Can patients with a history of cholecystectomy (gallbladder removal) take Mounjaro (tirzepatide)?

Mounjaro (Tirzepatide) Use in Patients After Cholecystectomy

Patients who have had their gallbladder removed can safely take Mounjaro (tirzepatide) without additional concerns or contraindications.

Rationale for Safety in Post-Cholecystectomy Patients

Cholecystectomy (gallbladder removal) is one of the most commonly performed surgical procedures worldwide. After reviewing the available evidence, there are no specific contraindications or concerns for using Mounjaro in patients who have undergone this procedure.

The primary considerations include:

• The absence of specific warnings or contraindications in guidelines regarding GLP-1 receptor agonists/dual GIP and GLP-1 receptor agonists in post-cholecystectomy patients
• Understanding of post-cholecystectomy physiology and how it relates to medication metabolism

Post-Cholecystectomy Physiological Changes

After gallbladder removal, patients experience several physiological changes:

• Continuous rather than intermittent bile flow into the intestine
• Altered bile acid metabolism and enterohepatic circulation
• Potential changes in intestinal transit time

These changes may lead to:

• Altered metabolic signaling via bile acid pathways 1
• Changes in glucose and lipid metabolism

However, these physiological changes do not create contraindications for Mounjaro therapy.

Clinical Considerations for Post-Cholecystectomy Patients on Mounjaro

Monitoring Parameters

• Digestive symptoms (particularly during dose titration)
• Glucose control (as with any patient on Mounjaro)
• Liver function tests as clinically indicated

Common Post-Cholecystectomy Issues to Consider

1. Persistent abdominal pain: Approximately 22-27% of patients may experience persistent abdominal pain after cholecystectomy 2. Mounjaro can cause GI side effects, which should be distinguished from post-cholecystectomy syndrome.

2. Altered bile flow: Without the gallbladder's storage function, bile flows continuously into the intestine. This altered flow doesn't affect Mounjaro's efficacy or safety profile.

3. Metabolic changes: Some research suggests cholecystectomy may be associated with metabolic syndrome risk 1. Mounjaro, with its effects on weight and glycemic control, may actually be beneficial in this population.

Management Approach

For patients who have had cholecystectomy and are candidates for Mounjaro therapy:

1. Standard dosing and titration can be followed as per usual recommendations

   • Begin with 2.5 mg once weekly for 4 weeks
   • Titrate as tolerated per standard protocol

2. Patient education about expected GI side effects to distinguish from post-cholecystectomy symptoms

   • Nausea, vomiting, and diarrhea are common with Mounjaro initiation
   • These should improve over time and with dose titration

3. Regular monitoring as would be done for any patient on Mounjaro therapy

Special Considerations

• If a patient experiences severe or persistent digestive symptoms, evaluate for other causes before attributing to Mounjaro
• No specific drug interactions between Mounjaro and medications commonly used after cholecystectomy have been reported

Conclusion

Based on the available evidence, patients who have undergone cholecystectomy can safely take Mounjaro. The physiological changes that occur after gallbladder removal do not create contraindications for this medication, and standard dosing and monitoring protocols can be followed.