Do patients taking Mounjaro (tirzepatide) need to stop the medication before a colonoscopy?

Management of Tirzepatide (Mounjaro) Before Colonoscopy

Patients taking Mounjaro (tirzepatide) should omit their dose for the week before a colonoscopy if they are scheduled for a high-risk procedure such as polypectomy, and can take their regular dose if only undergoing a diagnostic colonoscopy.

Understanding Tirzepatide and Colonoscopy Considerations

Tirzepatide (Mounjaro) is a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist administered as a once-weekly subcutaneous injection for type 2 diabetes and weight management 1, 2. When preparing for a colonoscopy, management of this medication requires consideration of:

1. The medication's pharmacokinetics
2. The type of colonoscopy procedure planned
3. The risk of complications

Decision Algorithm Based on Procedure Type

For Low-Risk Colonoscopy Procedures (Diagnostic Only)

• Continue tirzepatide therapy
• Simply omit the morning dose on the day of the procedure 3
• Low-risk procedures include diagnostic colonoscopy with or without biopsies

For High-Risk Colonoscopy Procedures

• Discontinue tirzepatide temporarily
• Last dose should be taken at least 48-72 hours before the procedure 3
• Given tirzepatide's 5-day elimination half-life 3, consider scheduling the last dose 7 days before the procedure
• High-risk procedures include:
  • Polypectomy
  • Endoscopic mucosal resection (EMR)
  • Endoscopic submucosal dissection (ESD)
  • Any therapeutic intervention

Rationale for Recommendations

1. Delayed Gastric Emptying: GLP-1 receptor agonists like tirzepatide slow gastric emptying, which could affect bowel preparation quality 3

2. Aspiration Risk: The American Society of Anesthesiologists advises that GLP-1 receptor agonists be stopped for 1-7 days (depending on the agent) before elective procedures to limit aspiration risk during sedation 3

3. Pharmacokinetics: Tirzepatide has a long elimination half-life of approximately 5 days 3, making a one-week pause appropriate for high-risk procedures

Special Considerations

• Bowel Preparation Quality: Ensure adequate bowel preparation by following a split-dose regimen as recommended by guidelines 3

• Renal Function: For patients with moderate renal impairment, consider a longer washout period before the procedure 3

• Resumption of Therapy: Resume tirzepatide 2-3 days after the procedure if no complications occur 3

Common Pitfalls to Avoid

1. Failing to distinguish between diagnostic and therapeutic procedures: The management approach differs based on whether interventions are planned

2. Ignoring the long half-life: Unlike daily medications, tirzepatide's weekly dosing and long half-life require advance planning

3. Overlooking potential effects on bowel preparation: GLP-1 receptor agonists may affect gastric emptying, potentially impacting bowel preparation quality

4. Not communicating with patients about medication management: Clear instructions should be provided well in advance of the scheduled colonoscopy

By following these guidelines, clinicians can optimize patient safety while ensuring effective colonoscopy procedures for patients on tirzepatide therapy.