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Seek medical attention if you experience: Severe or worsening fatigue that interferes with daily activities or does not improve after 46 weeks of treatment Fatigue accompanied by other concerning symptoms such as chest pain, shortness of breath, rapid heartbeat, dizziness, or fainting (seek emergency care for these symptoms) Signs of dehydration including dark urine, decreased urination, extreme thirst, dry mouth, or confusion (severe dehydration requires urgent evaluation) Symptoms suggesting hypoglycemia (low blood sugar) such as shakiness, sweating, confusion, or irritability, particularly if you take tirzepatide with insulin or sulfonylureas Persistent vomiting or diarrhea lasting more than 2448 hours, which increases risk of dehydration and electrolyte imbalances Severe, persistent abdominal pain (possibly radiating to the back), with or without vomiting, which could indicate pancreatitis Right upper quadrant abdominal pain, fever, or yellowing of skin/eyes , which may suggest gallbladder problems [12] [1] Unexplained weight loss exceeding 1-2 pounds per week consistently, suggesting excessive caloric deficit New or worsening depression or mood changes, as fatigue can sometimes reflect psychological rather than physical causes Your healthcare provider may evaluate persistent fatigue with appropriate tests based on your specific symptoms and medical history

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Ferro Y, Montalcini T, Mazza E, et al

Structure of Nampt/PBEF/visfatin, a mammalian NAD+ biosynthetic enzyme