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[1] When combined, the cumulative effect on heart rate and blood pressure may be clinically significant, particularly in patients with pre-existing cardiovascular disease, uncontrolled hypertension, or arrhythmias

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Clinical monitoring and patient safety advice includes: Gastrointestinal symptoms : Patients should report severe or persistent nausea, vomiting, or abdominal pain, which may indicate pancreatitis (a warning in tirzepatide labeling) or require dose adjustment