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[6] Important safety considerations include: Patients with a history of pancreatitis require careful risk-benefit assessment Risk of hypoglycemia when used with insulin or insulin secretagogues (dose reductions of these medications may be needed) Monitoring for gallbladder disease (stop if cholelithiasis or cholecystitis develops) Monitoring for signs of pancreatitis (persistent severe abdominal pain, sometimes radiating to the back, with or without vomiting) No dose adjustment is required for any degree of renal impairment, including end-stage renal disease [4] [5] Patients with diabetic retinopathy should be monitored closely, as rapid glycemic improvement may temporarily worsen retinopathy Tirzepatide is not indicated for use in patients under 18 years of age

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In addition, folate is necessary in the synthesis of dTMP from dUMP (4, 22)