Nighttime reflux is more damaging to the esophagus because gravity is no longer helping keep acid in the stomach, and the protective swallowing reflex is reduced during sleep

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

Drug Interactions Certain drugs may affect glucose metabolism, requiring insulin dose adjustment and close monitoring of blood glucose
Avoid brushing teeth for 45 minutes after administration