Naples Community Hospital Naples, Florida, United States
Disclosure(s):
Shauni Bobbs, DO, MS: No relevant financial relationship(s) with ineligible companies to disclose.
Objectives: Tirzepatide is a glucagon-like peptide-1 receptor agonist (GLP-1a) and glucose-dependent insulinotropic polypeptide receptor agonist. Tirzepatide is indicated as an antihyperglycemic agent for patients with Type 2 Diabetes. In 2023, tirzepatide gained Food and Drug Administration approval for treating patients with an overweight Body Mass Index (BMI) or obesity meeting specific criteria. Medical spas have emerged selling compounded tirzepatide to meet high demand. Our case demonstrates a potential link between compounded tirzepatide and psychiatric adverse effects.
Methods: A 61-year-old female with a history of anxiety and depression presented to the clinic due to a four-day history of headache, vomiting, diarrhea, paranoia, and visual hallucinations. Her symptoms began after increasing her dose of compounded subcutaneous tirzepatide which she obtained from a local medical spa with the goal of weight loss. She described her hallucinations as seeing “lines and shapes” that did not occur prior to her headache. She reported being afraid in her home, “like someone was planning to break in.” She was aware these were inaccurate depictions of reality and denied personal or family history of her current symptoms. Laboratory testing was significant for transaminitis. She was advised to discontinue tirzepatide. The patient returned to the clinic eight days later with a resolution of her paranoia and hallucinations.
Results: Despite having pre-existing anxiety and depression, the patient only developed paranoia and visual hallucinations after a dose increase of compounded tirzepatide which resolved with discontinuation. A recent three-case series described patients requiring Poison Control services after receiving ultrahigh doses of semaglutide (GLP-1a) due to administration errors from compounding pharmacies and a medical spa. It is important to recognize the indications of tirzepatide. Our patient had an overweight BMI prior to initiating the medication but did not have weight-related comorbidities therefore was receiving the medication off-label.
Conclusions: This is the first documented case report of paranoia and visual hallucinations associated with compounded tirzepatide. It is crucial for healthcare providers to acknowledge the potential dangers of compounded medications.
Funding Sources: No funding was accepted for this study.
