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There have been several publications indicating that the use of macrolide antibiotics, increase risk of serious ventricular arrhythmias and sudden cardiac death (FDA Adverse Event Reporting System)

Pharmaceutics 13:576

Cruz-Jentoft AJ, et al

3.1 Primary outcome: pulmonary embolism At 12 months, tirzepatide use was associated with a significantly lower risk of pulmonary embolism compared with lifestyle intervention alone ( Table 2 )

This disruption often leads to diarrhea

Alternating between medications doubles the dose-change events, potentially creating more hormonal disruption than staying on a single medication