Does Ozempic Cause Gallbladder Problems? Gallstone Risk on Semaglutide and Tirzepatide
Gallstones and gallbladder inflammation are listed warnings for Wegovy and Zepbound. In the injection weight-loss trials each added less than 1 percentage point over placebo, and a meta-analysis of 76 trials found the risk was higher with bigger doses, longer use and weight-loss treatment.
By Kymata Health Editorial Published Last checked
This guide
GLP-1 Companion- Question
- Do GLP-1 drugs like Ozempic, Wegovy and Zepbound cause gallstones?
- Sources
- 5 cited
- Quick answers
- 3 questions
- Clinician review
- None; sources cited inline
Key takeaways
4 points- In Wegovy's adult weight-loss trials, gallstones were reported in 1.6% on the injection vs 0.7% on placebo, and gallbladder inflammation (cholecystitis) in 0.6% vs 0.2%1.
- In two pooled Zepbound weight-loss trials, gallstones were reported in 1.1% vs 1%, cholecystitis in 0.7% vs 0.2%, and gallbladder removal in 0.2% vs none2.
- A meta-analysis of 76 randomized trials (103,371 people) found a 37% relative increase in gallbladder or bile-duct disease with GLP-1 drugs, rising to more than double in weight-loss trials3.
- Upper-right belly pain lasting hours, fever, chills or yellow skin or eyes needs prompt medical care4.
What the labels report
Ozempic and Wegovy both contain semaglutide; the gallbladder figures here come from the Wegovy label, which covers weight loss. It says Wegovy is associated with more gallstones (cholelithiasis) and gallbladder inflammation (cholecystitis)1. In adult weight-loss trials, gallstones were reported in 1.6% on the injection vs 0.7% on placebo, and in 2.5% on the Wegovy tablet vs 1% on placebo tablets1. In a trial in adolescents aged 12 and older, gallstones were reported in 3.8% vs 0%1.
The Zepbound (tirzepatide) label lists acute gallbladder disease as a warning too. In two pooled weight-loss trials, gallstones were reported in 1.1% vs 1%, cholecystitis in 0.7% vs 0.2%, and gallbladder removal in 0.2% vs no placebo-treated patients2.
The two labels describe the cause differently. Zepbound's says the gallbladder events were associated with weight reduction2. Wegovy's says rapid weight loss can raise gallstone risk but that gallbladder disease was still more common than on placebo after accounting for how much weight people lost1. These numbers come from different trials, so they cannot be used to rank one drug as safer than the other.
What 76 trials show
A 2022 JAMA Internal Medicine meta-analysis pooled 76 randomized trials of GLP-1 drugs with 103,371 participants3. Compared with placebo or other drugs, GLP-1 treatment was linked to more gallbladder or bile-duct disease overall (relative risk 1.37), including gallstones (1.27), cholecystitis (1.36) and bile-duct disease (1.55)3.
The increase was larger in weight-loss trials (relative risk 2.29) than in diabetes and other trials (1.27), at higher doses (1.56) than lower doses (0.99, no clear increase), and with longer use (1.40) than shorter use (0.79, no clear increase)3. The analysis was funded by Chinese government science grants and the authors reported no conflicts of interest3.
A relative increase is not the same as your personal chance. Because the starting risk is low, the label figures above translate to roughly one extra case of gallstones for every 100 people treated with Wegovy injections in the weight-loss trials1.
Why weight loss and gallstones go together
When you lose weight quickly or go long periods without eating, the liver releases extra cholesterol into bile, and the gallbladder may not empty properly, according to the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)5. Losing and regaining weight repeatedly also raises the risk5.
The NIDDK says people who already had gallstones, especially ones that caused symptoms, are more likely to have problems during rapid weight loss, and that the medicine ursodiol can help prevent gallstones during very low-calorie diets or after weight-loss surgery5. Whether that applies to people on a GLP-1 is not addressed in these sources, so ask your prescriber.
Symptoms that need a doctor
A gallbladder attack usually causes pain in the upper right abdomen that can last several hours, often after heavy meals and often in the evening or at night4. The NIDDK says to see a doctor right away for abdominal pain lasting several hours, nausea and vomiting, fever or chills, yellowing of the skin or the whites of the eyes, tea-colored urine or light-colored stools4.
Nausea and vomiting are also common GLP-1 side effects, and gallstone symptoms can look like pancreatitis or other conditions4, so do not assume stomach pain on a GLP-1 is just the drug. Both labels say that if gallbladder disease is suspected, gallbladder tests and follow-up are needed12.
- Tell your prescriber before starting if you have had gallstones or gallbladder attacks5.
- Neither label lists past gallstones or gallbladder removal as a reason not to take the drug; the contraindications are a personal or family history of medullary thyroid cancer or MEN 2, and a prior serious allergic reaction12.
- For the other serious warnings on these drugs, see our GLP-1 cancer, thyroid and pancreatitis risk page.
Quick answers
Questions
3 answersCan you take Ozempic or Zepbound if you have had your gallbladder removed?
The Wegovy and Zepbound labels do not list gallbladder removal as a contraindication12. Discuss your history with your prescriber.
Is Zepbound or Wegovy worse for the gallbladder?
There is no head-to-head answer in these sources. The label figures come from different trials and cannot be compared directly12.
Does a higher dose raise the risk?
In the 76-trial meta-analysis, the increase was seen at higher doses and longer durations but not clearly at lower doses or shorter use3.
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References
Every study and document cited in this guide, numbered as in the text.
Sources
5 sources- 1WEGOVY (semaglutide) injection and tablets: prescribing information. U.S. Food and Drug Administration (Drugs@FDA), 2026.
- 2ZEPBOUND (tirzepatide) injection: prescribing information. U.S. Food and Drug Administration (Drugs@FDA), 2026.
- 3Association of Glucagon-Like Peptide-1 Receptor Agonist Use With Risk of Gallbladder and Biliary Diseases: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA Intern Med, 2022. PMID 35344001
- 4Symptoms & Causes of Gallstones. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 2017.
- 5Dieting & Gallstones. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 2017.
Dietary supplements are not intended to diagnose, treat, cure or prevent any disease, and these statements have not been evaluated by the FDA. Prescription options need a licensed clinician. Talk to your clinician or pharmacist before starting anything new, especially if you take prescription medicines, are pregnant or breastfeeding.