When should I seek urgent care on a GLP-1?

Serious problems with GLP-1 medications are rare. Most people only have mild side effects that ease with time. This guide explains the rare risks people ask about most, what to watch for, and what to do. For everyday side effects, see "GLP-1 side effects and what's normal".

The key point: if a symptom is severe, sudden, or feels life-threatening, call 911 or go to the nearest emergency room, and do not inject again until a provider has cleared you. For anything else that worries you, message your care team.

Hold your next injection and wait for a provider's answer if you have:

• any symptom from the list below, even if it has passed
• a rash, hives, or swelling that spreads beyond the injection site
• vomiting or diarrhea that has not settled, or you cannot keep fluids down
• a new vision change in one eye, one that is getting worse, or flashes of light or a shadow in your vision
• a racing or irregular heartbeat that does not settle
• a provider has told you to wait, for example about a lab result

For milder symptoms, such as nausea, tiredness, headache, or constipation, you can usually keep your regular schedule while you wait to hear back. If you are not sure whether to take your next dose, message your care team before your injection day.

Call 911 or go to the ER for

• Sudden loss of vision, or sudden, significant vision changes (especially in one eye)
• Severe or persistent abdominal pain, especially pain that is intense and does not ease, with or without vomiting
• Swelling of the face, lips, tongue, or throat, trouble breathing, or trouble swallowing
• Chest pain, fainting, or shortness of breath
• A heart rate that is much higher than normal and does not settle, or is irregular, with chest pain, shortness of breath, fainting, or severe dizziness
• Vomiting blood, black or bloody stools, or being unable to keep fluids down
• Confusion or severe weakness

Vision changes

Vision problems linked to GLP-1 medications are very rare. A rare eye condition called NAION, which affects the nerve at the back of the eye, has been in the news. Regulators in Europe call it a very rare side effect of semaglutide, affecting up to 1 in 10,000 people who take it. Most of the research so far is on semaglutide. If you have no vision symptoms, there is no reason to stop your medication because of it.

• Sudden vision loss or a sudden, significant vision change (especially in one eye, and even if it does not hurt): do not take another injection. Go to the emergency room or an eye doctor the same day, then let your care team know. Fast care matters for the eye.
• Any other new vision change, such as blurry vision or trouble reading, even if it seems minor: message your care team and book an eye exam, which is the best way to find the cause. Blurriness often turns out to be something simple, such as dry eyes. Hold your next injection until a provider has reviewed it if the change is in one eye only, is getting worse, or comes with flashes of light, a shadow, or a curtain over part of your vision. Otherwise you can keep your usual schedule while you wait to hear back.
• If you have diabetes and diabetic eye disease (retinopathy): keep up your regular eye exams and tell your eye doctor you take a GLP-1. Fast improvements in blood sugar can briefly affect diabetic eye disease.
• If you have no new vision symptoms, keep taking your medication as directed.

Racing or fast heart rate

A higher heart rate can happen with tirzepatide, though it is uncommon. A slightly elevated or racing heartbeat can show up as your body adjusts to a new dose.

• Stay well hydrated and eat enough protein and fiber. Electrolytes (such as Liquid IV) can help, including if you do not feel thirsty much.
• Check in with your care team if your heart rate stays higher than normal.
• Get medical care if your heart rate is significantly higher than your normal, persistent, or irregular, or comes with chest pain, shortness of breath, fainting, or severe dizziness.

Allergic reactions

Mild redness, itch, or irritation at the injection site is common, especially after a dose increase. See "GLP-1 side effects and what's normal" for ways to ease it.

Get help right away if:

• A rash, hives, or itching spreads beyond the injection site or across your body: hold your next injection and contact your care team right away, as this can be an allergic reaction.
• You have tenderness in your throat or neck, or upper chest symptoms, after an injection: watch for swelling, trouble swallowing, trouble breathing, or hives. If any of these happen, seek emergency care.
• You have swelling of the face, lips, tongue, or throat, or trouble breathing: call 911.

Stomach pain and pancreatitis

Pancreatitis (inflammation of the pancreas) is rare but can be serious. Your provider asks about a history of it before you start. The main warning sign is severe stomach pain that does not go away, sometimes spreading to your back, with or without vomiting. It is a reason to stop injecting and get checked right away.

• Severe or persistent abdominal pain, with or without vomiting: do not take another injection and go to the emergency room or call 911. Then let your care team know. Your provider may order lab work and may stop your treatment.
• Pancreatic cancer: large studies so far have not shown that GLP-1 medications raise the risk of pancreatic cancer, and research is ongoing. If you have a personal or family history of pancreatic disease, tell your provider.
• Milder stomach pain, bloating, or gas is common and often tied to dose or food. For tips, see "GLP-1 side effects and what's normal".

Thyroid

GLP-1 medications carry a boxed warning (the FDA's strongest warning) about a rare type of thyroid tumor called medullary thyroid carcinoma. This is why people with a personal or family history of it, or with MEN 2, should not use these medicines. Your provider screens for this during your assessment. See "Is a GLP-1 right for me, and who should not take one?". Tell your care team if you notice a new lump or swelling in your neck, hoarseness that does not go away, or trouble swallowing.

Kidney function and lab results

Kidney problems are not commonly reported with GLP-1 medications. Dehydration from vomiting or diarrhea is the main risk, so keep your fluids up.

• If a lab result comes back elevated or your kidney function (eGFR) has gone down, do not inject again until you have spoken with a provider about the result and whether continuing is appropriate.
• Follow your primary care doctor's advice, and schedule a call with a Belle provider to talk it through. You may be asked to pause your medication around repeat lab work.

When to message your care team (not an emergency)

• Any new vision change, even a minor one
• A heart rate that stays higher than normal
• A rash that is getting worse
• Elevated lab results
• Anything that feels different from your usual side effects

Tell us what you are feeling, when it started, and whether you can keep taking your medication.

💬 If you are not sure whether something is an emergency, treat it as one and call 911. Your safety comes first.