How should Mounjaro (tirzepatide) be managed prior to a colonoscopy?

Management of Mounjaro (Tirzepatide) Prior to Colonoscopy

Discontinue Mounjaro at least 7 days before colonoscopy to prevent delayed gastric emptying that can compromise bowel preparation quality and increase aspiration risk during sedation. 1

Rationale for Discontinuation

GLP-1 receptor agonists, including the dual GIP/GLP-1 receptor agonist tirzepatide (Mounjaro), significantly delay gastric emptying, which poses two critical risks during colonoscopy:

• Inadequate bowel preparation: The 2025 US Multi-Society Task Force on Colorectal Cancer guidelines specifically emphasize that GLP-1 receptor agonists require proper management during the bowel preparation process, as they can interfere with adequate colon cleansing 1
• Aspiration risk: Retained gastric contents during sedation increase the risk of pulmonary aspiration, a potentially life-threatening complication 1

Specific Timing Recommendations

Hold tirzepatide for a minimum of 7 days before the scheduled colonoscopy. This timing is based on:

• The drug's prolonged half-life and sustained effects on gastric motility 2, 3
• The critical importance of achieving adequate bowel preparation, with target adequacy rates of 90% at both the endoscopist and unit level 4
• The need to allow sufficient time for normalization of gastrointestinal transit 1

Bowel Preparation Protocol Adjustments

When preparing patients who have been on tirzepatide:

• Use split-dose bowel preparation regimens for all patients, with the second portion beginning 4-6 hours before colonoscopy and completing at least 2 hours before the procedure 5
• Provide enhanced patient education using both verbal and detailed written instructions, as the complexity of managing medications during bowel preparation can negatively affect completion rates 1
• Consider patient navigation through telephonic or virtual automated messaging to improve bowel preparation adequacy 5

Diabetes Management During the Preparation Period

Since tirzepatide is used for type 2 diabetes management 2, 3, coordinate with the prescribing clinician regarding:

• Alternative glucose control strategies during the 7-day holding period, as patients with diabetes have distinct risks including hypoglycemia, electrolyte imbalance, and poor bowel preparation quality 6
• Blood glucose monitoring should be intensified during the bowel preparation period when dietary modifications are implemented 6
• Adjustment of other antihyperglycemic agents to maintain glycemic control while tirzepatide is held 6

Additional Dietary Considerations

• Limit dietary modifications to the day before colonoscopy for low-risk patients, using low-residue and low-fiber foods for early and midday meals 1, 7
• Discontinue iron-containing multivitamins at least 7 days before colonoscopy, as iron residue can compromise diagnostic accuracy 4, 7

Common Pitfalls to Avoid

• Do not assume shorter holding periods are adequate: The prolonged pharmacodynamic effects of GLP-1 receptor agonists necessitate the full 7-day discontinuation 1
• Do not neglect coordination with the prescribing clinician: Diabetes management requires individualized adjustment during the medication holding period 1, 6
• Do not overlook enhanced preparation protocols: Patients with diabetes have a threefold higher risk of inadequate bowel preparation and may benefit from multifactorial preparation strategies including educational interventions 8

Quality Assurance

• Each additional hour between the last purgative ingestion and colonoscopy can decrease the likelihood of good preparation by up to 10% 5
• If inadequate preparation occurs despite proper GLP-1 receptor agonist management, colonoscopy should be rescheduled within 12 months for screening or surveillance procedures 5