Which patients are contraindicated for Mounjaro (tirzepatide) injection?

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Last updated: February 25, 2026 • View editorial policy

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Who Should Not Take Mounjaro (Tirzepatide)

Mounjaro is absolutely contraindicated in patients with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2, and should not be used during pregnancy or breastfeeding. 1, 2

Absolute Contraindications

Thyroid Cancer Risk

  • Do not use in individuals with a personal or family history of medullary thyroid carcinoma 3, 1
  • Do not use in patients with multiple endocrine neoplasia type 2 1, 2
  • Black-box warning exists due to thyroid C-cell tumor findings in rodent studies, though human relevance remains uncertain 1

Pregnancy and Breastfeeding

  • Pregnancy is an absolute contraindication as safety has not been established 2
  • Breastfeeding is contraindicated due to lack of safety data 2

Conditions Requiring Extreme Caution or Avoidance

Gastrointestinal Disorders

  • Not recommended in patients with clinically meaningful gastroparesis, as tirzepatide delays gastric emptying and will worsen existing symptoms 2
  • Use with extreme caution in patients with prior pancreatitis, as acute pancreatitis has been reported in clinical trials 1, 2
  • Severe constipation and small-bowel obstruction/ileus have been documented 3, 1

Renal Disease

  • Use caution when initiating or escalating doses in patients with kidney disease due to increased risk of acute kidney injury from dehydration secondary to gastrointestinal side effects 3, 1, 2
  • While no dose adjustment is required for mild-to-moderate renal impairment, careful monitoring is essential 1

Important Clinical Precautions

Gallbladder Disease

  • May cause cholelithiasis and gallstone-related complications 1, 2
  • Monitor throughout treatment for right-upper-quadrant pain, fever, or other signs of biliary disease 1

Hypoglycemia Risk with Concomitant Medications

  • Dose reduction required when combined with insulin or sulfonylureas to minimize hypoglycemia risk 1, 2
  • When used as monotherapy, tirzepatide carries low intrinsic hypoglycemia risk due to its glucose-dependent mechanism 1

Drug Interactions

  • Delays gastric emptying, affecting absorption of oral medications 1, 2
  • Close monitoring required for medications with narrow therapeutic indices (e.g., warfarin) 1, 2
  • For oral hormonal contraceptive users, advise non-oral contraception or addition of barrier method for 4 weeks after initiation and each dose escalation 3, 1, 2

Genetic Considerations

  • Screening for G6PD deficiency is important when considering GLP-1 class medications, particularly in patients of African American, Mediterranean, or Southeast Asian descent 2

Common Pitfalls to Avoid

  • Do not ignore dosing errors: Real-world data shows incorrect dose administration is the most common adverse event, increasing 8-fold from 2022 to 2024 4
  • Discontinue immediately if pancreatitis is suspected—do not continue while investigating 1, 2
  • Do not overlook dehydration risk: Gastrointestinal side effects can lead to severe electrolyte disturbances, including documented cases of ventricular fibrillation 1
  • Stop before elective procedures: The 5-day half-life and delayed gastric emptying increase aspiration risk during anesthesia 1

References

1
Guideline

Tirzepatide Safety and Adverse‑Effect Management

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Guideline

Contraindications and Precautions of Mounjaro (Tirzepatide)

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

3
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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