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Since tirzepatide may slow gastric emptying as part of its mechanism of action, patients with pre-existing severe gastroparesis could experience worsening of symptoms, including nausea, vomiting, and potential complications related to delayed gastric emptying

Women of childbearing potential must comply with the MHRA Pregnancy Prevention Programme for topiramate, using highly effective contraception and signing risk acknowledgement forms

The researchers also reported: 46 Complete disappearance of nighttime pain in 91% of participants, and Healing in 65% of subjects during endoscopic assessment

Relative contraindications These are situations where the combination might be possible under very careful supervision but carry elevated risk that must be weighed against potential benefit: Controlled hypertension (even well-managed blood pressure requires closer monitoring on this combination) History of anxiety disorders (phentermine can exacerbate anxiety through CNS stimulation) History of pancreatitis (GLP-1 receptor agonists including tirzepatide carry a theoretical risk of pancreatitis) Gallbladder disease (rapid weight loss from combination therapy increases gallstone risk) Severe gastrointestinal conditions including gastroparesis (tirzepatide further slows already-compromised gastric motility) Kidney disease (dehydration risk from combined GI side effects can worsen renal function) If you fall into any of these categories, the conversation with your provider needs to be particularly thorough