When a Prescription Goes Wrong
Josephine Nasr was 19, a second-year law student at the University of East London, and by all accounts a healthy young woman with a future clearly mapped out. On September 23 last year, she was found dead on her bathroom floor in her university halls.
An empty vial of tirzepatide was found in her room.
The inquest, reported by The Independent, found that the cause of death was cardiac arrhythmia. It was triggered by a combination of a congenital heart condition she never knew she had, called myocardial bridging, and an electrolyte imbalance caused by severe vomiting. Vomiting is a known, documented side effect of the drug she was taking.
That drug was Zepbound, the US brand name for tirzepatide. In the UK it is sold as Mounjaro.
She Was Not Obese
This is the part of the story that deserves more attention than it is getting.
Josephine's BMI placed her in the overweight category. Not obese. The inquest heard she had been prescribed Zepbound by her doctor in the United States during the summer of 2025. Tirzepatide is a GLP-1 and GIP receptor agonist. These drugs work by mimicking hormones that regulate appetite and blood sugar. They were originally developed to treat type 2 diabetes and later approved for obesity management in higher doses.
The question that sits uncomfortably at the centre of this case is straightforward: why was a 19-year-old who was not clinically obese taking this medication?
The Side Effects Are Not a Surprise
Nausea and vomiting are among the most common and well-documented side effects of tirzepatide. The drug slows digestion significantly, and for some people that means serious gastrointestinal distress, especially in the early weeks and when doses are increased.
On the night she died, Josephine told her family she felt nauseous and had been vomiting. Her sister was worried enough about dehydration to call a private healthcare provider to arrange IV fluids. The family, who were preparing for a trip to Egypt, urged her to get some fresh air. Security staff and a nurse arrived at her room and found her on the bathroom floor.
The pathologist at the inquest explained the chain of events clearly. Severe vomiting can cause a drop in blood sugar. A drop in blood sugar can cause an electrolyte imbalance. An electrolyte imbalance can trigger a cardiac arrhythmia. And if you have an underlying heart condition that has never been detected, the risk is significantly higher.
The pathologist described her as "an otherwise healthy young woman." That phrase carries weight.
What This Reflects About Where Prescribing Is Heading
Tirzepatide has been studied extensively. The clinical trial data is real. But those trials focused on people with type 2 diabetes or significant obesity. The rapid expansion of prescribing through telehealth platforms, private clinics, and short consultations has moved these drugs well outside their original evidence base.
GLP-1 drugs are now being prescribed to people who are mildly overweight, to people managing their weight ahead of a specific event, and, as this case shows, to teenagers. Pre-prescription cardiac screening is not standardised. The monitoring in those first weeks, when side effects are most acute, is often left to the patient to self-manage.
Myocardial bridging, the condition Josephine had, is something many people live with their whole lives without ever knowing. It can be entirely benign. Under the right set of circumstances, it is not.
This Is Not a Reason to Panic About the Drugs
For people with genuine metabolic conditions, obesity-related health risks, or type 2 diabetes, the evidence supporting GLP-1 drugs is meaningful and the benefit to risk profile for the right patient is well established. That is not what this is about.
This is about the gap between what the evidence supports and what is actually being prescribed. It is about short consultations that do not include cardiac screening. It is about a 19-year-old being given a drug that was not designed for someone in her situation.
If you are considering tirzepatide or any GLP-1 drug, these are the questions worth asking your prescriber before you start:
What is the clinical basis for this prescription for me specifically?
Have I been screened for any cardiac conditions?
What should I do if I experience significant nausea or vomiting?
How will I be monitored during the first weeks of use?
A prescription without a monitoring plan is not enough. That should not need saying. But right now, in the current environment around weight loss drugs, it apparently does.
Frequently Asked Questions
What is tirzepatide and what is it approved for?
Tirzepatide is a medication that mimics two hormones involved in blood sugar regulation and appetite control. It is approved for treating type 2 diabetes and, at higher doses, for weight management in adults with obesity or with overweight plus a weight-related health condition. It is sold as Mounjaro in the UK and as Zepbound in the US.
What are the most common side effects of tirzepatide?
The most frequently reported side effects are gastrointestinal, including nausea, vomiting, diarrhoea, and reduced appetite. These tend to be most pronounced when starting the drug or when the dose is increased, and they vary significantly between individuals.
Can tirzepatide cause a heart problem?
Tirzepatide itself does not directly damage the heart in people without pre-existing conditions. However, severe vomiting as a side effect can cause a drop in blood sugar and an electrolyte imbalance, which can trigger a cardiac arrhythmia. People with undiagnosed heart conditions may face a higher risk in this scenario.
Should someone who is only slightly overweight take weight loss drugs like Mounjaro?
Current clinical guidelines generally recommend GLP-1 drugs for adults with a BMI of 30 or above, or 27 and above alongside a weight-related health condition. Prescribing to people outside these thresholds, including those who are mildly overweight or under 18, is outside the standard evidence base.
What should I check with my doctor before starting Mounjaro or Zepbound?
Ask specifically about your cardiac health and whether any screening is appropriate for you, how your symptoms will be monitored during the early weeks, and what to do if you experience severe or persistent side effects. A clear plan matters more than speed to the first prescription.
Is tirzepatide safe to use?
In appropriately selected patients, with proper baseline assessment and monitoring, tirzepatide has an acceptable safety profile based on the clinical trial data. The concern centres on prescribing without adequate screening or follow-up, particularly for younger patients or those outside the intended clinical population where the evidence is thin.