GLP-1 Contraindications: Who Should Not Take GLP-1

You have probably done some research about whether a GLP-1 medication is right for you. Maybe you are looking into what might work for your situation, or maybe you have been told by a provider that you should check whether it is safe given your medical history. The good news is that GLP-1 medications work well for many people. But they do not work for everyone. Some health conditions make GLP-1 medications unsafe, even if weight loss is desperately needed. This page walks through who should not take these medications and which conditions need extra care.

This content is for general education and is not medical advice. Talk with a licensed provider about your situation. Your provider makes the final determination about whether a GLP-1 medication is safe and appropriate for you. But knowing the contraindications upfront can save you time and help you understand what information your provider will need.

What is a contraindication?

A contraindication is a medical condition that makes a medication unsafe or inappropriate to use. Some contraindications are absolute, meaning the medication should not be used under any circumstances. Others are relative, meaning the medication might be used, but only with careful provider evaluation and close monitoring.

FDA prescribing information (the “label”) keeps these separate. Section 4 lists contraindications. Section 5 lists warnings and precautions, and section 8 covers use in specific populations such as pregnancy. The labels for Wegovy (semaglutide)^[1] and Zepbound (tirzepatide)^[3] list two contraindications. Everything else on this page comes from the warnings and other label sections, or from general clinical practice, and we say which is which. Compounded semaglutide and tirzepatide do not have FDA-approved labels; this page describes the FDA labels for the approved products.

Absolute contraindications: Do not use

These are the conditions the labels list as contraindications. The medication should not be used if any of them applies to you.

Personal or family history of medullary thyroid carcinoma (MTC)

Medullary thyroid carcinoma is a rare cancer of the thyroid that comes from thyroid cells called C-cells. Semaglutide and tirzepatide carry a “black box” (boxed) warning from the FDA^[1][3] because in studies in rodents, these medications caused thyroid C-cell tumors at exposures similar to those in people taking them. It is unknown whether they cause thyroid C-cell tumors, including MTC, in humans.

If you or a family member has had medullary thyroid carcinoma, the labels say not to use semaglutide or tirzepatide.

The contraindication covers any personal or family history. It does not make an exception for cancer that was many years ago or that was successfully treated.

Want to understand the thyroid warning in depth? Read our full explanation of the thyroid cancer black box warning and what the research actually shows.

Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)

MEN 2 is an inherited genetic condition that increases the risk of medullary thyroid carcinoma and other tumors. People with MEN 2 have an abnormally high lifetime risk of developing medullary thyroid cancer. Because of this elevated baseline risk, combined with the thyroid warning on GLP-1s, the labels contraindicate these medications if you have MEN 2^[1][3]. If MEN 2 runs in your family, tell the provider.

This is another case where the risk profile is too high, even if the potential weight loss benefit is significant.

Known serious allergic reaction to the medication

If you have had a serious allergic reaction (such as anaphylaxis or angioedema, a severe swelling of the face, lips, tongue, or throat) to semaglutide or tirzepatide, or to any of the inactive ingredients in the product, you should not take that medication^[1][3]. If you had anaphylaxis or angioedema with a different GLP-1 medication, the labels advise caution, because it is unknown whether you would react to another one.

Important relative contraindications and precautions

These conditions require careful provider evaluation. They are not on the labels’ contraindication lists, but they create meaningful clinical concerns that must be addressed before a prescription is written. Pregnancy, gastroparesis, pancreatitis, kidney problems, diabetic retinopathy, and low blood sugar come from the labels. Type 1 diabetes and eating disorders are general clinical considerations.

The labels also warn about acute gallbladder disease (such as gallstones), pulmonary aspiration (inhaling stomach contents) during general anesthesia or deep sedation, and, on the Wegovy label, an increase in resting heart rate^[1][3].

Pregnancy

Both labels say these medications may cause fetal harm, that weight loss offers no benefit during pregnancy, and that the medication should be stopped when pregnancy is recognized in people taking it for weight management^[1][3]. Animal studies suggested potential risks to the developing baby, and human data are not enough to rule a drug-related risk in or out.

The labels differ on planning ahead:

• Wegovy (semaglutide): stop at least 2 months before a planned pregnancy, because semaglutide stays in the body for a long time^[1]. (For people taking Wegovy for MASH, a liver condition, the label says this applies when the potential risk outweighs the potential benefit.) The label also says breastfeeding is not recommended while taking Wegovy tablets.
• Zepbound (tirzepatide): stop when pregnancy is recognized; the label does not set a stop time before conception^[3]. The label also says tirzepatide may make birth control pills less effective. It advises switching to a non-oral method, or adding a barrier method, for 4 weeks after starting and for 4 weeks after each dose increase.

If you become pregnant while on a GLP-1 medication, contact your provider right away so they can evaluate your specific situation and help you plan next steps.

Active or severe gastroparesis

Gastroparesis is a condition where the stomach does not empty normally. Food moves through the stomach more slowly than it should, which can cause bloating, nausea, and vomiting. GLP-1 medications delay gastric emptying, meaning they slow the rate at which food moves from the stomach into the small intestine.

Both labels say the medication is not recommended in people with severe gastroparesis^[1][3]. This appears in the warnings section, not the contraindications list, but “not recommended” is a strong caution. Both labels also warn that these medications can cause gastrointestinal side effects that are sometimes severe.

The labels do not name other gastrointestinal motility disorders. If you have any condition that affects how your stomach or intestines move food through your system, tell the provider so they can weigh it.

History of pancreatitis

The pancreas produces insulin and digestive enzymes. Pancreatitis is inflammation of the pancreas, and it can be very serious. Both labels carry a warning for acute pancreatitis, including fatal cases, in people taking GLP-1 medications. They say to watch for persistent or severe abdominal pain (sometimes spreading to the back, with or without vomiting) and to stop the medication if pancreatitis is suspected^[1][3]. In the weight management trials described in the labels, confirmed acute pancreatitis was uncommon.

If you have a history of pancreatitis, you are not automatically disqualified from using a GLP-1 medication. But your provider needs to know about it. They will evaluate:

• What caused your pancreatitis (gallstones, alcohol, high triglycerides, or unknown cause)
• How long ago it happened
• Whether you have any ongoing risk factors
• Your current pancreatic function

If you have active pancreatitis right now, you should not take a GLP-1 medication until the pancreatitis resolves. Your provider will guide you on when it is safe to start.

Read more about pancreatitis risk with GLP-1 medications.

Type 1 diabetes

Semaglutide and tirzepatide are FDA-approved, as different products, to treat type 2 diabetes and for chronic weight management. No GLP-1 medication is approved to treat type 1 diabetes, and they do not replace insulin. Type 1 diabetes requires insulin therapy because the pancreas cannot produce it. The Wegovy label notes that use in people with type 1 diabetes has not been evaluated^[1].

If you have type 1 diabetes, you must continue insulin regardless of whether you are on a GLP-1. The two are not interchangeable. Some research has looked at using GLP-1s as an add-on to insulin in type 1 diabetes, but this is not standard practice and carries risks that require specialist (endocrinologist) management. It would not be part of a routine weight loss program.

If you have type 1 diabetes and are interested in weight loss support, talk to your endocrinologist or your primary care provider about what medications or programs are appropriate for your situation.

Personal history of eating disorders

The FDA labels do not list eating disorders as a contraindication or warning, but this is an important clinical consideration. Eating disorders including anorexia and bulimia are serious mental health conditions. GLP-1 medications reduce appetite and can decrease the mental urge to eat. For someone with active or recent eating disorder history, suppressing appetite further could be psychologically harmful and could enable or deepen disordered eating patterns.

If you have a history of eating disorders, your provider needs to know. They may decide that a GLP-1 medication is not appropriate for you, or they may determine it is safe if combined with mental health support. This is a clinical judgment call that requires honest conversation with your provider and possibly with a mental health professional.

Severe kidney disease

The labels do not list kidney disease as a contraindication and do not set a kidney-function cutoff. The kidney concern they describe is acute kidney injury from dehydration. There have been reports of acute kidney injury, in some cases requiring dialysis, mostly in people who became dehydrated from nausea, vomiting, or diarrhea. The labels say to monitor kidney function in people with side effects that could lead to dehydration, especially when starting the medication and when the dose goes up^[1][3].

The Wegovy label notes that kidney-related side effects were more common in trial participants with a history of kidney impairment^[1]. The Zepbound label recommends no dose adjustment for kidney impairment, including end-stage kidney disease^[3].

If you have kidney disease at any stage, tell your provider so they can evaluate your kidney function and decide on monitoring.

History of diabetic retinopathy

Diabetic retinopathy is damage to the blood vessels in the back of the eye (the retina) caused by high blood sugar over time. Both labels include a warning for diabetic retinopathy complications in people with type 2 diabetes. Rapid improvement in blood sugar control has been linked to temporary worsening of diabetic retinopathy. In a 2-year trial of semaglutide in adults with type 2 diabetes and high cardiovascular risk, retinopathy complications occurred in 3% of people on semaglutide and 1.8% on placebo, and the increase was larger in people who already had retinopathy^[1].

This is not a contraindication, but the labels say people with a history of diabetic retinopathy should be monitored for progression^[1][3]. If you have a history of diabetic retinopathy, tell your provider, and ask whether you need more frequent eye exams with your eye care professional while taking the medication.

Patients taking insulin or insulin secretagogues

If you are already taking insulin or medications in the sulfonylurea family (like glyburide or glipizide, which stimulate the pancreas to produce more insulin), adding a GLP-1 medication increases your risk of low blood sugar (hypoglycemia), including severe hypoglycemia^[1][3]. This is not a reason to avoid a GLP-1, but your other medications may need to be adjusted.

The labels say a provider should consider lowering the dose of insulin or a sulfonylurea when starting a GLP-1 to reduce the risk of low blood sugar, and that people with diabetes should have their blood sugar monitored before starting and during treatment.

Separately, both labels say these medications delay stomach emptying and can affect how well oral medications are absorbed. They advise extra monitoring for oral medications that need careful dosing; the Zepbound label names warfarin as an example^[1][3].

Who qualifies: Eligibility criteria

Even if you do not have any of the conditions listed above, a GLP-1 medication is not right for everyone. Two things matter: whether you fall within a label indication, and a provider’s clinical judgment.

BMI and health conditions

The adult weight management indications on the Wegovy and Zepbound labels cover adults with obesity, or adults with overweight and at least one weight-related condition^[1][3]. NIDDK describes these as^[2]:

• Body Mass Index (BMI) of 30 or higher, OR
• BMI of 27 or higher with weight-related health problems

Weight-related conditions named by NIDDK or in the main label trials include^[2][3]:

• High blood pressure (hypertension)
• Type 2 diabetes
• High cholesterol (dyslipidemia)
• Obstructive sleep apnea
• Cardiovascular disease

Some label indications do not use these adult BMI thresholds. Wegovy injection is also approved for children 12 and older with obesity, and for adults with noncirrhotic MASH (a liver condition) with moderate to advanced liver fibrosis^[1]. Products containing semaglutide or tirzepatide are also approved separately to treat type 2 diabetes.

Provider clinical judgment

Even if your BMI is in range, a provider still has to evaluate your specific health situation and determine whether a GLP-1 medication is clinically appropriate for you. The provider considers:

• Your overall health history
• Your current medications and potential drug interactions
• Your motivation and ability to follow a weight loss program
• Your goals and expectations
• Whether you have any relative contraindications that need careful management

Meeting the BMI criteria alone does not mean a GLP-1 is right for you. The provider makes the final decision.

State requirements for live video consultation

Telehealth rules vary by state and by program. Some programs require a live video or phone visit in certain states, so ask the program what applies where you live, and check that the prescriber is licensed in your state. A video visit does not change whether a medication is appropriate for you; it is part of how some programs do the review.

What happens next if you qualify

If you do not have any contraindications and a provider decides a GLP-1 medication is appropriate, what happens next depends on the program you choose. At most telehealth programs, the process looks something like this:

1. You complete a health history form covering your medical history, current medications, and weight loss goals.
2. A licensed provider reviews your information.
3. The provider may ask for more information, lab work, or a video visit.
4. If the provider decides a GLP-1 medication is appropriate, they write a prescription.
5. The prescription goes to a pharmacy. Depending on the program and the medication, that may be a retail pharmacy, a mail-order pharmacy, or a state-licensed compounding pharmacy.
6. Follow-up with the provider continues while you take the medication. What else is included, such as coaching, labs, or dose changes, varies by program.

Timelines vary by program. Ask each program how long its review usually takes and whether you pay anything before a provider reviews your history.

Questions about your specific situation

This page covers the main contraindications and eligibility criteria. But your health history is unique. If you are unsure whether a condition you have is a contraindication, the right answer is to ask the provider who reviews your health history.

Be completely honest about:

• Any cancer history (especially thyroid cancer or family history of medullary thyroid carcinoma)
• Any genetic conditions, especially MEN 2
• Stomach or digestion problems, including gastroparesis
• History of pancreatitis or gallbladder problems
• Kidney or liver disease
• Diabetes and any diabetic eye disease
• Any eating disorders or history of eating disorders
• Pregnancy, plans to become pregnant, or breastfeeding
• Any planned surgery or procedure that needs anesthesia or sedation
• All medications you currently take, including birth control pills
• Any known allergies to medications

Your provider needs this information to make the right decision. There are no wrong answers, just important ones.

Citations

[1] FDA. “WEGOVY (semaglutide) injection and WEGOVY (semaglutide) tablets. Prescribing Information.” Novo Nordisk. Revised 06/2026. https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/215256s025lbl.pdf

[2] National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). “Prescription Medications to Treat Overweight and Obesity.” https://www.niddk.nih.gov/health-information/weight-management/prescription-medications-treat-overweight-obesity

[3] FDA. “ZEPBOUND (tirzepatide) injection. Prescribing Information.” Eli Lilly and Company. Revised 08/2026. https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/217806Orig1s041correctedlbl.pdf