A 28‑year‑old woman with POTS got much worse after starting tirzepatide for weight loss – her resting and standing heart rates jumped 20‑30 beats per minute and her dizziness returned. This is far bigger than the modest 3‑beat rise seen with other similar drugs, suggesting tirzepatide can seriously aggravate orthostatic intolerance in susceptible people.

Prescription of obesity medications is increasing, but our understanding of their effects in patients with cardiovascular disorders, such as postural orthostatic tachycardia syndrome (POTS), is limited. POTS was exacerbated in a 28-year-old woman with obesity after using tirzepatide for weight reduction. Her condition was effectively treated with progressive exercise training and counseling, which reduced supine and standing heart rates to normal values, before starting tirzepatide. However, while using tirzepatide, the patient's supine and standing heart rates were markedly elevated, and she experienced recurrence of orthostatic intolerance symptoms. Although small increases in resting heart rate with glucagon-like peptide-1 receptor agonist use have been reported in adults (approximately 3 beats/min), such a large increase in both supine and standing heart rate (20-30 beats/min) with tirzepatide has not been reported to our knowledge. Prescription of tirzepatide may exacerbate symptoms of orthostatic intolerance and cause marked tachycardia in patients with POTS.