major metabolite, 6β-naltrexol, are present in human milk.” It then applies the benefits-versus-need framing. There is no section 8.3.

Orlistat exists in two forms with two labels. Prescription Xenical is “contraindicated in: Pregnancy”, and on nursing says: “It is not known if XENICAL is present in human milk. Caution should be exercised when XENICAL is administered to a nursing woman.” The over-the-counter version, Alli 60 mg (label updated 18 March 2026), reduces the whole question to a single line in its Drug Facts warnings: “If pregnant or breast-feeding, do not use.”

If any of this is live for you, the useful next move is a conversation, not more reading — the labels are written for prescribers and they stop short of telling anyone what to do. Our page on talking to your doctor has questions worth bringing, and the page on stopping treatment covers what the trial data shows about coming off these drugs.