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| Risk Tier | Drug Class | Interaction Type | Management Action | |---|---|---|---| | Tier 1 (Act Before Prescribing) | Basal insulin, sulfonylurea | Additive hypoglycemia | Reduce co-medication dose 20-50% before first tirzepatide dose | | Tier 1 (Act Before Prescribing) | Oral contraceptives | Reduced Cmax 20-23% | Switch to non-oral method or add barrier for 4 weeks per escalation | | Tier 2 (Monitor Within 4-8 Weeks) | Levothyroxine | Absorption rate change | Recheck TSH at 6-8 weeks and after each dose escalation | | Tier 2 (Monitor Within 4-8 Weeks) | Warfarin | Indirect INR shift via diet and motility | INR at 2-4 weeks after initiation | | Tier 2 (Monitor Within 4-8 Weeks) | ACE inhibitors, ARBs, thiazides | Relative overdose from weight-loss BP reduction | Blood pressure at every visit

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