Contraindications for Zepbound (Tirzepatide)
Zepbound (tirzepatide) is contraindicated in patients with personal or family history of medullary thyroid cancer, multiple endocrine neoplasia syndrome type 2, pregnancy or breastfeeding, and severe gastroparesis. 1
Absolute Contraindications
- Personal or family history of medullary thyroid carcinoma (MTC)
- Multiple endocrine neoplasia syndrome type 2 (MEN 2)
- Pregnancy or women planning pregnancy
- Breastfeeding
- Severe gastroparesis
Precautions and Relative Contraindications
Gastrointestinal Conditions
- History of severe gastrointestinal disease
- Pancreatitis (history of or active)
- Inflammatory bowel disease with active symptoms
Endocrine Conditions
- Diabetic retinopathy requiring monitoring
- Concurrent use with insulin secretagogues (increased risk of hypoglycemia)
Reproductive Considerations
- Women of reproductive potential must use reliable contraception methods while on tirzepatide 2
- All medications for obesity treatment are contraindicated in women who are or may become pregnant 2
Medication Interactions
- Caution with medications that slow gastric emptying
- Medications with narrow therapeutic index may require monitoring due to delayed absorption
Safety Considerations
Monitoring Requirements
- Regular ophthalmologic evaluations in patients with diabetic retinopathy
- Blood glucose monitoring when used with insulin or insulin secretagogues
- Renal function in patients with kidney impairment
Adverse Effects Profile
- Most common adverse effects are gastrointestinal (nausea, vomiting, diarrhea, constipation)
- Additional side effects include alopecia and abdominal pain 1
Special Populations
Renal Impairment
- No dose adjustment needed for mild to moderate renal impairment
- Use with caution in severe renal impairment (eGFR <30 mL/min/1.73m²) 1
Elderly
- No specific dose adjustment required based on age alone
- Consider increased sensitivity to gastrointestinal effects
Clinical Pearls
- Tirzepatide has a black box warning regarding the risk of thyroid C-cell tumors in rodents, though human relevance has not been determined 2
- The risk of hypoglycemia is low when used without insulin or insulin secretagogues 1
- Slow dose titration is recommended to minimize gastrointestinal side effects
- Patients should be counseled about the potential for significant weight loss and the need for ongoing monitoring
Remember that contraindications should be carefully assessed before initiating therapy with Zepbound, and patients should be monitored regularly for potential adverse effects throughout treatment.