Who Should Not Take GLP-1 Drugs, According to the Labels

Search “who can’t take Ozempic” and you will find dozens of lists that mix together three completely different things: absolute prohibitions, cautionary warnings, and situations nobody has studied. The FDA labels keep those separate, and the difference matters.

This article walks through what the current US prescribing information actually says, section by section, for Wegovy and Ozempic (semaglutide) and Zepbound and Mounjaro (tirzepatide). Labels read directly and verified September 14, 2026: Wegovy revised 06/2026, Ozempic revised 05/2026, Zepbound revised 8/2026, Mounjaro revised 8/2026.

This article summarizes those FDA-approved labels and their Instructions for Use. It is not a set of instructions, and it is not medical advice: follow your own prescription and your own provider. Only a healthcare provider who knows your history can tell you whether any of this applies to you.

What is an absolute contraindication, and what is just a warning?

A contraindication is the strongest thing a label can say. It means do not use this drug in this situation, full stop.

A Warning and Precaution means the drug can be used, but a specific risk has been identified and needs managing.

A “not recommended” statement sits in between: the label declines to prohibit use but tells prescribers it is not advised.

And then there is the largest category of all, which appears nowhere on a label: things nobody has studied. Absence from the label is not a safety clearance.

What are the two contraindications on every label?

Wegovy, Ozempic, Zepbound and Mounjaro each list exactly two [1][2][3][4].

1. A personal or family history of medullary thyroid carcinoma, or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

This comes from the boxed warning that every product in this class carries. In rodents, both semaglutide and tirzepatide caused dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. The labels state plainly that it is unknown whether these drugs cause thyroid C-cell tumors, including medullary thyroid carcinoma, in humans, because the human relevance of the rodent finding has not been determined [1][3].

Two things follow that most consumer articles get wrong. First, the contraindication is specific to medullary thyroid carcinoma and MEN 2 — not hypothyroidism, not Hashimoto’s, not garden-variety thyroid nodules, not papillary thyroid cancer. Second, the labels say routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection in people taking these drugs [3]. So the contraindication stands, but the label does not offer a screening test to work around it.

What does the human evidence say? A 2026 review in the European Journal of Endocrinology examined GLP-1 receptor expression across endocrine tissues and the evidence on neuroendocrine neoplasms. Preclinical studies show proliferative effects in pancreatic and small intestinal neuroendocrine tumor cell lines, but data from retrospective studies, randomized trials and cancer registries conflict and do not support a generalized increase in neuroendocrine neoplasms; some epidemiological studies even show survival benefits [5]. A small prospective study in Endocrine measured serum calcitonin in 58 adults with obesity and no known thyroid disease before and after 12 weeks of tirzepatide: mean calcitonin rose from 2.7 to 3.2 pg/mL, statistically significant but small, with no participant exceeding the 20 pg/mL clinical threshold and no nodules on ultrasound [6].

None of that changes the label. A contraindication is not a probability estimate. It means the label says do not use.

2. A known serious hypersensitivity reaction to the active ingredient or any excipient.

The exact wording varies slightly. Ozempic and Zepbound say “serious hypersensitivity reaction”; the Wegovy highlights say “known hypersensitivity,” while section 5.7 of the same label specifies a “prior serious hypersensitivity reaction” [1][2][3].

Serious hypersensitivity reactions including anaphylaxis and angioedema have been reported in the postmarketing period with tirzepatide, and the Zepbound label instructs patients who suspect one to seek medical attention promptly and discontinue [3].

Who does the label say should be careful, but not necessarily avoid it?

This is the long list, and it is where nearly every real-world decision actually happens. The Zepbound label organizes its warnings as follows [3]:

• Severe gastrointestinal adverse reactions (5.2). In a pool of two Zepbound weight-reduction trials, severe gastrointestinal adverse reactions occurred in 1.7 percent (5 mg), 2.5 percent (10 mg) and 3.1 percent (15 mg) of Zepbound patients versus 1 percent on placebo. The label states Zepbound is not recommended in patients with severe gastroparesis [3]. Wegovy carries a parallel statement, and reports severe gastrointestinal adverse reactions in 4.1 percent of Wegovy injection patients versus 0.9 percent on placebo, and 2 percent of Wegovy tablet patients versus 0 percent on placebo [1].
• Acute kidney injury due to volume depletion (5.3). Postmarketing reports of acute kidney injury, in some cases requiring hemodialysis, mostly in people who got dehydrated from nausea, vomiting or diarrhea. The labels say to monitor kidney function in anyone reporting reactions that could cause volume depletion, especially during dose initiation and escalation [1][3].
• Acute gallbladder disease (5.4). In the pooled Zepbound weight trials, cholelithiasis was reported in 1.1 percent of treated patients versus 1 percent on placebo [3]. A meta-analysis of 13 randomized trials in 26,894 adults with obesity and no diabetes found semaglutide increased gallbladder-related disorders, particularly cholelithiasis, by more than 2.6 times (95 percent CI 1.40-4.82), while tirzepatide showed no significant biliary risk in that analysis [7]. Rapid weight loss from any cause raises gallstone risk, so this is partly an effect of the weight loss itself.
• Acute pancreatitis (5.5). Not a contraindication. The labels say to discontinue if pancreatitis is suspected [1][3].
• Hypersensitivity reactions (5.6).
• Hypoglycemia (5.7). Only relevant in combination — see below.
• Diabetic retinopathy complications in patients with type 2 diabetes (5.8). The labels say to monitor patients with a history of diabetic retinopathy for progression. This section was updated on the Zepbound label in 08/2026 [3].
• Pulmonary aspiration during general anesthesia or deep sedation (5.9). Covered below.
• Never share a Zepbound KwikPen between patients (5.10). Sharing risks transmission of blood-borne pathogens even if the pen needle is changed [3]. The parallel Wegovy item is at 5.11 [1].

The Wegovy label adds heart rate increase (5.9) to its own list [1], and the Ozempic label leads with acute pancreatitis and diabetic retinopathy complications [2].

One warning is notably absent: Suicidal Behavior and Ideation was removed from the Zepbound label in 02/2026, and from the Wegovy label in January 2026 [3]. Removal reflects a regulatory judgment on the accumulated evidence.

What if I am on insulin or a sulfonylurea?

Every relevant label carries the same instruction. Concomitant use with insulin or an insulin secretagogue such as a sulfonylurea may increase the risk of hypoglycemia, including severe hypoglycemia, and reducing the dose of the insulin or secretagogue may be necessary [1][2][3][4].

This is a drug interaction, not a prohibition, and the combination is used widely. Note who the label is talking to: it tells prescribers to monitor blood glucose before and during treatment and to consider reducing the dose of the insulin or secretagogue when starting [1][2][3][4]. Nothing in the labeling directs a patient to adjust an insulin or sulfonylurea dose independently.

The Wegovy label also states that use of Wegovy in patients with type 1 diabetes, or in combination with insulin, has not been evaluated [1]. That is not a prohibition either — it is a gap. All use in type 1 diabetes is off-label.

Can I take these if I am pregnant, planning a pregnancy, or breastfeeding?

Pregnancy. The Wegovy label says weight loss offers no benefit to a pregnant patient and may cause fetal harm, and instructs that Wegovy be discontinued when pregnancy is recognized in patients using it for weight reduction or cardiovascular risk reduction. For the MASH indication, the label says to use during pregnancy only if the potential benefit justifies the risk [1]. The Zepbound label says available data in pregnant patients are insufficient to evaluate drug-related risk, that animal reproduction studies showed fetal growth reductions and fetal abnormalities at clinically relevant exposures in rats and fetal growth reductions in rabbits, and to discontinue when a pregnancy is recognized [3].

Before a planned pregnancy. The Wegovy label says to discontinue at least 2 months before a planned pregnancy, to account for semaglutide’s long half-life [1]. ADA Standards of Care in Diabetes 2026, recommendation 15.5, says GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists should be discontinued prior to pregnancy and that contraception should be used while taking them; it notes the US tirzepatide label sets no pre-pregnancy interval while Canadian labeling recommends stopping at least 1 month before [8].

Contraception. This is a real difference between the two drugs. The Zepbound label, section 8.3, says use may reduce the efficacy of oral hormonal contraceptives because of delayed gastric emptying, that the delay is largest after the first dose and diminishes over time, and advises switching to a non-oral method or adding a barrier method for 4 weeks after starting and for 4 weeks after each dose escalation [3]. Semaglutide labels carry no equivalent instruction.

Breastfeeding. The Wegovy highlights say breastfeeding is not recommended during treatment with Wegovy tablets [1]. The Mounjaro and Zepbound labels report that in a single-dose lactation study, tirzepatide in breast milk was either undetectable or low relative to the maternal dose, with no data on effects on the breastfed infant or on milk production [3][4].

What about surgery, endoscopy or dental sedation?

Both labels carry a Pulmonary Aspiration During General Anesthesia or Deep Sedation warning. The text says there have been rare postmarketing reports of pulmonary aspiration in people on GLP-1 receptor agonists undergoing elective surgeries or procedures requiring general anesthesia or deep sedation who had residual gastric contents despite reported adherence to preoperative fasting recommendations, and that available data are insufficient to inform recommendations on whether modifying fasting instructions or temporarily discontinuing the drug would reduce retained gastric contents [1][3].

The label’s only instruction to patients: tell your healthcare providers before any planned surgery or procedure.

The observational evidence is more reassuring than the warning sounds. A propensity-matched analysis in Anesthesiology in August 2026, covering surgeries between June 2013 and June 2023 — before the 2023 American Society of Anesthesiologists guidance to hold these drugs preoperatively — found preoperative GLP-1 use associated with lower 14-day postoperative mortality compared with metformin (0.98 percent versus 2.20 percent, risk ratio 0.44) and with DPP-4 inhibitors (1.84 versus 2.89 percent, risk ratio 0.63), and no increased aspiration risk compared with any other drug class [9].

Whether to hold a dose before a specific procedure is a decision for your surgical and anesthesia team, not something to decide from an article.

Are there groups the labels simply have no data on?

Yes, and this is the most underreported part of the picture.

• Children on Zepbound. The label states safety and effectiveness have not been established in pediatric patients [3]. Wegovy injection is approved for pediatric patients 12 and older with obesity [1], and Mounjaro is approved for children 10 and older with type 2 diabetes [4]. These are not interchangeable.
• Type 1 diabetes. Not evaluated for Wegovy [1]. Not an approved indication for any product in the class.
• Combining products. The Wegovy label states that concomitant use with other semaglutide-containing products, or any other GLP-1 receptor agonist, is not recommended [1]. Stacking is not a strategy the label supports.
• Eye risk. Nonarteritic anterior ischemic optic neuropathy (NAION) is not in the US Wegovy or Ozempic Warnings and Precautions as of the labels verified here. A 2026 meta-analysis of eight observational cohort studies covering 5,916,559 participants found semaglutide users had higher NAION risk (relative effect 1.93, 95 percent CI 1.22-3.08), significant in people with diabetes but not in people with overweight or obesity, with very high heterogeneity [10]. A separate multicenter study found the main risk factor is a crowded optic disc: eyes with a measured cup-to-disc ratio of 0.20 or less had an odds ratio of 46.3 for NAION regardless of GLP-1 exposure [11].

What about kidney disease, liver disease and older age?

The labels are more permissive here than people expect.

• Kidney impairment. No dosage adjustment is recommended for Zepbound in renal impairment, including end-stage renal disease, where no change in tirzepatide pharmacokinetics was observed [3]. Monitoring is advised for anyone with reactions causing volume depletion.
• Liver impairment. No dosage adjustment is recommended for Zepbound in hepatic impairment [3]. Wegovy injection additionally carries an indication for noncirrhotic MASH with moderate to advanced fibrosis (stages F2 to F3) in adults. That indication was granted under accelerated approval based on improvement in MASH and fibrosis, and the label states that continued approval may depend on a confirmatory trial [1].
• Age. No US label sets an upper age limit or an age-based dose. The Zepbound label notes that 226 patients (9 percent) in its pooled weight-reduction studies were 65 or older and 13 (0.5 percent) were 75 or older, with no overall differences in safety or effectiveness observed [3].

The short version

The list of people the labels say must not take these drugs is very short: people with a personal or family history of medullary thyroid carcinoma or MEN 2, and people who have had a serious allergic reaction to the product.

Everything else — pancreatitis history, gallbladder disease, gastroparesis, pregnancy, insulin use, upcoming surgery, retinopathy, kidney or liver disease — lives in warnings, monitoring instructions, and “not recommended” language that a prescriber has to weigh against your situation.

That is the honest answer, and it is why the only useful next step is a real conversation with a healthcare provider who can read your history alongside the label.

Sources

1. Wegovy (semaglutide) injection and tablets, US prescribing information, revised 06/2026. Novo Nordisk. https://www.novo-pi.com/wegovy.pdf
2. Ozempic (semaglutide) injection, US prescribing information, revised 05/2026. Novo Nordisk. https://www.novo-pi.com/ozempic.pdf
3. Zepbound (tirzepatide) injection, US prescribing information, revised 8/2026. Eli Lilly and Company. https://uspl.lilly.com/zepbound/zepbound.html
4. Mounjaro (tirzepatide) injection, US prescribing information. Eli Lilly and Company. https://uspl.lilly.com/mounjaro/mounjaro.html
5. Safety of glucagon-like peptide-1 receptor agonists in neuroendocrine neoplasms. European Journal of Endocrinology. 2026. https://doi.org/10.1093/ejendo/lvag135
6. Short-term effect of tirzepatide on serum calcitonin in adults with obesity. Endocrine. 2026. https://doi.org/10.1007/s12020-026-04655-y
7. Gastrointestinal safety of semaglutide and tirzepatide vs. placebo in obese individuals without diabetes: a systematic review and meta-analysis. Annals of Saudi Medicine. 2025. https://doi.org/10.5144/0256-4947.2025.129
8. American Diabetes Association. Management of Diabetes in Pregnancy: Standards of Care in Diabetes 2026. Diabetes Care. https://doi.org/10.2337/dc26-S015
9. Preoperative Glucagon-Like Peptide-1 Receptor Agonists and Postoperative Outcomes: An Observational Analysis. Anesthesiology. 2026. https://doi.org/10.1097/ALN.0000000000006326
10. Semaglutide-Induced Nonarteritic Anterior Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis. Journal of Clinical Pharmacology. 2026. https://doi.org/10.1002/jcph.70248
11. Cup-to-disc ratio in GLP-1 RA associated non-arteritic anterior ischemic optic neuropathy. Ophthalmology. 2026. https://doi.org/10.1016/j.ophtha.2026.07.036