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patients should be counseled to report symptoms such as neck mass, dysphagia, or persistent hoarseness Contraindication : Personal or family history of MTC or MEN2 Gallbladder disease : Tirzepatide may increase risk of gallstones and cholecystitis Acute kidney injury : Dehydration from gastrointestinal adverse effects may impair renal function Pancreatitis : Patients should be counseled to report severe, persistent abdominal pain Niacin-specific safety concerns: Hepatotoxicity : Baseline liver function tests and monitoring during dose titration and periodically thereafter are recommended