Medication Safety & Who Should Not Use a GLP-1

Personal or family history of medullary thyroid carcinoma, or diagnosis of Multiple Endocrine Neoplasia type 2. This boxed warning applies across the class.

Serious hypersensitivity to the active drug or components.

Pregnancy for weight‑management indications. Weight loss drugs offer no benefit in pregnancy and may cause fetal harm. For semaglutide used for weight reduction, discontinue at least 2 months before a planned pregnancy because of the long half‑life. Stop tirzepatide or semaglutide immediately if pregnancy is recognized.

History of pancreatitis, or unexplained severe abdominal pain. Stop the drug and evaluate if pancreatitis is suspected.

Gallbladder disease risk. Substantial or rapid weight loss and the drugs themselves can be associated with gallstones or cholecystitis. Educate on symptoms and evaluate promptly.

Acute kidney injury risk with dehydration. Persistent vomiting or diarrhea can tip vulnerable patients into kidney injury. Push fluids and pause the drug when needed.

Diabetic retinopathy complications in patients with a history of retinopathy, particularly during rapid glucose improvement. Monitor vision changes and coordinate eye care.

Severe gastrointestinal disease, including gastroparesis. These medicines slow gastric emptying and can worsen symptoms. Use with caution or avoid in severe cases.

Procedures with general anesthesia or deep sedation. Delayed gastric emptying increases aspiration risk. Inform the anesthesia team well in advance and follow their peri‑procedural plan.

Not for type 1 diabetes or diabetic ketoacidosis, and not a substitute for insulin.

Hypoglycemia risk rises when combined with insulin or sulfonylureas; consider dose reduction of those agents and educate patients on recognition and treatment.

Counsel on common GI effects and how to mitigate them. Pause dose escalation if symptoms are significant.