Can Mounjaro Cause Jaundice?
Mounjaro (tirzepatide) is not established as a cause of jaundice, though one isolated case report documents hepatotoxicity with elevated liver enzymes, which theoretically could progress to jaundice if severe enough.
Evidence for Hepatotoxicity
The medical literature contains only a single documented case of tirzepatide-induced liver injury:
- A 37-year-old woman with metabolic syndrome developed elevated liver enzymes secondary to tirzepatide use, representing the first reported case of tirzepatide-induced hepatotoxicity 1
- This case did not specifically mention jaundice or hyperbilirubinemia, only elevated aminotransferases 1
Expected Hepatic Effects of Tirzepatide
The predominant hepatic effect of tirzepatide is actually protective rather than harmful:
- Tirzepatide reduces hepatic steatosis (fatty liver) in patients with type 2 diabetes 2
- The drug has been reported as beneficial in reducing liver fat content 1
- However, its effects on steatohepatitis and fibrosis remain unknown 2
Common Adverse Effects (Not Including Jaundice)
The established safety profile of tirzepatide does not include jaundice or hepatobiliary dysfunction as recognized adverse events:
- Gastrointestinal symptoms are most common: nausea (17-31%), diarrhea (12-23%), vomiting (12%), and constipation (12-18%) 3
- Serious concerns include pancreatitis, cholelithiasis, acute kidney injury risk, and thyroid C-cell tumors (rodent studies) 3
- The overall safety profile is consistent with GLP-1 receptor agonists 4
Clinical Context: When Jaundice Actually Occurs
If a patient on tirzepatide develops jaundice, investigate the established causes rather than assuming drug causation:
- Drug-induced liver injury from other medications or herbal supplements accounts for a significant proportion of jaundice cases in the United States 5
- Alcoholic liver disease, chronic liver disease decompensation, gallstone disease, and malignancy are far more common etiologies 5
- Pre-existing chronic liver disease with decompensation accounts for 20.5% of new-onset jaundice 5
Practical Recommendation
Do not attribute jaundice to tirzepatide without excluding all other established causes first. If jaundice develops in a patient taking tirzepatide:
- Immediately evaluate for common causes: gallstones (14% of jaundice cases), alcoholic liver disease, viral hepatitis, malignancy, and other hepatotoxic medications 5
- Check complete hepatic panel including direct/indirect bilirubin, aminotransferases, alkaline phosphatase, and coagulation studies
- Obtain right upper quadrant ultrasound to evaluate biliary obstruction and hepatic parenchyma
- Review all concurrent medications and supplements for known hepatotoxins 5
- Consider discontinuing tirzepatide only after ruling out more likely etiologies, given the extreme rarity of reported hepatotoxicity 1