How to manage nausea caused by Mounjaro (tirzepatide)?

From the Guidelines

To manage nausea caused by Mounjaro (tirzepatide), start with simple dietary changes and consider taking ondansetron (Zofran) 4–8 mg bid or tid as it has been shown to be effective in improving nausea and vomiting in patients with refractory gastroparesis symptoms 1. When taking Mounjaro, it is essential to eat smaller, more frequent meals and avoid fatty, spicy, or strong-smelling foods. Staying well-hydrated is also crucial, but it is recommended to sip fluids slowly throughout the day rather than drinking large amounts at once. Some key points to consider when managing nausea caused by Mounjaro include:

• Taking Mounjaro at bedtime to sleep through the initial nausea period
• Always injecting Mounjaro in the recommended sites (abdomen, thigh, or upper arm)
• Trying ginger products (tea, candies, or capsules), peppermint tea, or over-the-counter medications like dimenhydrinate (Dramamine) or meclizine (Bonine) for immediate relief
• Asking your healthcare provider about prescription anti-nausea medications such as ondansetron (Zofran) or promethazine if needed
• Remembering that nausea typically improves after the first few weeks as your body adjusts to the medication
• Contacting your healthcare provider if nausea becomes severe or persistent, as they may recommend temporarily pausing dose escalation or adjusting your treatment plan Nausea occurs because tirzepatide slows gastric emptying and affects certain brain receptors involved in nausea and vomiting, and ondansetron has been shown to be effective in improving nausea and vomiting in patients with refractory gastroparesis symptoms, with a recommended dose of 4–8 mg bid or tid 1. Other treatment options for nausea and vomiting include:
• Granisetron, with a recommended dose of 1 mg bid or a granisetron patch with 34.3 mg patch weekly 1
• Prochlorperazine, with a recommended dose of 5–10 mg qid 1
• Chlorpromazine, with a recommended dose of 10–25 mg tid or qid 1
• Meclizine, with a recommended dose of 12.5–25 mg tid 1
• Scopolamine, with a recommended dose of 1.5 mg patch every 3 days 1
• Dimenhydrinate, with a recommended dose of 25–50 mg tid 1
• Diphenhydramine, with a recommended dose of 12.5–25 mg tid 1
• Trimethobenzamide, with a recommended dose of 300 mg tid 1
• Aprepitant, with a recommended dose of 80 mg/day 1
• Ginger, with a recommended dose of 1 g bid 1

From the FDA Drug Label

MOUNJARO has been associated with gastrointestinal adverse reactions, which include nausea, vomiting, and diarrhea [see Adverse Reactions (6. 1)]. These events may lead to dehydration, which if severe could cause acute kidney injury.

To manage nausea caused by Mounjaro (tirzepatide), consider the following:

• Monitor renal function when initiating or escalating doses of MOUNJARO in patients with renal impairment reporting severe gastrointestinal adverse reactions.
• Be aware that dehydration can occur due to nausea, vomiting, and diarrhea, and may lead to acute kidney injury.
• There is no specific guidance on managing nausea in the provided drug labels, but patients should be instructed to inform their healthcare provider if they experience any adverse reactions. 2

From the Research

Managing Nausea Caused by Mounjaro (Tirzepatide)

To manage nausea caused by Mounjaro (tirzepatide), consider the following tips:

• Start with a low dose and gradually increase as needed and under medical supervision to minimize side effects 3
• Take the medication with food to reduce gastrointestinal side effects
• Stay hydrated by drinking plenty of water
• Avoid lying down after taking the medication to prevent nausea and vomiting
• Consider taking antiemetic medications such as ondansetron or metoclopramide if nausea is severe, as they have been shown to be effective in reducing nausea and vomiting in various clinical settings 4, 5, 6

Antiemetic Options

Some studies suggest that:

• Ondansetron and metoclopramide have similar efficacy in reducing nausea and vomiting in adult emergency department patients 4
• Ondansetron is more effective than metoclopramide in preventing chemotherapy-induced nausea and vomiting 5
• Ondansetron is more effective than metoclopramide in treating severe nausea and vomiting of pregnancy 6

Important Considerations

When taking Mounjaro (tirzepatide), it is essential to be aware of the potential side effects, including:

• Gastrointestinal side effects such as nausea, vomiting, diarrhea, and constipation 3
• Serious adverse events, including serious gastrointestinal events and discontinuation due to adverse effects 3
• Perioperative considerations, such as delayed gastric emptying and pulmonary aspiration during general anesthesia 7