From the Guidelines
Tirzepatide can be taken with a history of CVA, hypertension, diverticulitis, hypothyroidism, and high cholesterol, but individual medical evaluation is necessary to monitor potential interactions and side effects. The medication appears compatible with metoprolol, rosuvastatin, aspirin, and NP Thyroid, though potential interactions should be monitored 1. Tirzepatide may actually provide cardiovascular benefits for patients with stroke history and hypertension by promoting weight loss and improving glycemic control, which is supported by the 2022 ACC expert consensus decision pathway on the role of nonstatin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk 1. It can also complement rosuvastatin's cholesterol-lowering effects. However, caution is warranted as tirzepatide can cause gastrointestinal side effects that might exacerbate diverticulitis symptoms, and patients with a history of diverticulitis should be advised to avoid nonaspirin NSAIDs if possible, as suggested by the American Gastroenterological Association institute guideline on the management of acute diverticulitis 1.
The medication should be started at a low dose (2.5mg weekly) and gradually increased to minimize gastrointestinal side effects. Blood pressure and thyroid function should be monitored regularly, as tirzepatide may affect both. Patients should stay well-hydrated and report any severe abdominal pain, persistent nausea/vomiting, or signs of thyroid dysfunction. A healthcare provider should make the final determination based on the patient's complete medical history and current health status, taking into account the potential benefits and risks of tirzepatide in the context of their individual condition, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APHA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
Some key considerations for the use of tirzepatide in this patient include:
- Monitoring for potential interactions with metoprolol, rosuvastatin, aspirin, and NP Thyroid
- Gradually increasing the dose of tirzepatide to minimize gastrointestinal side effects
- Regularly monitoring blood pressure and thyroid function
- Advising the patient to avoid nonaspirin NSAIDs if possible to reduce the risk of exacerbating diverticulitis symptoms
- Encouraging the patient to stay well-hydrated and report any severe side effects or signs of thyroid dysfunction.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medication Interactions and Contraindications
- The patient is taking metoprolol, rosuvastatin, aspirin, and NP thyroid, and has a history of CVA, hypertension, diverticulitis, hypothyroidism, and high cholesterol.
- There is no direct evidence in the provided studies to suggest that tirzepatide interacts with these medications or is contraindicated in patients with these conditions 2, 3, 4, 5.
Cardiovascular Safety and Efficacy
- Tirzepatide has been shown to reduce the risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes and atherosclerotic cardiovascular disease 2, 5.
- The SURPASS-CVOT trial is ongoing to assess the cardiovascular safety and efficacy of tirzepatide compared to dulaglutide 2.
- A systematic review and meta-analysis found that GLP-1 receptor agonists, including tirzepatide, reduce the risk of MACE and stroke in patients with type 2 diabetes 5.
Renal Effects and Safety
- A systematic review and meta-analysis found that tirzepatide has a positive impact on urine albumin-to-creatinine ratio (UACR) and does not have detrimental effects on estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes and obesity 4.
- Tirzepatide did not increase the risk of adverse renal events, urinary tract infection, nephrolithiasis, acute kidney injury, and renal cancer compared to placebo or insulin 4.
Other Considerations
- Tirzepatide has been shown to improve blood pressure and reduce Low-Density Lipoprotein (LDL) cholesterol and triglycerides 3.
- The patient's history of diverticulitis, hypothyroidism, and high cholesterol should be considered when initiating tirzepatide, but there is no direct evidence to suggest that tirzepatide is contraindicated in these conditions 3, 6.