PEBC: What You Need to Know: GLP-1 Receptor Agonists

Examples: liraglutide, semaglutide (oral and injectable), dulaglutide, exenatide, lixisenatide

Mechanism: Promotes satiety, slows gastric emptying, weight loss

Efficacy: effective A1c lowering option, however, injectable options work better than oral. Evidence for improved cardiovascular and renal outcomes.

Dosing:

Oral semaglutide: once daily first thing in the morning, empty stomach, 30 minutes before any food or drink (except for water). No more than half a glass of water.

Injectables:

Lixisenatide: once daily before meals

Exenatide-daily formulation: twice daily before meals

Liraglutide: once daily without regard to meals

Semaglutide, dulaglutide, exenatide-once weekly formulation: once weekly

Adverse Effects:

-gastrointestinal: nausea, vomiting, diarrhea (mitigated by slow titration of dose)

-hypoglycemia is rare (usually when combined with other agents)

-pancreatitis risk

-contraindicated in some thyroid cancers

-weight loss

Drug Interactions:

Hypoglycemia when combined with other agents, particularly sulfonlyureas and insulin. The dose may need to be decreased when starting GLP-1 agents.