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J Am Acad Dermatol 22:104106 Rodriguez HA, Ackerman LV (1968) Cellular blue nevus

If any of these are present, do not use the medication regardless of what the pharmacy says, because visible degradation indicates severe damage

Patients should also contact their provider promptly if they experience: Persistent or worsening nausea and vomiting lasting more than a few days Inability to maintain adequate oral intake of food or fluids Symptoms of hypoglycemia (shakiness, sweating, confusion, rapid heartbeat), particularly if taking tirzepatide with insulin or sulfonylureas Signs of allergic reaction, including rash, itching, swelling, or difficulty breathing Changes in vision or symptoms of diabetic retinopathy progression, especially with rapid improvement in blood glucose New lump or swelling in the neck, hoarseness, or difficulty swallowing (potential thyroid tumor symptoms) Routine follow-up should address less urgent concerns such as persistent mild nausea affecting quality of life, ongoing constipation or diarrhea, injection site reactions that don't resolve, or questions about dose adjustment

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Avoid brushing teeth for 45 minutes after administration