Semaglutide is contraindicated in patients with a history of angioedema, anaphylaxis, or other serious hypersensitivity reactions to semaglutide.
Semaglutide is contraindicated in patients with a personal or family history of certain types of thyroid cancer, specifically thyroid C-cell tumors such as medullary thyroid carcinoma (MTC), or in patients with multiple endocrine neoplasia syndrome type 2 (MEN 2).
Semaglutide should not be used for the treatment of type 1 diabetes mellitus.
Semaglutide has not been studied in patients with a history of pancreatitis to determine whether these patients are at increased risk for pancreatitis.
Use semaglutide with caution in patients with known gallbladder disease or a history of cholelithiasis. If cholelithiasis or cholecystitis is suspected in a patient taking semaglutide, gallbladder imaging is indicated.
During semaglutide therapy, patients with a history of diabetic retinopathy should be closely monitored.
Use caution during treatment with semaglutide in patients with renal impairment or end-stage renal disease.
Suicidal behavior and ideation have been reported in clinical trials with other incretin mimetics indicated for weight management.
Semaglutide for the treatment of obesity or weight management should not be used during pregnancy because weight loss offers no potential benefit to a pregnant woman and may result in fetal harm due to the potential hazard of maternal weight loss to the fetus. According to the American Association of Clinical Endocrinologists and American College of Endocrinology (AACE/ACE) Obesity Clinical Practice Guidelines, weight loss medications must not be used during pregnancy; Semaglutide may be associated with reproductive risk and preconceptual planning is recommended; females of childbearing potential should discontinue semaglutide at least 2 months before a planned pregnancy due to the drug’s long washout period. Geriatric adults are especially at risk for hypoglycemic episodes.
Cyanocobalamin is contraindicated in those with hypersensitivity to the cobalt moiety or the cobalamin molecule due to the risk of anaphylaxis.
The use of cyanocobalamin is contraindicated in patients with early Leber’s disease, as there have been reports of severe and swift optic atrophy with its administration. Appropriate caution should be exercised while treating severe megaloblastic anemia with cyanocobalamin, as intense treatment may lead to hypokalemia and sudden death.
Cautious use of parenteral cyanocobalamin is also recommended in patients with renal impairment.
Tirzepatide causes thyroid C-cell tumors in rats. It is unknown whether Tirzepatide causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as the human relevance of tirzepatide-induced rodent thyroid C-cell tumors has not been determined.
Tirzepatide is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)—counsel patients regarding the potential risk of MTC and symptoms of thyroid tumors.
Patients with Renal Impairment: Tirzepatide is associated with gastrointestinal ADRs, including nausea, vomiting, and diarrhea, leading to dehydration, which can cause acute kidney injury. Use with caution in patients prone to dehydration.