GLP-1 Contraindications Reference: Absolute, Relative, and Precautions for Prescribers
Complete contraindications reference for GLP-1 medications. Absolute contraindications, relative contraindications, precautions, and special population considerations.
More on Provider-Facing
Contraindications Summary
All GLP-1 agonists carry a black box warning for MTC risk (rodent data). Screen for personal/family history of MTC and MEN2 before prescribing. Pregnancy is an absolute contraindication. Active pancreatitis precludes use.
Contraindications and Precautions Table
| Condition | Type | Action | Notes |
|---|---|---|---|
| Personal/family MTC | Absolute | Do not prescribe | GLP-1 causes thyroid C-cell tumors in rodents |
| MEN2 syndrome | Absolute | Do not prescribe | Associated with MTC risk |
| Hypersensitivity to drug | Absolute | Do not prescribe | Prior anaphylaxis or angioedema |
| Pregnancy | Absolute | Discontinue immediately | Stop 2+ months before conception |
| Active pancreatitis | Absolute | Do not initiate | May reinitiate after resolution if benefit outweighs risk |
| History of pancreatitis | Relative | Use with caution | Monitor symptoms, check lipase if symptomatic |
| Gastroparesis | Relative | Generally avoid | GLP-1 worsens gastric emptying delay |
| Severe renal impairment | Relative | Use with caution | Monitor hydration and renal function closely |
| Gallbladder disease | Precaution | Monitor | Rapid weight loss increases cholelithiasis risk |
| Diabetic retinopathy | Precaution | Ophthalmology consult | Rapid glucose improvement may worsen retinopathy |
Pre-Prescribing Screening Checklist
Must Ask
- Any personal or family history of thyroid cancer?
- Any history of pancreatitis?
- Are you pregnant or planning pregnancy?
- Any history of gastroparesis or severe GI disorders?
Must Evaluate
- Current renal function (eGFR)
- Hepatic function
- Current medication list for interactions
- Mental health history and current status
Clinical Disclaimer: This reference is for licensed providers. Verify current FDA labeling for complete contraindication information. Clinical judgment should guide individual prescribing decisions.
Frequently Asked Questions
What are the absolute contraindications for GLP-1 agonists?
Absolute contraindications: personal or family history of medullary thyroid carcinoma (MTC), Multiple Endocrine Neoplasia syndrome type 2 (MEN2), known hypersensitivity to semaglutide/tirzepatide or any excipient, pregnancy (Category X), and active pancreatitis.
What are relative contraindications?
Relative contraindications (use with caution): history of pancreatitis, gastroparesis or severe GI motility disorders, severe renal impairment (eGFR <15), severe hepatic impairment, history of suicidal ideation/behavior, gallbladder disease, and diabetic retinopathy with active complications.
Can patients with Type 1 diabetes use GLP-1 medications?
GLP-1 medications are not FDA-approved for Type 1 diabetes weight loss. However, off-label use may be considered with endocrinology supervision. The primary concern is that GLP-1 medications may mask hypoglycemia symptoms. Insulin management requires careful adjustment.
How do I screen for MTC/MEN2 before prescribing?
Screen with: personal history of thyroid cancer or thyroid nodules, family history of MTC or MEN2, unexplained calcitonin elevation. Routine calcitonin screening is NOT recommended per FDA labeling, but inquire about family cancer history. If thyroid nodule present, evaluate with ultrasound and calcitonin before initiating GLP-1.
Trimi Provider Resources
Compounded semaglutide from $99/mo or tirzepatide from $125/mo.
View Treatment OptionsMedical Disclaimer: This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting any medication or treatment program.
Sources & References
- Wilding JPH et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. NEJM 2021;384:989-1002.
- Jastreboff AM et al. Tirzepatide Once Weekly for the Treatment of Obesity. NEJM 2022;387:205-216.
- Lincoff AM et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. NEJM 2023;389:2221-2232.
- FDA Prescribing Information for Wegovy (semaglutide) and Zepbound (tirzepatide).