What are the management options for a 32-year-old female experiencing stomach burning and constipation after starting 2.5mg Tirzepatide (glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist)?

Management of Gastrointestinal Side Effects in a Patient Starting Tirzepatide

For a 32-year-old female experiencing stomach burning and constipation after starting 2.5mg tirzepatide, continue the medication while implementing supportive measures to manage these common gastrointestinal side effects, as they typically improve over time with continued use. 1, 2

Understanding the Side Effect Profile

• Gastrointestinal (GI) adverse events are the most common side effects of tirzepatide, with nausea, constipation, and decreased appetite being very common, occurring in 39-49% of patients depending on dose 2
• These GI side effects are dose-dependent and tend to decrease gradually over time with continued use 1
• At the 2.5mg starting dose, these effects are typically milder than at higher doses (5mg, 10mg, 15mg) 2

Management Approach

Immediate Supportive Measures

• Maintain adequate hydration to help with both constipation and stomach discomfort 3
• Implement dietary modifications:
  • Smaller, more frequent meals to reduce gastric distension 3
  • Low-fat, bland foods that are easier to digest 3
  • Increase fiber intake gradually to help with constipation 3

Medication Management

• Continue tirzepatide at the current 2.5mg dose as these side effects are expected and typically transient 3
• Consider over-the-counter options for symptom relief:
  • For constipation: osmotic laxatives like polyethylene glycol (Miralax) 3
  • For stomach burning: antacids or H2 blockers if symptoms are consistent with acid reflux 3

Monitoring and Follow-up

• Monitor for signs of more severe GI complications, which are rare but reported:
  • Severe or persistent abdominal pain 4
  • Significant constipation that doesn't respond to basic measures 5
  • Signs of dehydration or electrolyte disturbances (dizziness, weakness) 6

Important Considerations and Cautions

• Severe GI side effects can lead to serious complications in rare cases:

  • Small bowel obstruction has been reported, particularly with dose escalations 5
  • Colonic ischemia is a rare but documented complication 4
  • Severe vomiting and diarrhea can lead to electrolyte disturbances that may cause cardiac arrhythmias 6

• If GI symptoms become severe or persistent despite supportive measures:

  • Consider temporary dose reduction or maintaining at current dose rather than escalating 2
  • Seek medical attention if symptoms significantly impact daily activities or if warning signs develop 6

Long-term Expectations

• Most patients experience improvement in GI side effects within the first few weeks of treatment 1
• Continuing the medication at a stable dose is likely to result in decreased side effects over time 1
• The benefits of weight loss and metabolic improvement typically outweigh these transient side effects for most patients 3

When to Seek Immediate Medical Attention

• Development of severe abdominal pain, especially if associated with vomiting 4
• Signs of bowel obstruction (severe constipation, abdominal distension, inability to pass gas) 5
• Symptoms of significant dehydration (extreme thirst, dizziness, dark urine) 6
• Any unusual or concerning symptoms that differ from the expected mild to moderate GI effects 3