Does tirzepatide cause palpitations?

Does Tirzepatide Cause Palpitations?

Based on the available evidence, tirzepatide does not appear to cause palpitations as a recognized adverse effect, though it does cause an elevation in resting heart rate that is distinct from palpitations.

Heart Rate Elevation vs. Palpitations

Tirzepatide increases resting heart rate, but this is not the same as palpitations. 1 An elevated heart rate is an objective physiologic change measured by vital signs, whereas palpitations are a subjective sensation of irregular, rapid, or forceful heartbeats that patients perceive. The guideline evidence documents heart rate elevation but does not list palpitations among the adverse effects of tirzepatide.

In the comprehensive network meta-analysis comparing tirzepatide to placebo and other diabetes medications, palpitations were not identified as an adverse event associated with tirzepatide. 2 The analysis included data from multiple phase III trials with over 1,000 patients receiving tirzepatide, yet palpitations did not emerge as a safety signal. 2

Documented Cardiovascular Effects

The cardiovascular effects of tirzepatide that are documented include:

• Resting heart rate elevation occurs with tirzepatide treatment 1
• Blood pressure reduction through multiple mechanisms, including weight loss and metabolic improvements 1
• No increased risk of major adverse cardiovascular events (MACE), with hazard ratios <1.0 and upper confidence bounds <1.3, meeting cardiovascular safety criteria 1, 3

Gastrointestinal Side Effects and Electrolyte Disturbances

The most important cardiovascular risk with tirzepatide is indirect: severe electrolyte disturbances from gastrointestinal side effects can cause life-threatening arrhythmias, though this is rare. 4 A case report documented ventricular fibrillation in a patient on tirzepatide 15 mg who developed severe vomiting and diarrhea, leading to profound electrolyte imbalances (potassium 2.2, magnesium 1.1, corrected calcium 5.6). 4 This highlights that while palpitations are not a direct effect of tirzepatide, severe electrolyte disturbances from GI side effects can cause serious cardiac arrhythmias.

Routine electrolyte monitoring is advised for patients on high doses (10 mg and 15 mg) or those at risk of dehydration from gastrointestinal side effects. 1

Common Adverse Effects of Tirzepatide

The most frequently reported adverse effects are gastrointestinal:

• Nausea occurs in 17–31% of patients, dose-dependent and typically mild-to-moderate 1, 5
• Diarrhea affects 12–23% of patients 1, 5
• Vomiting occurs in 6–12% of patients 1, 5
• Decreased appetite affects 10–12% of patients 1

These gastrointestinal effects are generally transient, improving after the first 4–8 weeks of therapy. 1

Clinical Implications

If a patient on tirzepatide reports palpitations, investigate alternative causes rather than attributing them to the medication itself. Consider:

• Electrolyte disturbances from severe GI side effects (check potassium, magnesium, calcium) 4
• Dehydration from vomiting or diarrhea 1
• Hypoglycemia if tirzepatide is combined with insulin or sulfonylureas 1
• Underlying cardiac conditions unrelated to tirzepatide
• Anxiety or stress related to medication initiation or weight loss

Monitor blood pressure closely during tirzepatide therapy, as weight loss may necessitate adjustment of antihypertensive medications. 1 The reduction in blood pressure could theoretically lead to compensatory tachycardia in some patients, though this is not documented as a common occurrence.

Common Pitfalls to Avoid

• Do not dismiss patient-reported palpitations as a benign side effect without investigating electrolyte status, especially in patients experiencing significant GI symptoms 4
• Do not overlook the need for electrolyte monitoring in patients on high doses (10 mg or 15 mg) who develop severe vomiting or diarrhea 1, 4
• Do not confuse elevated resting heart rate (an objective finding) with palpitations (a subjective symptom) 1