DOI: 10.12890/2025_005392
Rhabdomyolysis associated with the use of tirzepatide
Authors
sonavanekunal@gmail.com
Keywords
Tirzepatide, rhabdomyolysis, GLP-1 receptor agonist, necrotising myopathy, muscle damageAbstract
Introduction: Tirzepatide is one of the commonly used combined glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) agonists for weight loss in recent years. There are significant advantages of these medications for weight reduction, improved glycaemic control and cardiorenal benefits. However, these medications come with serious adverse events and need closer monitoring once they are initiated.
Case description: We present a case of a 35-year-old female with no comorbidities taking tirzepatide for weight loss. She developed severe rhabdomyolysis that required hospitalisation; muscle biopsy revealed necrotising myopathy. Her rhabdomyolysis resolved after stopping tirzepatide and conservative management with intravenous fluids. Since no other contributing factor could be identified, we believe tirzepatide may have increased her risk of rhabdomyolysis.
Conclusion: In patients presenting with rhabdomyolysis, consideration should be given to GLP-1 agonists as a potential contributing factor for the development of rhabdomyolysis.
References
- Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, et al. SURMOUNT-1 investigators. Tirzepatide once weekly for the treatment of obesity. N Engl J Med 2022;387:205–216.
- Garvey WT, Frias JP, Jastreboff AM, le Roux CW, Sattar N, Aizenberg D, et al. SURMOUNT-2 investigators. Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet 2023;402:613–626.
- Rosenstock J, Wysham C, Frias JP, Kaneko S, Lee CJ, Fernández Landó L, et al. Efficacy and safety of a novel dual GIP and GLP-1 receptor agonist tirzepatide in patients with type 2 diabetes (SURPASS-1): a double-blind, randomised, phase 3 trial. Lancet 2021;398:143–155.
- Yin DG, Ding LL, Zhou HR, Qiu M, Duan XY. Comprehensive analysis of the safety of semaglutide in type 2 diabetes: a meta-analysis of the SUSTAIN and PIONEER trials. Endocr J 2021;68:739–742.
- Gabow PA, Kaehny WD, Kelleher SP. The spectrum of rhabdomyolysis. Medicine (Baltimore) 1982;61:141–152.
- Zimmerman JL, Shen MC. Rhabdomyolysis. Chest 2013;144:1058–1065.
- Billings SA, Felix HM, Prier CC, Hedges MS. Rhabdomyolysis associated with semaglutide therapy: a case report. Cureus 2023;15:e50227.
- Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239–245.
- Marx N, Husain M, Lehrke M, Verma S, Sattar N. GLP-1 receptor agonists for the reduction of atherosclerotic cardiovascular risk in patients with type 2 diabetes. Circulation 2022;146:1882–1894.
- Filippatos TD, Panagiotopoulou TV, Elisaf MS. Adverse effects of GLP-1 receptor agonists. Rev Diabet Stud 2014;11:202–230.
- Green CJ, Henriksen TI, Pedersen BK, Solomon TP. Glucagon like peptide-1-induced glucose metabolism in differentiated human muscle satellite cells is attenuated by hyperglycemia. PLoS One 2012;7:e44284.
