A real-world analysis of nearly 500,000 adults prescribed GLP-1 or GLP-1/GIP therapy identified an association between incretin use and vestibular disorders, adding a new safety consideration beyond the familiar GI profile.
A large real-world cohort study published in 2026 examined vestibular disorder risk among 419,497 adults prescribed semaglutide and 77,259 prescribed tirzepatide between January 2018 and October 2024. Investigators reported a measurable association between incretin therapy and the subsequent diagnosis of vestibular disorders, which include dizziness, vertigo, and balance disturbances.
The analysis is observational and cannot establish causation, but the size of the cohort and the consistency of the signal across both molecules make it difficult to dismiss. The authors note that vestibular effects had been reported anecdotally in patient surveys and adverse-event databases but had not previously been quantified in a large cohort. The underlying mechanism is unclear and may involve autonomic changes, dehydration from GI symptoms, or direct central nervous system effects.
Separately, a 2026 case series highlighted another safety consideration — residual gastric content during upper endoscopy in patients on GLP-1 therapy — reinforcing growing attention to delayed gastric emptying as a procedural risk. Clinicians prescribing these agents will likely need to incorporate both findings into informed-consent discussions.
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