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A systematic review and thematic synthesis of the qualitative literature

regular eye exams for people with diabetes Suicidal Thoughts or Behavior : Warning : FDA is investigating reports of suicidal thoughts and behaviors in people taking GLP-1 medications Causality not established, but monitoring warranted Symptoms : New or worsening depression Thoughts of suicide or self-harm Unusual mood changes Increased anxiety or agitation Withdrawal from activities or relationships Action Required : Contact healthcare provider immediately Call 988 (Suicide and Crisis Lifeline) if experiencing suicidal thoughts Call 911 if immediate danger to self or others Inform family/friends so they can provide support and monitoring Risk Factors : History of depression or mental health conditions Previous suicidal thoughts or attempts Pulmonary Aspiration During Surgery : Risk : GLP-1 medications slow gastric emptying Stomach may contain food even after fasting During general anesthesia, stomach contents can enter lungs (aspiration) Can cause serious lung infection (aspiration pneumonia) Prevention : Inform surgeon and anesthesiologist about GLP-1 medication BEFORE any surgical procedure (even minor) Follow specific instructions about when to hold medication before surgery May need to hold medication 1 week or longer before elective surgery For emergency surgery, anesthesiologist will take special precautions Important : Don't skip informing surgical team - this is critical safety information Drug Interactions and Special Population Considerations Oral Contraceptive Effectiveness (Critical for Women of Childbearing Potential): According to FDA prescribing information: Tirzepatide (Zepbound) Specific Warning : May reduce effectiveness of oral contraceptives due to delayed gastric emptying Could result in unintended pregnancy Recommendations for Women Taking Oral Birth Control : Discuss contraception with healthcare provider BEFORE starting GLP-1 medication Consider switching to non-oral contraception methods: Intrauterine device (IUD - copper or hormonal) Contraceptive implant (Nexplanon) Contraceptive injection (Depo-Provera) Contraceptive patch Vaginal ring Permanent sterilization (if family complete) If continuing oral contraceptives, use additional barrier method (condoms) for: 4 weeks after starting GLP-1 medication 4 weeks after each dose increase Pregnancy Prevention Critical: Unintended pregnancy while taking GLP-1 medications should be avoided