Pancreatitis in Patients Receiving Tirzepatide (Mounjaro): A One-Year Audit in a UK District General Hospital.

BACKGROUND

Tirzepatide (Mounjaro) is a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist increasingly prescribed for type 2 diabetes and obesity due to its efficacy in weight loss and glycaemic control. In US FDA-reviewed clinical trials, pancreatitis occurred rarely, at rates of approximately 0.32-0.39% across all doses, comparable to placebo groups. Nevertheless, concerns remain about potential drug-associated pancreatitis, with case reports describing variable severity.

AIM: To determine the frequency and clinical characteristics of pancreatitis among patients receiving tirzepatide in a UK District General Hospital over a 12-month period.

METHODS

This retrospective single-centre audit reviewed 222 inpatient admissions coded as acute or chronic pancreatitis between February 2024 and February 2025. Demographics, comorbidities, drug history, imaging, and outcomes were extracted from electronic health records, focusing on anti-diabetic and anti-obesity medications. Acute and chronic cases were analysed separately to maintain the cohort context.

RESULTS

Of 222 patients, four (1.8%) were prescribed tirzepatide at admission. All were female with a body mass index (BMI) > 24 kg/m² (overweight to obese range), presenting with first-episode acute pancreatitis. All cases were mild, with no intensive care admission, necrosis, or pseudocyst formation. Confounding risk factors were frequent: two had gallstones, one reported alcohol intake, and one had no alternative cause identified. These findings align with the literature suggesting that rapid weight loss may increase gallstone-related pancreatitis risk.

CONCLUSION

In this single-centre audit, pancreatitis in patients receiving tirzepatide was rare, mild, and commonly associated with other aetiologies, such as gallstones or alcohol. No cases of chronic pancreatitis occurred among tirzepatide users. Although causality cannot be established, the overall risk appears low. Clinicians should remain vigilant during early treatment phases when weight loss is greatest. Further multicentre studies with prescribing denominator data are warranted to clarify incidence and potential preventive measures, such as short-term ursodeoxycholic acid prophylaxis in high-risk individuals.