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Can GLP-1s cause pancreatitis or gallbladder problems? How common, and the warning signs

The label numbers for each medicine against placebo, what large reviews add, why fast weight loss matters, and the signs that need urgent care.

GLP Guidebook teamPublished 5 Oct 202610 min read25 sourcesWritten from published sources

Written for India. Reading from the US? US versionComing soon

The short answer

Pancreatitis is uncommon on Wegovy, Ozempic and Mounjaro: EU labels put it at up to 1 in 100 people. The EU Rybelsus label rates it rare, up to 1 in 1,000. Gallstones are common on Wegovy and Ozempic, up to 1 in 10. Severe stomach pain that won't go away, or yellow eyes with fever, needs urgent care.

Key takeaways

  • Pancreatitis is uncommon on Wegovy, Ozempic and Mounjaro, up to 1 in 100 people on EU labels; Wegovy's weight trials found about 2 cases per 1,000 people a year.1,6,7,8
  • Gallstones are common on Wegovy and Ozempic, up to 1 in 10 people on EU labels: 1.6% of adults on Wegovy injections vs 0.7% on placebo.1,6,7
  • A 2022 review of 76 trials found about 27 extra gallbladder or bile-duct problems per 10,000 people on GLP-1 medicines each year.9
  • Gallstone risk rises steeply when weight falls faster than 1.5 kg a week, but Wegovy's extra risk remained after allowing for weight loss.1,14
  • The label warning sign for pancreatitis is severe stomach pain that won't go away, sometimes spreading to the back, with or without vomiting.1
Before you go further
  • GLP-1 medicines are prescription-only in India. A government statement on 1 Apr 2026 said only endocrinologists, internal-medicine specialists and cardiologists can prescribe them.20 CDSCO expert-committee minutes attach a similar condition to some approvals (endocrinologist or internal-medicine specialist), but we found no rule covering every brand.21
  • We found no Indian prescribing information online, so the rates below come from US and EU labels, named each time.
  • All figures are group results from trials. They can't tell you your own risk.
On this page
  1. What are pancreatitis and gallbladder disease?
  2. How common are they in the label trials?
  3. What do large trials and reviews show?
  4. Why does fast weight loss raise gallstone risk?
  5. Are gallstones more common in India?
  6. What are the warning signs?
  7. Who do the labels say should be careful?
  8. Questions people ask
  9. How we researched this

What are pancreatitis and gallbladder disease?

Pancreatitis is a swollen, inflamed pancreas. Gallbladder disease usually means gallstones, sometimes with an inflamed gallbladder. Gallstones are the commonest cause of sudden pancreatitis.16,17

Other common causes of pancreatitis are heavy alcohol use, inherited pancreas disorders and some medicines.16

The pancreas is a large gland behind the stomach. It makes insulin and the juices that digest food.16 Sudden (acute) pancreatitis usually gets better within several days with treatment. Some people get a severe form with infection, bleeding or organ failure.16

The gallbladder is a small, pear-shaped bag under the liver, on the upper right side of the belly. It stores bile, a digestive juice made by the liver.17 Most gallstones are "silent" and cause no pain.17 A stone that blocks a duct can cause pain, an inflamed gallbladder (cholecystitis) or pancreatitis.16,17

GLP-1 medicines include semaglutide (Ozempic, Wegovy, Rybelsus) and tirzepatide (Mounjaro). Our answer to "Is semaglutide the same as Ozempic?" explains the brand names. Our answers explain what "GLP-1" stands for and what tirzepatide is. Every US label for these medicines carries warnings for both problems.1,2,3,4,5

How common are they in the label trials?

In the US label trials, pancreatitis stayed under 1 case per 100 people a year. Gallbladder problems rose above placebo.1,2,3,4,5

Labels count pancreatitis per 100 "patient-years". One patient-year is one person treated for one year. So 0.2 cases per 100 patient-years means about 2 cases if 1,000 people took the medicine for a year.1

EU labels class pancreatitis as uncommon (up to 1 in 100 people) for Wegovy, Ozempic and Mounjaro.6,7,8 They class gallstones as common (up to 1 in 10) for Wegovy and Ozempic, but uncommon (up to 1 in 100) for Mounjaro.6,7,8 The EU label for Rybelsus tablets puts pancreatitis at rare (up to 1 in 1,000) and gallstones at uncommon (up to 1 in 100).25 Wegovy's pancreatitis figure, about 2 cases per 1,000 people a year, sits in that uncommon band.1,6

Medicine and trialsPancreatitisGallstonesInflamed gallbladder
Wegovy injectionAdult weight trials0.2 vs under 0.1 per 100 patient-years11.6% vs 0.7%10.6% vs 0.2%1
Zepbound (tirzepatide)Adult weight trials0.2% vs 0.2%21.1% vs 1%20.7% vs 0.2%2
OzempicDiabetes trials0.3 vs 0.2 per 100 patient-years, vs other diabetes medicines31.5% on 0.5 mg and 0.4% on 1 mg vs 0%3Not given separately3
MounjaroDiabetes trials0.23 vs 0.11 per 100 patient-years, vs other diabetes medicines40.6% vs 0% (gallstones, gallbladder pain or gallbladder removal)4Not given separately4
Rybelsus 14 mg4-year heart trialPooled trials: 0.1 vs under 0.1 per 100 patient-years, vs placebo or other diabetes medicines51.1% vs 0.9%51.1% vs 0.7%5

Medicine vs placebo unless the cell names other diabetes medicines. All rows are US labels, not Indian ones: Wegovy (June 2026), Zepbound and Mounjaro (August 2026), Ozempic (May 2026), Rybelsus (January 2026). Zepbound is tirzepatide's US weight brand; India sells tirzepatide as Mounjaro. Checked 5 Oct 2026.

Teens had more gallstones. In Wegovy's trial in children aged 12 and over, 3.8% got gallstones vs 0% on placebo.1 Wegovy tablets showed 2.5% vs 1%.1

Results differ by trial. In tirzepatide's weight trials, it was 0.2% on both the medicine and placebo.2 In its sleep apnoea trials, the rate was 0.84 per 100 patient-years vs 0 on placebo.2 Those trials were small, with 467 people.2

When pancreatitis does happen it can be serious. The US labels list fatal and non-fatal severe forms, including bleeding (haemorrhagic) and tissue-death (necrotising) pancreatitis.1,2 Some gallbladder problems need surgery.1 In tirzepatide's weight trials, 0.2% had their gallbladder removed, vs none on placebo.2

What do large trials and reviews show?

Heart trials and two of three large reviews found no clear rise in pancreatitis; one review found a slight rise. The reviews of gallbladder problems all found a small rise.6,7,9,10,11,12

Pancreatitis in two big heart trials. Bars are zoomed in: every number here is under 1 in 100.

SELECTPancreatitis: Wegovy vs placebo

Wegovy's heart trial.6

Wegovy0.2%
Placebo0.3%
SUSTAIN-6Pancreatitis: Ozempic vs placebo

Ozempic's 2-year heart trial.7

Ozempic0.5%
Placebo0.6%

Gallbladder problems, pooled across many trials:

ReviewsGallbladder: extra cases on GLP-1 medicines
Gallbladder or bile-duct problems, across 76 trials927 per 10,000each year
Gallstones, across 55 placebo-controlled trials102 per 1,000

Gallbladder. A 2022 review pooled 76 trials with 103,371 people. GLP-1 medicines raised gallbladder or bile-duct problems by 37% in relative terms.9 In absolute terms, that is about 27 extra cases per 10,000 people treated for a year.9 The rise was larger in weight-loss trials, at higher doses and with longer use.9 The authors note many trials did not set out to count these problems, so some may be missed.9

A 2025 review of 55 trials and 106,395 people found 2 extra cases of gallstones per 1,000 people.10 A 2025 review of 21 outcome trials, with 99,599 people, found 26% more gallbladder problems.12 Some of its authors declare fees from Novo Nordisk or Eli Lilly.12

Pancreatitis. The 55-trial review found GLP-1s "probably have little or no effect" on other gut and bile problems, pancreatitis among them.10 The 21-trial review found no difference between groups.12 A third 2025 review of 62 trials found a 44% relative rise. It was no longer significant when trials were split by other medicines taken, and its authors called the rise "slight".11 That review left out the many trials with zero cases in both groups.11

Why does fast weight loss raise gallstone risk?

When you lose weight, your liver sends more cholesterol into bile. Bile overloaded with cholesterol can form stones, and the risk climbs as weight falls faster.13,14

This happens with any fast weight loss, not only with medicines. In older studies, 10–12% of people developed new gallstones after 8–16 weeks of a low-calorie diet. More than 30% did so within 12–18 months of gastric bypass surgery.13 About a third of these stones caused symptoms.13

A 1995 analysis found gallstone risk rose steeply once weight fell faster than 1.5 kg a week.14 Other risk factors were losing over 24% of body weight, a no-fat very low-calorie diet, and a long overnight fast.13

A worked example. In the STEP 1 trial, people on semaglutide 2.4 mg lost 15.3 kg on average over 68 weeks.15 That averages about 0.2 kg a week, by our arithmetic, well below 1.5 kg.15 Individual speeds vary, and some people lose faster.

Weight loss is not the whole story. The US Wegovy label says the extra gallbladder problems remained after allowing for how much weight people lost.1 It also says gallbladder disease can happen without fast or large weight loss.1 The tirzepatide label links its gallbladder events to weight reduction.2

GLP-1 may also slow the gallbladder. In a 12-week trial in 52 adults, liraglutide 3.0 mg, an older GLP-1 medicine, was tested against placebo.23 It did not change how much the gallbladder emptied after a meal. But reaching peak emptying took about twice as long: a median of 151 vs 77 minutes.23

In a study of 20 people, a GLP-1 drip blunted the rise of CCK after a meal. CCK is the gut hormone that makes the gallbladder squeeze.24 The authors say this may help explain the extra gallbladder problems on these medicines.24 Neither study tested semaglutide or tirzepatide, and Novo Nordisk funded the liraglutide trial.23

Are gallstones more common in India?

National studies have found gallstones in 4–6% of adults in India, with higher rates in parts of the north and north-east. Women are affected more.18,19

A survey in 60 villages of Uttar Pradesh and Bihar gave ultrasound scans to 6,548 adults over 30. Most were chosen because they had symptoms. Of those scanned, 4.15% had gallstones: 5.59% of women vs 1.99% of men.18 Men with diabetes had about 4 times the odds of gallbladder disease.18

A 2026 study of 28,395 adults aged 30–65 compared 5 sites. Gallstones were reported by 10.8% in Mullanpur, Punjab, and 10.7% in Kamrup, Assam, but 0.3% in Barshi, Maharashtra.19 This study relied on people's own reports, not scans.19 Data from the 1960s suggested gallstones were about 7 times more common in north India than the south.19

No study we found has measured gallbladder problems on GLP-1 medicines in Indians. None of the labels we read gives separate figures for Indian patients.

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What are the warning signs?

The labels name two patterns. One is severe stomach pain that won't go away (pancreatitis). The other is upper belly pain with fever or yellow eyes (gallbladder).1,3

Get help now: call 112.
  • Possible pancreatitis: severe pain in your stomach area that will not go away, with or without vomiting. The pain may spread to your back.1,3
  • Possible gallbladder problem: pain in your upper stomach, fever, yellow skin or eyes (jaundice), or pale, clay-coloured stools.1,3
The US labels say to stop the medicine and contact your doctor if pancreatitis is suspected.1

A gallbladder attack often brings belly pain lasting several hours, feeling sick, vomiting, chills, or dark, tea-coloured urine.17 Pancreatitis can also cause fever, a fast heartbeat and a swollen, tender belly.16

Mild stomach upset is very common: more than 1 in 10 people on the EU Wegovy label.6 It is most frequent after a dose step.1 Our side-effects guide and our post on Mounjaro side effects cover the everyday effects. The signs in the red box differ: the pain is severe, doesn't settle, or comes with fever or yellowing.1,17

You can report a suspected side effect to India's Pharmacovigilance Programme. Its helpline is 1800 180 3024, on working days from 9:00 am to 5:30 pm, and patients can report.22

Who do the labels say should be careful?

The labels single out people who have had pancreatitis before: EU labels urge caution, and US guides ask you to mention it.1,3,6,7,8

  • Past pancreatitis. The EU semaglutide labels say "caution should be exercised" in people with a history of pancreatitis.6,7 The EU Mounjaro label says tirzepatide has not been studied in them.8
  • Confirmed pancreatitis on the medicine. The EU labels say the medicine should not be restarted if pancreatitis is confirmed.6,8
  • Pancreas or kidney problems. The US Wegovy Medication Guide asks you to mention any past or current pancreas or kidney problems.1
  • Teens. Gallstones were more common in Wegovy's teen trial than in adults: 3.8% vs 0% on placebo.1

Blood tests need care too. On Wegovy, lipase, a pancreas enzyme, rose by 39% on average in weight trials.1 The EU labels say a raised enzyme alone does not predict pancreatitis.6,8 Our guide Should I consider a GLP-1? covers who the labels exclude.

RisksThe other risks, in brief
  • Stomach effects are very common, more than 1 in 10 people on the EU Wegovy label.6 They appear most often during dose steps.1
  • Dehydration can hurt the kidneys. Kidney injury was 0.4 vs 0.2 cases per 100 patient-years in Wegovy's weight trials.1
  • Low blood sugar is more likely when these medicines are taken with insulin or a sulfonylurea.1
  • Thyroid warning. Ruled out by the US label for people with a personal or family history of medullary thyroid cancer (MTC) or MEN 2; tell your doctor if this applies.1 Not in pregnancy: the Wegovy label says to stop at least 2 months before a planned pregnancy.1
Full detail in Guide 5: Side effects and risks →

Questions people ask

Can Ozempic cause pancreatitis?

It can, but it is uncommon: the EU Ozempic label puts it at up to 1 in 100 people. On the US Ozempic label, diabetes trials confirmed 0.3 cases per 100 patient-years, vs 0.2 on other diabetes medicines. In the 2-year SUSTAIN-6 heart trial it was 0.5% vs 0.6% on placebo.3,7

Can Mounjaro cause gallbladder problems?

Yes, but it is uncommon: the EU Mounjaro label puts gallstones and an inflamed gallbladder at up to 1 in 100. In the diabetes trials on the US Mounjaro label, 0.6% had gallstones, gallbladder pain (biliary colic) or gallbladder removal, vs 0% on placebo. In tirzepatide's weight trials, an inflamed gallbladder affected 0.7% vs 0.2%.2,4,8

Can I take a GLP-1 medicine if I have had pancreatitis before?

The EU labels for semaglutide say to take care in people with a history of pancreatitis. The EU Mounjaro label says tirzepatide has not been studied in them. The US Medication Guides ask you to tell the prescriber about any past pancreas problems.1,6,8

Does a high lipase test mean I have pancreatitis?

Not on its own. People on Wegovy had lipase, a pancreas enzyme, rise by 39% on average in trials. The EU labels say raised pancreas enzymes alone do not predict pancreatitis without other signs.1,6

Do GLP-1 medicines cause pancreatic cancer?

A 2025 review of 62 trials found no significant link overall. It did find a small signal in trials where people also took background medicines. The authors think this difference is likely minimal, because many trials with no cases in either group were left out.11

How we researched this

On 5 October 2026 we downloaded the US labels for Wegovy, Ozempic, Rybelsus, Mounjaro and Zepbound. We also downloaded the EU labels for Wegovy, Ozempic, Mounjaro and Rybelsus. We searched each one for every pancreatitis and gallbladder figure and quoted them exactly. We read four trial reviews, the STEP 1 trial, two gallbladder-emptying studies, two Indian gallstone studies and US health-service pages.

We could not find Indian prescribing information online, so the label figures are US and EU. Labels pool trials differently. The EU Wegovy label gives a placebo gallstone rate of 1.1% and the US one 0.7%; our table uses the US figures.1,6 We left out one regional figure from the 2026 Indian study that we could not confirm in the paper's text.

Before you move on

  • Pancreatitis is uncommon on Wegovy, Ozempic and Mounjaro (up to 1 in 100 on EU labels) and rare on Rybelsus (up to 1 in 1,000). Large reviews disagree on whether it rises at all.
  • Gallstones are common on Wegovy and Ozempic (up to 1 in 10 on EU labels) and a small but consistent extra risk.
  • Fast weight loss raises gallstone risk, but it doesn't explain all of the extra risk on Wegovy.
  • Severe stomach pain that won't settle, or yellow eyes with fever, means call 112.
I'm already on itShould I consider a GLP-1?Doctor questions

More from the India blog

INIndiaRisksMounjaro side effects: what the trials and the label say INIndiaMedicinesHow much weight do people lose on Ozempic or Mounjaro? What the trials found INIndiaMedicinesWegovy vs Ozempic: same medicine, different brand?
About GLP Guidebook

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An independent guide to GLP‑1 medicines. We don't sell medicines, take drug-company money or earn clinic commissions. Once a month: new brands, price changes, approvals and recalls. How we write

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Sources

  1. Novo Nordisk. Wegovy (semaglutide) injection and tablets, US prescribing information and Medication Guide, revised June 2026 (US label, not the Indian one). PDF
  2. Eli Lilly. Zepbound (tirzepatide), US prescribing information, revised August 2026 (US label, not the Indian one). PDF
  3. Novo Nordisk. Ozempic (semaglutide) injection, US prescribing information and Medication Guide, revised May 2026 (US label, not the Indian one). PDF
  4. Eli Lilly. Mounjaro (tirzepatide), US prescribing information, revised August 2026 (US label, not the Indian one). PDF
  5. Novo Nordisk. Rybelsus (semaglutide) tablets, US prescribing information, revised January 2026 (US label, not the Indian one). PDF
  6. European Medicines Agency. Wegovy: EU product information (summary of product characteristics), sections 4.4 and 4.8 (EU label). PDF
  7. European Medicines Agency. Ozempic: EU product information, sections 4.4 and 4.8 (EU label). PDF
  8. European Medicines Agency. Mounjaro: EU product information, sections 4.4 and 4.8 (EU label). PDF
  9. He L, et al. Association of GLP-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;182:513–19. Declared interests: none reported. DOI · PMID 35344001 · Free full text
  10. Chiang CH, et al. Glucagon-like peptide-1 receptor agonists and gastrointestinal adverse events: a systematic review and meta-analysis. Gastroenterology. 2025;169:1268–81. DOI · PMID 40499738
  11. Wen J, et al. Evaluating the rates of pancreatitis and pancreatic cancer among GLP-1 receptor agonists: a systematic review and meta-analysis of randomised controlled trials. Endocrinol Diabetes Metab. 2025;8:e70113. Declared interests: none. DOI · PMID 40988099 · Free full text
  12. Galli M, et al. Cardiovascular effects and tolerability of GLP-1 receptor agonists: a systematic review and meta-analysis of 99,599 patients. J Am Coll Cardiol. 2025;86:1805–19. Declared interests: some authors report fees from Novo Nordisk and Eli Lilly (paper's own declaration). DOI · PMID 40892610
  13. Erlinger S. Gallstones in obesity and weight loss. Eur J Gastroenterol Hepatol. 2000;12:1347–52. DOI · PMID 11192327
  14. Weinsier RL, Wilson LJ, Lee J. Medically safe rate of weight loss for the treatment of obesity: a guideline based on risk of gallstone formation. Am J Med. 1995;98:115–17. DOI · PMID 7847427
  15. Wilding JPH, et al. Once-weekly semaglutide in adults with overweight or obesity (STEP 1). N Engl J Med. 2021;384:989–1002. Funded by Novo Nordisk. DOI · PMID 33567185
  16. US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Pancreatitis: definition and facts; symptoms and causes (US health service pages, last reviewed November 2017). Definition · Symptoms and causes
  17. NIDDK. Gallstones: definition and facts; symptoms and causes (US health service pages, last reviewed November 2017). Definition · Symptoms and causes
  18. Unisa S, et al. Population-based study to estimate prevalence and determine risk factors of gallbladder diseases in the rural Gangetic basin of North India. HPB (Oxford). 2011;13:117–25. DOI · PMID 21241429
  19. Mohite SU, et al. Prevalence of gallstone disease in India: insights from a community-based cross-sectional study. BMJ Public Health. 2026;4:e004015. Funded by Tata Memorial Centre. DOI · PMID 41658223 · Free full text
  20. Press Information Bureau (PIB Research). GLP-1 Drugs: Use, Risks, and Regulation. Government backgrounder, 1 April 2026. PDF
  21. CDSCO. Recommendations of the Subject Expert Committee (Endocrinology & Metabolism): 20–21 April 2023, item 1 (tirzepatide), and 13–14 February 2024, items 3–4 (semaglutide, Novo Nordisk). Committee minutes. April 2023 PDF · archived copy · February 2024 PDF · archived copy
  22. Indian Pharmacopoeia Commission. Pharmacovigilance Programme of India (PvPI): reporting adverse drug reactions. Link
  23. Nexøe-Larsen CC, et al. Effects of liraglutide on gallbladder emptying: a randomized, placebo-controlled trial in adults with overweight or obesity. Diabetes Obes Metab. 2018;20:2557–64. Funded by Novo Nordisk; three authors are Novo Nordisk employees. DOI · PMID 29892986 · Free full text
  24. Rehfeld JF, et al. Cholecystokinin secretion is suppressed by glucagon-like peptide-1: clue to the mechanism of the adverse gallbladder events of GLP-1-derived drugs. Scand J Gastroenterol. 2018;53:1429–32. DOI · PMID 30449207
  25. European Medicines Agency. Rybelsus: EU product information, package leaflet section 4 (EU label). PDF

Last checked 5 Oct 2026 · Next review due 5 Oct 2027 · Report an error

How this post was made. Written by the GLP Guidebook team from the sources above. It's general information, not medical advice. Talk to a qualified doctor before starting, stopping or changing any medicine. How we write