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Other important safety considerations include: Tirzepatide is not recommended in patients with severe gastrointestinal disease, including severe gastroparesis [3] [4] Risk of hypoglycaemia when used with insulin or sulfonylureas (dose reduction of these agents may be required) Potential for gallbladder disease (cholelithiasis, cholecystitis) Risk of dehydration leading to acute kidney injury Reduced exposure to oral contraceptives (additional contraception recommended for 4 weeks after initiation and after each dose increase) Patients should report suspected side effects via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk)