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HealthRX.com · Printable surgery planning sheet

Mounjaro imaging appointment sheet

Fill this in before a CT, MRI or other scan that uses contrast or sedation: your last Mounjaro injection, metformin and kidney results, recent stomach symptoms, and the restart plan the team agrees.

Companion to “Mounjaro and Imaging Contrast Dye: What You Need to Know Before Your Scan” · healthrx.com/interactions-v2-mounjaro/contrast-dye-interaction · Facts checked 2026-10-18

The appointment

Scan type and dateCT, MRI, fluoroscopy, other
Contrast plannediodinated into a vein, into an artery, gadolinium, oral, none
Sedation or anesthesia planned?
Imaging department phone

Medicines to report

Mounjaro dose (mg)
Date and time of the last Mounjaro injection
Metformin dose, if any
Most recent eGFR, with date
Insulin or sulfonylurea

Tell the team about

  • Nausea, vomiting, fullness or bloating in the past few days
  • Diarrhea or trouble keeping fluids down
  • Any earlier reaction to contrast
  • Kidney disease, heart failure, liver disease or heavy alcohol use
  • Any instructions you were given to change your fast or your Mounjaro schedule

Label points for the team

  • Rare aspiration has been reported under general anesthesia or deep sedation in people on GLP-1 medicines who still had food in the stomach despite fasting.[1]
  • The Mounjaro label says the data do not yet show whether changing the fast or pausing Mounjaro lowers this risk, and asks patients to tell providers before any planned procedure.[1]
  • With eGFR 30 to 60, a history of liver disease, alcoholism or heart failure, or contrast given into an artery, metformin stops at or before the scan, and eGFR is rechecked 48 hours later before restarting.[2]
  • Dehydration and diabetes are listed risk factors for kidney injury after iodinated contrast, and hydration before and after is advised.[3]
  • Mounjaro needs no dose change for kidney impairment.[1]

After the scan, get help promptly for

  • Rash, hives, swelling or breathing trouble after you leave: contrast reactions can be delayed.[3]
  • Nausea, vomiting or diarrhea that persists, or other signs of kidney injury your team described.[1]

Restart plan

eGFR result after the scan, with date
Metformin restart date
Next Mounjaro injection date
Who confirmed the plan
Sources for the facts on this sheet
  1. Eli Lilly and Company, via DailyMed. Mounjaro (tirzepatide) injection, for subcutaneous use: prescribing information and Medication Guide. Effective 2026-08-27. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d2d7da5d-ad07-4228-955f-cf7e355c8cc0
  2. Zydus Pharmaceuticals USA Inc., via DailyMed. Metformin hydrochloride tablets: prescribing information. Effective 2026-07-15. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c82a10fa-1e8e-46b6-890a-737de3f34ee1
  3. GE Healthcare Inc., via DailyMed. Omnipaque (iohexol) injection and oral solution: prescribing information. Effective 2026-04-07. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=eee15ebe-d349-4497-acef-6abe7a8247fb

This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.