Abstract

Tirzepatide, a dual GLP-1 and GIP receptor agonist, is effective in managing type 2 diabetes and obesity. However, concerns about neuropsychiatric adverse events (AEs), particularly dizziness and suicidal ideation, warrant further investigation. To evaluate the risk of suicidal thoughts and dizziness associated with once-weekly subcutaneous tirzepatide in patients with type 2 diabetes mellitus or obesity, compared to placebo. A systematic review and meta-analysis were conducted according to PRISMA guidelines. Databases including PubMed, EMBASE, Web of Science, and ClinicalTrials.gov were searched thoroughly till July 15, 2025. Only randomized controlled trials comparing tirzepatide with placebo and reporting AEs were included. Data were analyzed using Review Manager 5.4. Thirteen RCTs met the inclusion criteria. Tirzepatide was associated with a significantly increased risk of dizziness (OR = 2.12, 95% CI: 1.67–2.68). The risk was consistent across both low (10 mg) doses. No significant association was found between tirzepatide and suicidal ideation (OR = 1.96, 95% CI: 0.76–5.05), though wide confidence intervals reflect limited data. Tirzepatide is associated with a higher risk of dizziness, irrespective of dose. No clear link to suicidal thoughts was observed; however, the low event rate limits firm conclusions. Ongoing surveillance and further research are needed to better understand potential neuropsychiatric risk.

Key words: Tirzepatide, suicidal thoughts, dizziness, meta-analysis