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Active or symptomatic gallstones Usually not recommended to start Mounjaro Higher risk of complications (pain, inflammation, bile duct blockage) These patients typically need further assessment or treatment first

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Seek immediate medical attention (call 999 or go to A&E) if you experience: Signs of pancreatitis such as severe, persistent abdominal pain radiating to the back, often accompanied by nausea and vomiting Signs of allergic reaction including rash, itching, swelling, difficulty breathing, or feeling faint You should contact your healthcare provider if you experience: Persistent or severe gastrointestinal symptoms including nausea, vomiting, diarrhoea, or abdominal pain that interferes with daily activities or prevents adequate nutrition and hydration Symptoms of gallbladder disease including right upper abdominal pain, particularly after eating fatty meals Hypoglycaemia symptoms (if taking tirzepatide alongside insulin or sulfonylureas) such as trembling, sweating, confusion, or palpitations Changes in vision or eye problems, especially if you have diabetic retinopathy Unexplained rapid heart rate or palpitations Regarding treatment effectiveness, schedule a review appointment if: Your weight loss or blood glucose control has not improved as expected after several months of treatment at the maximum tolerated dose You experience significant weight regain (more than 35% of lost weight) despite maintaining lifestyle modifications You are considering stopping treatment or have concerns about long-term use You are planning pregnancy or become pregnant (tirzepatide should be discontinued) You need to discuss contraception (reduced oral contraceptive effectiveness requires barrier method use for 4 weeks after starting and after each dose increase) You have upcoming surgery or procedures requiring sedation (due to delayed gastric emptying effects) Never discontinue tirzepatide abruptly without medical guidance, particularly if using it for diabetes management, as this may lead to deterioration in glycaemic control

Manufacturer assistance programs, specialty pharmacy discounts, and therapeutic alternatives all deserve evaluation before defaulting to the cheapest compounded option with unknown quality controls