To the Editor:
A 66-year-old woman with history of recurrent ventral incisional hernia, multiple abdominal surgeries, small bowel obstruction, type 2 diabetes, and class III obesity presented to the emergency department with 2 days of abdominal pain, nausea, vomiting, and belching. She had been taking tirzepatide (Mounjaro), 2.5 mg/week, for 2 weeks, and had lost 3.18 kg (7 lb). Radiography showed distended loops of the small bowel, and laboratory tests showed mild dehydration. Abdominal computed tomography found a small bowel obstruction with the transition point at the entrance of the ventral hernia. After nasogastric tube placement and fluids, she passed bowel movements, and small bowel follow-through showed partial small bowel obstruction. She was discharged with instructions to discontinue tirzepatide.
The use of tirzepatide, a glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide receptor agonist, showed a monthly prescribing growth rate of 254% over 7 months in 2022, likely due to the benefit of weight loss.1,2 Despite increased prescription frequency, a 2023 cohort study showed serious adverse gastrointestinal events (eg, bowel obstruction) in individuals taking medications similar to tirzepatide.3 In September 2023, the US Food and Drug Administration added a boxed warning for ileus to the approved drug label for semaglutide (Ozempic).4
This case and two 2023 case reports identify bowel obstructions in individuals taking tirzepatide, offering compelling reasons for it to carry a warning of this potential adverse effect.5,6 Family physicians managing type 2 diabetes and obesity should identify components of a patient's history that could increase the risk for bowel obstruction before prescribing a glucagon-like peptide-1 agonist.
