Who Should Not Take GLP-1 Drugs: Contraindications and Warnings
Only two things rule out these drugs outright: a personal or family history of medullary thyroid carcinoma or MEN 2, and hypersensitivity to the drug or its ingredients (Wegovy's label says "known" hypersensitivity; the other three say "serious"). Everything else is a warning or "not recommended."
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Only two conditions absolutely rule out Ozempic, Wegovy, Zepbound and Mounjaro. On the official prescribing labels for Wegovy and Ozempic (semaglutide) and Zepbound and Mounjaro (tirzepatide), the Contraindications section lists exactly two items: a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), and a hypersensitivity reaction to the drug or its ingredients [1][2][3][4]. Nothing else appears in that section on any of the four labels [1][2][3][4].
Everything else people worry about — pancreatitis history, gallbladder disease, gastroparesis, pregnancy, insulin use, upcoming surgery, diabetic retinopathy — sits in a different part of the label called Warnings and Precautions, or in “not recommended” language [1][2][3][4]. Those sections call for caution, monitoring, or avoiding the drug in a specific situation. They are not the same as a contraindication, and treating them as one goes beyond what the labels say.
This page is based on four specific label versions: the Wegovy label revised 06/2026, the Ozempic label revised 05/2026, and the Zepbound and Mounjaro labels each revised 8/2026 [1][2][3][4]. Where the text says “as of these revisions,” it means those four dated versions.
What’s the difference between a contraindication, a warning, and “not recommended”?
A contraindication is the strongest statement a label makes: do not use this drug in this situation. All four labels put contraindications in Section 4 and warnings in a separate Section 5 [1][2][3][4].
Warnings and precautions describe problems seen in trials or after approval, and they usually come with an instruction to prescribers — monitor a patient, watch for symptoms, or stop the drug if a problem is suspected. Acute pancreatitis is the classic example: all four labels say to discontinue if pancreatitis is suspected, not that people with a pancreatitis history can never use the drug [1][2][3][4].
“Not recommended” is a third, softer category that appears outside both sections. Severe gastroparesis is the main one — all four products say they are not recommended in patients with severe gastroparesis [1][2][3][4]. The labels also use this language for stacking products: Wegovy says concomitant use with other semaglutide-containing products or any other GLP-1 receptor agonist is not recommended [1], and Zepbound says the same about other tirzepatide-containing products or any GLP-1 receptor agonist [3].
What exactly do the two contraindications say?
The first contraindication is identical in substance on all four labels: personal or family history of MTC, or MEN 2 [1][2][3][4]. The second is a hypersensitivity contraindication, and the wording differs by product:
| Product | Contraindication wording | Source |
|---|---|---|
| Wegovy | Known hypersensitivity to semaglutide or any of the excipients | [1] |
| Ozempic | Serious hypersensitivity reaction to semaglutide or any of the excipients | [2] |
| Zepbound | Known serious hypersensitivity to tirzepatide or any of the excipients | [3] |
| Mounjaro | Known serious hypersensitivity to tirzepatide or any of the excipients | [4] |
Wegovy’s wording drops the word “serious” from the hypersensitivity item, while Ozempic, Zepbound and Mounjaro all include it [1][2][3][4]. No other condition appears under Contraindications on any of the four labels [1][2][3][4].
Can I take semaglutide or tirzepatide with thyroid problems?
It depends on which thyroid problem. The contraindication names only MTC and MEN 2 [1][2][3][4]. It does not list hypothyroidism, Hashimoto’s thyroiditis, benign thyroid nodules, or papillary thyroid cancer [1][2][3][4]. The labels make no statement about those conditions either way.
All four products carry a boxed warning — the most prominent warning the FDA requires — about thyroid C-cell tumors. In rodents, semaglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures [2]. Tirzepatide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors in rats at clinically relevant exposures [3], and the Mounjaro label specifies that this was seen in both male and female rats [4]. Each label states that it is unknown whether the drug causes thyroid C-cell tumors, including MTC, in humans, because the human relevance of the rodent findings has not been determined [1][2][3][4].
The Ozempic, Zepbound and Mounjaro labels add that routine monitoring of serum calcitonin or thyroid ultrasound is of uncertain value for early detection of MTC in treated patients [2][3][4]. They also list symptoms to watch for and discuss with a prescriber: a mass in the neck, trouble swallowing (dysphagia), trouble breathing (dyspnea), and persistent hoarseness [2][3][4].
One small study has looked at calcitonin directly in people. A prospective observational study followed 58 adults with obesity and no known thyroid disease — mean age 47.5 years, 72% female, mean BMI 41.4 — through 12 weeks of tirzepatide [6]. Mean calcitonin rose from 2.7 to 3.2 pg/mL, a change that was statistically significant (p = 0.003) but small in absolute terms [6]. No participant crossed the clinical threshold of 20 pg/mL, and no thyroid nodules were found on ultrasound [6]. The authors concluded the findings support short-term safety in patients without known thyroid disease or MTC risk factors [6]. This is one 12-week study of 58 people, not a label change, and it does not apply to people with MTC risk factors.
Which conditions call for caution rather than avoidance?
The Warnings and Precautions sections cover most of the situations people ask about. The four labels organize them differently, but the content overlaps heavily:
| Warning | Wegovy | Ozempic | Zepbound | Mounjaro |
|---|---|---|---|---|
| Acute pancreatitis — discontinue if suspected | Yes (5.2) | Yes (5.2) | Yes (5.5) | Yes (5.2) |
| Severe GI reactions / not recommended in severe gastroparesis | Yes (5.6) | Yes (5.7) | Yes (5.2) | Yes (5.6) |
| Acute kidney injury from volume depletion — monitor renal function | Yes (5.5) | Yes (5.6) | Yes (5.3) | Yes (5.5) |
| Acute gallbladder disease | Yes | Yes (5.9) | Yes (5.4) | Yes (5.8) |
| Hypersensitivity — anaphylaxis and angioedema reported | Yes (5.7) | Yes (5.8) | Yes (5.6) | Yes (5.4) |
| Hypoglycemia with insulin or secretagogues | Yes (5.4) | Yes (5.5) | Yes (5.7) | Yes (5.3) |
| Diabetic retinopathy — monitor for progression | Yes (5.8) | Yes (5.3) | Yes (5.8) | Yes (5.7) |
| Pulmonary aspiration with anesthesia or deep sedation | Yes (5.10) | Yes (5.10) | Yes (5.9) | Yes (5.9) |
| Heart rate increase — monitor at regular intervals | Yes (5.9) | Not in the highlights provided | Not in the highlights provided | Not in the highlights provided |
A few details differ by product. On gallbladder disease, Ozempic says gallbladder studies are indicated if cholelithiasis or cholecystitis is suspected [2]; Zepbound says studies and clinical follow-up are indicated if cholecystitis is suspected [3]; Mounjaro says studies and follow-up are indicated if cholelithiasis is suspected [4]. On hypersensitivity, the Wegovy and Zepbound labels report anaphylactic reactions and angioedema postmarketing [1][3], while the Ozempic and Mounjaro highlights state that serious hypersensitivity reactions, such as anaphylaxis and angioedema, have been reported [2][4]. All four instruct patients to discontinue the drug if a reaction is suspected and promptly seek medical advice [1][2][3][4].
The labels have also changed recently. Wegovy removed its Suicidal Behavior and Ideation warning in January 2026 [1], and Zepbound removed the same warning in February 2026 [3]. The severe GI sections were updated in October 2025 for Wegovy and Ozempic, December 2025 for Mounjaro, and February 2026 for Zepbound [1][2][3][4]. The diabetic retinopathy sections on Zepbound and Mounjaro were updated in August 2026 [3][4].
All four labels also prohibit sharing pens between patients, even if the needle is changed [1][2][3][4].
How common are GI and gallbladder problems in trials?
A meta-analysis of 13 randomized controlled trials with 26,894 participants with obesity and without diabetes pooled the gastrointestinal safety data for both drugs [7]. Overall, GI adverse events were 1.86 times more likely than with placebo (95% CI 1.56 to 2.21) [7]. Tirzepatide carried the higher relative risk — 2.94 (95% CI 2.61 to 3.32) — versus 1.68 for semaglutide (95% CI 1.46 to 1.94) [7].
The two drugs split on gallbladder outcomes. Semaglutide increased gallbladder-related disorders, particularly cholelithiasis, by more than 2.6 times (95% CI 1.40 to 4.82), while tirzepatide showed no significant biliary risk [7]. Neither drug significantly increased hepatic or pancreatic adverse events in this analysis [7]. The authors noted that most GI cases were mild [7].
Can I take these drugs with insulin or a sulfonylurea?
The labels treat this as a hypoglycemia risk, not a reason to avoid the drugs. All four say that concomitant use with insulin or an insulin secretagogue (such as a sulfonylurea) may increase the risk of hypoglycemia, including severe hypoglycemia, and that reducing the dose of insulin or the secretagogue may be necessary [1][2][3][4]. That dose-reduction instruction is directed at prescribers — the labels do not tell patients to adjust their own insulin.
Wegovy and Zepbound add that all patients should be informed of the hypoglycemia risk and educated on its signs and symptoms [1][3]. Wegovy also instructs prescribers to monitor blood glucose before starting and during treatment in patients with diabetes [1]. Wegovy and Ozempic each carry a dedicated drug-interaction section on concomitant use with an insulin secretagogue such as a sulfonylurea [1][2].
What about pregnancy, trying to conceive, or breastfeeding?
The pregnancy sections differ between the products. Wegovy’s label states it may cause fetal harm [1]. Zepbound states it may cause fetal harm and should be discontinued when pregnancy is recognized [3]. Mounjaro states that, based on animal studies, it may cause fetal harm [4].
For anyone planning a pregnancy, the semaglutide labels give a specific timeline. Wegovy instructs patients receiving it for cardiovascular risk reduction, weight reduction, or MASH (where the potential risk outweighs the potential benefit) to discontinue at least 2 months before a planned pregnancy, because of semaglutide’s long half-life [1]. Ozempic likewise says to discontinue in women at least 2 months before a planned pregnancy due to the long washout period [2].
The tirzepatide labels take a different approach. Zepbound and Mounjaro advise females using oral contraceptives to switch to a non-oral method or add a barrier method for 4 weeks after initiation and for 4 weeks after each dose escalation [3][4]. Wegovy and Ozempic carry no equivalent oral-contraceptive instruction in their highlights [1][2].
On breastfeeding, Wegovy’s label states that breastfeeding is not recommended during treatment with Wegovy tablets [1].
Do I need to stop before surgery or a colonoscopy?
Pulmonary aspiration during general anesthesia or deep sedation is a warning on all four labels [1][2][3][4]. The labels say it has been reported in patients receiving GLP-1 receptor agonists undergoing elective surgeries or procedures [1][2][3][4].
The only instruction the labels give patients is to inform their healthcare providers of any planned surgeries or procedures [1][2][3][4]. None of the four labels states a required hold interval — how long to stop the drug before a procedure — so any hold decision comes from the surgical or anesthesia team, not the label [1][2][3][4].
Do these drugs affect other oral medications?
All four drugs delay gastric emptying and may affect the absorption of oral medications taken alongside them [1][2][3][4]. Wegovy’s label advises prescribers to consider increased clinical or laboratory monitoring when it is used with oral drugs that have a narrow therapeutic index or require monitoring [1]. Ozempic’s label says to use oral medications with caution [2].
Wegovy tablets come with their own set of instructions: take once daily on an empty stomach with up to 4 ounces of water, swallow whole, and wait at least 30 minutes before taking other oral medications [1]. Wegovy tablets come in 1.5 mg, 4 mg, 9 mg and 25 mg strengths [1].
Who isn’t covered by the labels?
A few groups fall outside what the labels address. Type 1 diabetes is not an approved indication on any of the four labels [1][2][3][4]. The labels do not list NAION (nonarteritic anterior ischemic optic neuropathy) in their Warnings and Precautions highlights as of the label revisions dated above — 06/2026 for Wegovy, 05/2026 for Ozempic, and 8/2026 for Zepbound and Mounjaro [1][2][3][4].
Age coverage differs by product. Wegovy injection is approved for adults and pediatric patients aged 12 years and older with obesity [1]. Mounjaro is approved for adults and pediatric patients 10 years of age and older with type 2 diabetes, with a maximum of 10 mg once weekly in pediatric patients [4]. Zepbound’s indications are adult-only: weight reduction and maintenance, and moderate-to-severe obstructive sleep apnea in adults with obesity [3].
The labels also discourage combining products. Wegovy’s Limitations of Use says concomitant use with other semaglutide-containing products or any other GLP-1 receptor agonist is not recommended [1]. Zepbound says coadministration with other tirzepatide-containing products or any GLP-1 receptor agonist is not recommended [3].
Which drug is approved for what?
Indications differ, and that changes who is a candidate in the first place:
| Product | Approved uses | Source |
|---|---|---|
| Wegovy injection | Cardiovascular risk reduction; weight reduction and maintenance; noncirrhotic MASH with moderate-to-advanced fibrosis (F2–F3) in adults | [1] |
| Wegovy tablets | Reducing risk of major adverse cardiovascular events in adults with established cardiovascular disease plus obesity or overweight | [1] |
| Ozempic | Glycemic control in adults with type 2 diabetes; MACE reduction in type 2 diabetes with established CVD; reduced risk of sustained eGFR decline, ESKD and CV death in type 2 diabetes with CKD | [2] |
| Zepbound | Weight reduction and maintenance; moderate-to-severe obstructive sleep apnea in adults with obesity | [3] |
| Mounjaro | Glycemic control in adults and pediatric patients 10 and older with type 2 diabetes; MACE risk reduction in adults with type 2 diabetes at high risk | [4] |
Wegovy’s MASH indication was granted under accelerated approval based on improvement of MASH and fibrosis, and continued approval may be contingent on a confirmatory trial [1]. Mounjaro’s cardiovascular indication was added in August 2026 [4].
What is the complete list of people who cannot take these drugs?
The absolute “do not use” list has two items: a personal or family history of MTC or MEN 2, and hypersensitivity to the drug or its excipients — worded as “known hypersensitivity” on the Wegovy label and as a serious hypersensitivity reaction on the Ozempic, Zepbound and Mounjaro labels [1][2][3][4].
Pancreatitis history, gallbladder disease, gastroparesis, pregnancy, insulin use, upcoming surgery and retinopathy all fall under warnings or “not recommended” language instead [1][2][3][4].
Each label comes with a Medication Guide and a patient counseling section (Section 17) [1][2][3][4]. Suspected adverse reactions can be reported to the manufacturer — Novo Nordisk at 1-833-934-6891 for Wegovy or 1-888-693-6742 for Ozempic, and Eli Lilly at 1-800-545-5979 — or to the FDA at 1-800-FDA-1088 [1][2][3][4].
Sources
- Novo Nordisk. Wegovy (semaglutide) prescribing information.
- Novo Nordisk. Ozempic (semaglutide) prescribing information.
- Eli Lilly and Company. Zepbound (tirzepatide) prescribing information.
- Eli Lilly and Company. Mounjaro (tirzepatide) prescribing information.
- European Journal of Endocrinology. Safety of glucagon-like peptide-1 receptor agonists in neuroendocrine neoplasms.
- Endocrine. Short-term effect of tirzepatide on serum calcitonin in adults with obesity. May 4, 2026.
- Annals of Saudi Medicine. Gastrointestinal safety of semaglutide and tirzepatide vs. placebo in obese individuals without diabetes: a systematic review and meta analysis. 2025.
- Diabetes Care. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2026. January 2026.
- Anesthesiology. Preoperative Glucagon-Like Peptide-1 Receptor Agonists and Postoperative Outcomes: An Observational Analysis. August 12, 2026.
- The Journal of Clinical Pharmacology. Semaglutide-Induced Nonarteritic Anterior Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis. 2026.
- Ophthalmology. Cup-to-disc ratio in GLP-1 RA Associated Non-Arteritic Anterior Ischemic Optic Neuropathy.
Frequently asked questions
Is a thyroid nodule or hypothyroidism a reason to avoid these drugs?
No. The contraindication covers only medullary thyroid carcinoma (personal or family history) and MEN 2. Hypothyroidism, Hashimoto's and benign nodules are not listed as contraindications on any of the four labels. The labels do say to watch for thyroid tumor symptoms like a neck mass, trouble swallowing, or persistent hoarseness.
Does a history of pancreatitis rule you out?
No. Acute pancreatitis is a warning, not a contraindication. All four labels say pancreatitis has been observed with GLP-1 receptor agonists and to discontinue the drug if pancreatitis is suspected. A prior history of pancreatitis is not listed in the Contraindications section of any label.
Can you use them with insulin or a sulfonylurea?
Yes, with caution. All four labels say combining these drugs with insulin or an insulin secretagogue may raise the risk of hypoglycemia, including severe hypoglycemia, and that reducing the insulin or secretagogue dose may be necessary. That adjustment is a prescriber decision — the labels do not direct patients to change doses themselves.
How long before trying to conceive should you stop semaglutide?
The Wegovy and Ozempic labels both say to discontinue at least 2 months before a planned pregnancy, citing semaglutide's long half-life and washout period. Wegovy frames this for patients receiving it for cardiovascular risk reduction, weight reduction, or MASH where risk outweighs benefit.
Do these drugs interfere with birth control pills?
The tirzepatide labels address this directly: Zepbound and Mounjaro advise females on oral contraceptives to switch to a non-oral method or add a barrier method for 4 weeks after initiation and 4 weeks after each dose escalation. Wegovy and Ozempic carry no equivalent instruction in their highlights.
Can you breastfeed while using them?
The Wegovy label states that breastfeeding is not recommended during treatment with Wegovy tablets.
Do you need to stop before surgery or a colonoscopy?
The labels do not set a required hold period. All four warn that pulmonary aspiration during general anesthesia or deep sedation has been reported in GLP-1 users undergoing elective procedures, and the only patient instruction is to tell healthcare providers about planned surgeries or procedures. Any hold decision rests with the surgical or anesthesia team.
Are they allowed with gastroparesis or severe GI disease?
Not with severe gastroparesis. All four labels state the drug is not recommended in patients with severe gastroparesis.
This article summarizes FDA labeling, published research and company information current as of September 14, 2026. It is not medical advice and does not replace a conversation with your own healthcare provider. How we research and verify.