Can Monjuaro (tirzepatide) cause sphincter of Oddi dysfunction?

Monjuaro (Tirzepatide) and Sphincter of Oddi Dysfunction

There is no evidence that Monjuaro (tirzepatide) causes sphincter of Oddi dysfunction based on current medical literature and guidelines.

Understanding Sphincter of Oddi Dysfunction (SOD)

SOD is a condition characterized by abnormal contractions or stenosis of the sphincter of Oddi, which controls the flow of bile and pancreatic secretions into the duodenum 1.

• SOD can present as biliary pain, biliary colic, recurrent pancreatic pain, or pancreatitis 2
• It occurs in approximately 5% of liver transplant patients due to denervation 1, 3
• SOD can be classified into three types based on the Milwaukee classification:
  • Type I: Biliary pain with abnormal liver enzymes and dilated bile ducts 2
  • Type II: Biliary pain with either abnormal liver enzymes or dilated bile ducts 2
  • Type III: Biliary pain alone without other abnormalities 2

Risk Factors for SOD

Known risk factors for sphincter of Oddi dysfunction include:

• Cholecystectomy (most common risk factor) 2, 4
• Opioid medications (particularly morphine and pentazocine) 4, 5
• Alcohol consumption 4

Tirzepatide (Monjuaro) and SOD

• No evidence in the provided guidelines or research indicates that tirzepatide (Monjuaro) causes sphincter of Oddi dysfunction
• The mechanism of action of tirzepatide as a GIP/GLP-1 receptor agonist does not suggest a direct effect on sphincter of Oddi function
• None of the provided guidelines mention tirzepatide as a cause of SOD

Diagnosis of SOD

If SOD is suspected, diagnostic approaches include:

• Exclusion of other causes like choledocholithiasis or ampullary tumors using ERCP, endoscopic ultrasound, or MRI/MRCP 2
• Biliary manometry (considered the gold standard but with high risk of inducing pancreatitis) 6, 2
• Biliary scintigraphy (safer alternative but with lower sensitivity) 2

Management of SOD

If SOD is diagnosed, treatment options include:

• Medical therapy:

  • Calcium channel blockers (e.g., nifedipine) 1
  • Nitrates (e.g., nitroglycerin) 1, 5
  • Trimebutine for pain management 2

• Endoscopic therapy:

  • Endoscopic sphincterotomy (most effective for Type I SOD) 1, 6
  • Botulinum toxin injection (can be used diagnostically before permanent sphincterotomy) 1, 3

• Surgical intervention:

  • Conversion to Roux-en-Y hepaticojejunostomy for refractory cases 1

Clinical Implications

• If a patient on tirzepatide develops symptoms suggestive of SOD (biliary-type pain, elevated liver enzymes), consider other more established causes first 2, 4
• Evaluate for gallstones, which are a more common cause of similar symptoms 7
• Consider the possibility that pre-existing SOD risk factors (such as prior cholecystectomy) may be present rather than attributing symptoms directly to tirzepatide 4

Conclusion

Based on current evidence, there is no established link between tirzepatide (Monjuaro) and sphincter of Oddi dysfunction. If a patient on tirzepatide develops symptoms suggestive of biliary pathology, standard diagnostic workup for more common causes should be pursued.