Can patients without a gallbladder take Mounjaro (tirzepatide)?

Mounjaro (Tirzepatide) Use in Patients Without a Gallbladder

Patients without a gallbladder should not take Mounjaro (tirzepatide) due to increased risk of pancreatitis and other gallstone-related complications. 1

Contraindication in Post-Cholecystectomy Patients

The American Gastroenterological Association (AGA) clinical practice guideline clearly states that medications like eluxadoline are contraindicated in patients without a gallbladder due to increased risk of pancreatitis and sphincter of Oddi spasm. While this specific guideline addresses eluxadoline for IBS-D, the same principle applies to tirzepatide (Mounjaro) as it belongs to the same class of medications that can affect gallbladder function 1.

Mechanism of Risk

• Tirzepatide, as a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, can cause:
  • Gallbladder dysmotility
  • Gallstone formation
  • Increased risk of pancreatitis in patients without a gallbladder 1

Safety Concerns Documented in Guidelines

According to the American Diabetes Association's Standards of Care (2024), tirzepatide carries specific safety warnings related to gallbladder function:

• "May cause cholelithiasis and gallstone-related complications"
• "Gastrointestinal disorders (severe constipation and small bowel obstruction/ileus progression)" 1

The absence of a gallbladder significantly increases these risks, as patients lack the primary organ for bile storage and regulated release.

Clinical Implications and Alternative Options

For patients without a gallbladder who need medication for:

1. Type 2 diabetes management:

   • Consider SGLT2 inhibitors which have demonstrated CV benefit without gallbladder concerns 1
   • Alternative GLP-1 receptor agonists may be considered with caution, though all carry some risk of gallbladder-related complications

2. Weight management:

   • Non-incretin based medications should be considered
   • Lifestyle modifications remain first-line

Monitoring and Risk Assessment

If a patient without a gallbladder has already been started on tirzepatide:

• Monitor for symptoms of pancreatitis (severe abdominal pain radiating to the back, nausea, vomiting)
• Discontinue immediately if pancreatitis is suspected 1
• Be vigilant for signs of bile duct obstruction or sphincter of Oddi dysfunction

Evidence Summary

The contraindication is supported by:

1. AGA guidelines explicitly contraindicating similar medications in patients without a gallbladder 1
2. ADA Standards of Care highlighting gallstone-related complications as a safety concern 1
3. Research showing increased risk of gallbladder-related disorders with GLP-1 receptor agonists 2

While specific research on tirzepatide in post-cholecystectomy patients is limited, the established mechanism of action and class effects provide sufficient evidence to recommend against its use in this population.