For kidney and liver function, the labels are mostly reassuring on dosing, with one clear exception. Ozempic, Mounjaro and Zepbound state that no dose adjustment is recommended for renal or hepatic impairment, and Foundayo recommends no dosage modification for renal impairment. Foundayo, however, is not recommended in severe hepatic impairment (Child-Pugh Class C), where the label reports orforglipron exposure (AUC) up to 4.6-fold higher. The Wegovy label reports no clinically significant pharmacokinetic differences across the kidney and liver ranges studied. For breastfeeding, the labels disagree: Wegovy tablets and Foundayo say not recommended, Mounjaro and Zepbound report that tirzepatide was undetectable or low in breast milk, and Wegovy injection and Ozempic report no human data. None of this replaces a prescriber’s judgment, and a reduced-kidney-function patient still needs attention to dehydration.
Two questions the label answers differently from the internet
Two questions come up constantly: can I use a GLP-1 medicine if my kidneys or liver are not working normally, and is it safe while I am breastfeeding? Online answers tend to be confident and uniform. The labels are more specific, and they differ by product. This guide pulls the relevant wording from the current prescribing information, mainly the “Use in Specific Populations” section (8) and the clinical pharmacology section (12.3), and keeps what the label says separate from what it does not say.
We reviewed the Wegovy label (injection and tablets, revised 06/2026), the Ozempic label, the Mounjaro label (revised 08/2026), the Zepbound label (revised 08/2026) and the Foundayo label (revised 07/2026) on 12 October 2026. Where a label did not contain a statement in the sections we reviewed, we say so rather than fill the gap.
Kidney (renal) impairment
| Medicine | Label statement on renal impairment |
|---|---|
| Ozempic (8.6) | No dose adjustment is recommended for patients with renal impairment. Renal impairment, including kidney failure, produced no clinically relevant change in semaglutide pharmacokinetics. |
| Wegovy (12.3) | No clinically significant differences in semaglutide pharmacokinetics were observed in renal impairment with an estimated glomerular filtration rate (eGFR) of 30 to below 90 mL/minute. We did not find a separate dose-adjustment sentence in the sections reviewed. |
| Mounjaro (8.6, 12.3) | No dosage adjustment is recommended. In people with renal impairment, including end-stage renal disease (ESRD), tirzepatide pharmacokinetics were not changed. |
| Zepbound (8.6, 12.3) | No dosage adjustment is recommended. A single 5 mg dose was studied in mild, moderate and severe renal impairment and ESRD against normal renal function; renal impairment did not affect pharmacokinetics. |
| Foundayo (8.7, 12.3) | No dosage modification is recommended for patients with renal impairment; renal impairment does not impact the pharmacokinetics of orforglipron. |
The pharmacokinetic point is about how the body handles the drug, which is different from the safety question of how a kidney copes with a side effect. This is the distinction people most often miss. The Ozempic and Wegovy labels both carry a warning on acute kidney injury due to volume depletion, noting postmarketing reports in which, in some cases, hemodialysis was required, and that most events occurred in patients with nausea, vomiting or diarrhea causing dehydration. Both labels say to monitor renal function in patients reporting adverse reactions that could lead to volume depletion. So “no dose adjustment” does not mean “no extra care”: a person with reduced kidney function who becomes dehydrated is the situation the warning is written for. Our full walk-through is in the article on dehydration and acute kidney injury on GLP-1 labels.
One further point from the Ozempic label: its pharmacokinetic section notes that exposure was adequate across a body weight range of 40 to 198 kg for the 0.5 mg and 1 mg doses and that age, sex, race, ethnicity and renal impairment did not have a clinically meaningful effect on semaglutide exposure. That is a statement about exposure, not about every outcome.
Liver (hepatic) impairment
| Medicine | Label statement on hepatic impairment |
|---|---|
| Ozempic (8.7) | No dose adjustment is recommended for patients with hepatic impairment. |
| Wegovy (12.3) | No clinically significant differences in semaglutide pharmacokinetics in mild, moderate and severe hepatic impairment (Child-Pugh Class A to C); none by fibrosis stage F2 or F3 in MASH. |
| Mounjaro (8.7, 12.3) | No dosage adjustment is recommended. A single 5 mg dose was studied in mild, moderate and severe hepatic impairment; pharmacokinetics were not affected. |
| Zepbound (8.7, 12.3) | No dosage adjustment is recommended; hepatic impairment does not impact tirzepatide pharmacokinetics. |
| Foundayo (8.6, 12.3) | Not recommended in severe hepatic impairment (Child-Pugh Class C). Orforglipron AUC(0-infinity) increased 1.7-fold and 4.6-fold in moderate and severe hepatic impairment respectively. |
Foundayo is the outlier, and the reason is stated in the label itself: a higher exposure in people whose livers handle the drug less well. The Child-Pugh scale referenced there is the standard clinical grading of liver disease severity (Class A mild, B moderate, C severe). For moderate impairment the label reports the 1.7-fold exposure increase; the wording we reviewed does not translate that into a different dose, and we will not guess at one. If you have liver disease and your prescriber is considering Foundayo, this is the sentence to ask them about.
Liver and gallbladder are not the same organ system, and a separate label warning covers gallstones and cholecystitis; see our guide to gallbladder and gallstone warnings. Pancreatic safety is covered in the pancreatitis label review.
Breastfeeding and lactation
| Medicine | Label wording (section 8.2) |
|---|---|
| Wegovy tablets | Advise patients that breastfeeding is not recommended during treatment with Wegovy tablets. |
| Wegovy injection | No data on the presence of subcutaneously administered semaglutide or its metabolites in human milk; the label says the developmental and health benefits of breastfeeding should be weighed against the mother’s clinical need. |
| Ozempic | No data on semaglutide in human milk. In lactating rats semaglutide was detected in milk at levels 3- to 12-fold lower than in maternal plasma; the clinical relevance is unclear because of species differences. Weigh benefits of breastfeeding against clinical need. |
| Mounjaro and Zepbound | Concentration of tirzepatide in breast milk was found to be either undetectable or low. No data on effects on the breastfed infant or on milk production. |
| Foundayo | Not recommended for nursing women. |
What the tirzepatide study actually measured
The tirzepatide result rests on a small clinical lactation study. According to the Zepbound label, a single 5 mg subcutaneous dose was given to 11 healthy lactating adult women. Tirzepatide was undetectable in 164 of 171 milk samples (limit of detection 4 ng/mL). In the remaining 7 samples, the cumulative amount over 28 days was below 0.02% of the maternal dose, and the last measurable concentration was 5 days after dosing. The Mounjaro label describes the same study. Three cautions apply: it was a single dose, not months of therapy at escalating doses; it enrolled healthy volunteers; and the label states there are no data on effects on the breastfed infant or on milk production. A low milk concentration is not the same as a finding of safety for the baby.
The semaglutide labels are the opposite: there simply are no human milk data, and the animal finding is flagged as of unclear relevance. The Wegovy tablet label goes further and says breastfeeding is not recommended, which is consistent with the Foundayo wording. The tablets have their own absorption considerations covered in our article on oral medication absorption and drug interactions, but the lactation sentence does not give a reason in the passage we reviewed, so we do not supply one.
Breastfeeding often overlaps with planning another pregnancy. For that stage, see pregnancy and contraception on GLP-1 labels.
How to use this with your care team
- Bring your latest kidney and liver results. The eGFR value and, if relevant, a Child-Pugh class are the numbers the labels use.
- Ask which label statement applies to your product. The Foundayo hepatic limit, for example, does not appear on the other labels.
- Plan for dehydration if kidney function is reduced. The AKI warning on Ozempic and Wegovy is about volume depletion from vomiting or diarrhea.
- If you are breastfeeding, expect a conversation, not a rule. Labels range from “not recommended” to “no data” to “undetectable or low”, so the decision rests on weighing benefit and uncertainty.
- Tell every prescriber. Specialists treating kidney or liver disease may not know your GLP-1 label wording.
Compounded products
The statements above apply to FDA-approved products. Compounded semaglutide and tirzepatide have no label of their own and no breast-milk or impairment data tied to them, so the pharmacy and prescriber carry that responsibility. Prices are intentionally not discussed here.
Common mistakes
- Reading “no dose adjustment” as “no monitoring”. Dosing and dehydration risk are separate questions.
- Assuming all five labels agree on the liver. Foundayo does not recommend use in Child-Pugh Class C.
- Treating undetectable milk levels as proof of infant safety. The label says infant effects are unknown.
- Applying tirzepatide lactation data to semaglutide. The semaglutide labels report no human milk data.
Questions people ask
Do I need a lower dose if my kidney function is reduced?
Ozempic, Mounjaro and Zepbound say no dose adjustment is recommended, and Foundayo recommends no dosage modification. Wegovy reports no clinically significant pharmacokinetic differences at eGFR 30 to below 90 mL/minute. Your prescriber decides on your dose.
Can I take Foundayo with liver disease?
The label says it is not recommended in severe hepatic impairment (Child-Pugh Class C) and reports 1.7-fold and 4.6-fold higher exposure in moderate and severe impairment. Ask your prescriber about moderate impairment.
Is any GLP-1 medicine approved as safe while breastfeeding?
No label in this article says so. Wegovy tablets and Foundayo say not recommended; Mounjaro and Zepbound report low or undetectable milk levels with no infant data; Wegovy injection and Ozempic report no human data.
Does the dehydration warning apply to kidney patients specifically?
The Ozempic and Wegovy warnings describe acute kidney injury after volume depletion in patients with nausea, vomiting or diarrhea; the label does not limit it to people with existing kidney disease.
Where can I read the full wording?
In the prescribing information linked in the sources below and the Medication Guide with your fill.
Sources
- Novo Nordisk, Wegovy (semaglutide) injection and tablets prescribing information, revised 06/2026, checked 12 October 2026.
- Novo Nordisk, Ozempic (semaglutide) injection prescribing information, checked 12 October 2026.
- Eli Lilly and Company, Mounjaro (tirzepatide) prescribing information, revised 08/2026, checked 12 October 2026.
- Eli Lilly and Company, Zepbound (tirzepatide) prescribing information, revised 08/2026, checked 12 October 2026.
- Eli Lilly and Company, Foundayo (orforglipron) tablets prescribing information, revised 07/2026, checked 12 October 2026.
Medical disclaimer. This article is informational, was prepared by the GLP-1.Reviews editorial team from the public sources listed above, and is not medical advice. Label wording can change; confirm the instructions for your product with the Medication Guide that came with it. Talk to your prescriber or pharmacist about your own treatment, and see our medical disclaimer and editorial standards.
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