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consider reducing doses of these medications when initiating tirzepatide Signs of acute kidney injury, particularly in patients experiencing severe gastrointestinal adverse effects with dehydration Symptoms of pancreatitis (severe abdominal pain radiating to the back, nausea, vomiting) Gallbladder disease (right upper quadrant pain, fever, jaundice) Gastrointestinal adverse effects, which occur commonly but are usually self-limited Tirzepatide is not recommended for patients with severe gastrointestinal disease, including severe gastroparesis