A short list of histories rules this treatment out regardless of BMI, and a second list means proceeding carefully rather than not at all. Both are established before anything is prescribed, which is the whole purpose of the assessment.
A personal or family history of medullary thyroid carcinoma, or of multiple endocrine neoplasia syndrome type 2, rules out this class of medication. That is why the question about family thyroid history gets asked, and why a vague answer is followed up rather than waved through.
Pregnancy is the other clear exclusion. GLP-1 medication is not used during pregnancy and is stopped in advance where pregnancy is planned. Where pregnancy is possible, contraception is discussed before treatment starts.
Thyroid cancer and endocrine syndromes in particular. If you are unsure, it is worth asking relatives before the appointment rather than guessing.
Personal history
Pancreatitis, gallbladder disease, severe gastrointestinal conditions and any previous reaction to a GLP-1.
Current medication
Especially diabetes treatment, thyroid medication and anything with strict absorption timing.
Pregnancy and planning
Whether pregnancy is possible now or planned, and what contraception is in place.
Care, not exclusion
Histories that mean proceed carefully
Previous pancreatitis or gallbladder disease does not automatically rule out treatment, but it changes the threshold for investigating abdominal pain later and usually means a slower titration.
Severe gastroparesis or significant gastrointestinal disease is similar: the medication slows gastric emptying, so it can worsen symptoms that are already there. That is a conversation, not an automatic no. Serious side effects, Physician-supervised care and Common side effects go further into it.
Previous poor reactionSlower titration
Pancreas or gallbladderCloser watch
GI conditionsCase by case
Safety
The rest of the safety picture
Side effects, interactions and what to do about each.
Family history, pregnancy, past reactions and what gets asked.
Because a personal or family history of medullary thyroid carcinoma, or of MEN2, rules out this class of medication. It is a short question with a significant consequence, so it is not skipped.
It is worth asking relatives before the appointment. Where it genuinely cannot be established, that uncertainty is factored into the decision rather than ignored.
No. It is not used in pregnancy and is stopped in advance where pregnancy is planned. Discuss breastfeeding specifically with your clinician, as the guidance differs from pregnancy.
Not automatically. It means a lower threshold for investigating abdominal pain during treatment and usually a slower titration. It is a reason for care rather than refusal.
Often yes, once what went wrong is established. A slower schedule, a different molecule, or both. What is not appropriate is repeating the same approach and hoping.
