GLP-1 drugs increase vestibular disorder risk with semaglutide showing higher rates than tirzepatide | Research

The takeaway

In 496,756 matched patients from TriNetX, semaglutide increased vestibular disorder risk from 0.03% to 0.12% (6m) to 0.41% (3y), with higher risk than tirzepatide, representing a newly identified otologic safety signal for GLP-1 drugs.

New vestibular safety signal
Semaglutide increased vestibular disorders from 0.03% to 0.12% at 6 months to 0.41% at 3 years—a newly identified GLP-1 drug side effect affecting balance

What the researchers found

Semaglutide vestibular disorders: 0.12% (6m), 0.41% (3y) vs controls 0.03%, 0.16% (all p significant). Tirzepatide: increased risk but lower than semaglutide (p significant). 419,497 semaglutide + 77,259 tirzepatide users matched.

Why it matters

Vestibular disorders cause debilitating dizziness and imbalance. With nearly 500,000 semaglutide users studied, even a 0.41% 3-year risk means thousands of affected patients nationally.

How the study worked

Retrospective cohort from TriNetX (Nov 2024). Propensity score 1:1 matching. Semaglutide (419,497) and tirzepatide (77,259) vs matched controls. New-onset vestibular disorders at 6m, 1y, 3y.

What this study cannot tell us

Retrospective TriNetX data. Vestibular disorder definitions may vary. Cannot determine mechanism. Weight loss itself could affect vestibular function.

How to read the evidence

Large retrospective cohort with propensity matching. First study on this topic.

When this study was published

Published in 2025; TriNetX data through October 2024.

The bigger picture

This is the latest in a growing list of unexpected GLP-1 drug side effects affecting specific organ systems—from "Ozempic face" to Eustachian tube problems to vestibular disorders.

Questions still open

What mechanism causes GLP-1-associated vestibular disorders?
Does rapid weight loss or the drug itself drive the vestibular risk?
Should vestibular screening be included in GLP-1 drug monitoring?

Common questions

Can GLP-1 drugs cause dizziness or balance problems?

This large study found GLP-1 drugs are associated with a small but significant increase in vestibular disorders (dizziness, balance problems). Semaglutide had a higher risk than tirzepatide. While the absolute risk is low (0.41% over 3 years), patients should report new dizziness to their doctor.

Why might weight loss drugs affect balance?

The mechanism is unknown. Possibilities include: rapid weight changes affecting inner ear fluid dynamics, GLP-1 receptor effects on vestibular neurons, or metabolic changes affecting inner ear function. This is a new finding that needs further investigation.

Read the original research

The Risk of Vestibular Disorders with Semaglutide and Tirzepatide: Findings from a Large Real-World Cohort.

Biomedicines, 13(5)

View on PubMed ↗Publisher’s paper ↗

Citation

Toraih, Eman A; Alenezy, Awwad; Hussein, Mohammad H; Hashmat, Shahmeer; Mummadi, Saitej; Alrawili, Nawaf Farhan; Abdelmaksoud, Ahmed; Fawzy, Manal S. (2025). The Risk of Vestibular Disorders with Semaglutide and Tirzepatide: Findings from a Large Real-World Cohort.. Biomedicines, 13(5). https://doi.org/10.3390/biomedicines13051049