Off-label use of tirzepatide: analysis of sarcopenia risk in individuals without clinical indication

Abstract

Objective: To analyze the potential impacts of off-label tirzepatide use on muscle mass and the risk of sarcopenia in individuals without a formal metabolic indication. Methods: This is an integrative literature review conducted using the PubMed/MEDLINE, SciELO, and LILACS databases. Articles published between 2016 and 2026, available in full text and in Portuguese, English, or Spanish, were included. After applying the eligibility criteria, six studies were selected for qualitative synthesis, with the robustness of the evidence assessed using the GRADE methodology. Results: The studies demonstrated that tirzepatide promotes significant body weight reduction; however, part of this loss may occur at the expense of lean mass. The available evidence suggests an association between drug-induced weight loss and reduced lean mass, although studies directly assessing sarcopenia, muscle strength, and physical performance remain scarce. Final considerations: Despite the high efficacy of tirzepatide in reducing body weight, evidence regarding the development of sarcopenia in individuals without a formal metabolic indication remains limited. Its use in this context should be approached with caution, with multidisciplinary follow-up, monitoring of body composition, and investigation of its effects on physical functionality.