Gallstones on GLP-1s — anyone here had a GB issue during treatment?

Prophylactic ursodiol (UDCA) 300mg twice daily during active weight loss has been studied in bariatric surgery populations with meaningful reduction in stone formation. Not standard of care for GLP-1 users but some providers prescribe it for high-risk patients. Worth asking your doctor if you have a family history or a prior sludge finding.

Had gallstones at month 8 on tirze. Started with upper right quadrant ache post-meal, progressed over 3 weeks to sharp pain and nausea. Ultrasound confirmed. Elective cholecystectomy. Stayed off tirze 6 weeks post-op, back on at lower dose. The GB was probably pre-existing and the rapid loss tipped it into symptomatic.

TUDCA 500mg daily, running for 14 months on tirze. No stones on ultrasound at the 12-month check. N=1, not a clinical trial, but it's a reasonable adjunct if you're not prescribed UDCA. Cheaper too.

Symptom hierarchy that got me to the ER: constant RUQ pain (not intermittent), referred pain to right shoulder, dark urine, pale stool. First three red flags on my weight loss journey in 18 months. Don't ignore RUQ pain that lingers more than 2-3 days.

Had sludge (pre-stone) found on a routine abdominal ultrasound 5 months into sema. My doctor put me on UDCA and I haven't progressed. Kept on sema. Ultrasound every 6 months as monitoring.

The gallstone risk is real but the absolute numbers are still low. Baseline rate ~0.5-1% per year in middle-aged adults, GLP-1 bumps that ~2-3x = 1.5-3% per year. Most people won't have problems. But 'low absolute risk' is not 'zero,' and if you have family history or known risk factors, the risk-benefit shifts.

Appreciate all replies. Key takeaways for the thread: 1) RUQ pain post-meal + nausea = ultrasound, don't wait. 2) UDCA or TUDCA prophylaxis is reasonable for higher-risk patients. 3) Baseline abdominal ultrasound before starting is a cheap and valuable data point. Pin this list somewhere.

Small point — slowing down weight loss when you have known sludge also reduces stone progression. The rate of loss is the driver, not the weight loss itself. Holding at current weight for 2-3 months can let sludge clear on its own.