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Special Populations Requiring Monitoring : Elderly patients may be more susceptible to gastrointestinal side effects and dehydration Patients taking insulin or sulfonylureas require dose adjustments of these medications to prevent hypoglycemia Patients with cardiovascular disease should be monitored, though cardiovascular outcomes data are still emerging Patients with depression or suicidal ideation (particularly for Zepbound) require careful monitoring for worsening symptoms Pediatric patients : Safety and efficacy have not been established in patients under 18 years of age Regarding renal function, no dose adjustment is required for patients with renal impairment, including those with end-stage renal disease