• Personal or family history of medullary thyroid carcinoma (MTC).

• Patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

• Known serious hypersensitivity to tirzepatide or any of the excipients.

• Risk of Thyroid C-Cell Tumors: Has been observed in rodent studies. Relevance to humans unknown. Monitor patients for signs and symptoms of thyroid tumors.

• Pancreatitis: Has been reported. Discontinue promptly if pancreatitis is suspected.

• Hypoglycemia: May occur when used concomitantly with insulin secretagogues (e.g., sulfonylureas) or insulin. Consider lowering the dose of these medications.

• Acute Kidney Injury: Monitor renal function in patients with renal impairment reporting severe adverse gastrointestinal reactions.

• Severe Gastrointestinal Disease: Use may be associated with gastrointestinal adverse reactions, sometimes severe.

• May delay gastric emptying and impact the absorption of concomitantly administered oral medications.

• Use with insulin or insulin secretagogues increases the risk of hypoglycemia.

• Instruct on proper injection technique and the importance of dose titration to manage GI side effects.

• Advise patients to report symptoms of pancreatitis (persistent severe abdominal pain), thyroid tumors (lump in neck, dysphagia), or hypoglycemia.

• Counsel on the importance of a reduced-calorie diet and increased physical activity.