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Another popular weight-loss drug is in short supply.

Doses of tirzepatide (Zepbound) are few and far between, experts told MedPage Today, and the injectable had not been listed on the FDA as of Tuesday. Since the publication of this story, however, the FDA has added Zepbound to the list.

Another version of tirzepatide, for type 2 diabetes (Mounjaro), has been on the FDA shortage list since December 2022.

As prescriptions for the glucagon-like peptide-1 (GLP-1) agonist go unfilled, patients are having pandemic flashbacks, according to one physician.

Jody Dushay, MD, of Beth Israel Deaconess Medical Center in Boston, told MedPage Today that one of her patients picked up a refill for a GLP-1 agonist and joked that "she felt like she was buying toilet paper during COVID; she's going to take it home on the T [train] and she feels like she has to extra protect it."

"There is no Zepbound available and [it is] out of stock. Patients have been frantic and it has been chaotic," Gitanjali Srivastava, MD, of Vanderbilt University Medical Center in Nashville, Tennessee, told MedPage Today in an email. "It has to do with supply and demand and the manufacturers have quite underestimated the demand/supply chain issue."

Dushay said she suspected the shortage was due partially to insurance coverage expanding to include Zepbound after it hit the U.S. market in . "At first, there wasn't much insurance coverage, and then -- it's almost been week to week -- additional insurance companies were approving it," she said. "I'm getting a lot of approvals, way more approvals than denials, I would say, over the past month, and even approximately over the past couple of weeks."

Dushay noted that all drugs in this class, including the blockbuster semaglutide (Ozempic, Wegovy), have ultimately proven difficult to access amidst continuing intermittent shortages. She also cautioned that the situation may get worse if a for tirzepatide is approved. "If there are data with tirzepatide that show CV benefit, similar to what they found in Wegovy ... I think the shortages will accelerate," Dushay said.

Ethan Melillo, PharmD, a senior manager of integrated health at L'Oreal who previously worked as a diabetes pharmacist, said he believes patients switching from Wegovy to Zepbound are driving up demand and straining supply.

"There's more weight loss with Zepbound, so that's why a lot of people are switching, and that's why you probably saw the same thing with Mounjaro," Melillo told MedPage Today. "Just because people are noticing the greater weight loss, but it makes sense because [of] the mechanism of action -- how it doesn't work just on GLP-1 but also works on GIP [glucose-dependent insulinotropic polypeptide] as well."

Dushay noted that because of "spotty" shortages for the various , patients have asked her if they can skip a dose. For example, going from 2.5 mg to 7.5 mg, and bypassing the recommended 5-mg dose. More often she may take them down a dose, for example, from 10-mg injections to 7.5 mg, Dushay said.

An Eli Lilly company spokesperson told MedPage Today in an email that "[w]hile Lilly continues to manufacture and ship all doses of Zepbound, due to the unprecedented demand for these medicines, some patients may experience difficulty when trying to fill their prescription at their pharmacy. We recognize this situation may cause a disruption in people's treatment regimens. ...We are in regular contact with the FDA to provide updates on supply, and they will follow their process to update the Drug Shortages Database."

The FDA did not respond to MedPage Today's requests for comment as of press time.

Srivastava pointed out that "given that greater than , these ... medications are more like aspirin or statins, given their benefits in [cardiovascular] disease and other medical conditions, coupled with high efficacy compared to ."

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