Excellent points all around. To summarize the red flags that should prompt immediate evaluation:

• Severe epigastric pain (upper middle/left abdomen) radiating to the back
• Pain that is constant and worsening over hours, not intermittent
• Nausea and vomiting accompanying the severe pain
• Pain that worsens after eating and is not relieved by antacids
• Fever with abdominal pain

If you experience this constellation, go to the ER. They will check lipase levels and do imaging. But I want to echo — in 15 years of practice, I have had exactly two patients develop pancreatitis on GLP-1 RAs, both had pre-existing risk factors (one had gallstones, one had significant alcohol use). It is genuinely rare.

Contraindications for GLP-1 RAs related to pancreatic risk: personal history of pancreatitis is listed as a precaution (not absolute contraindication) in prescribing information. Discuss with your provider.

Thank you all so much. I feel like I can breathe again. The data really helps — <0.2% is very different from how the article my friend sent made it sound. I have no history of pancreatitis, don't drink, and don't have gallstones. I'm going to keep taking my tirzepatide and stop googling at 2am. 🙃