GLP-1 agonists
Revision as of 20:35, 31 January 2024 by Rossdonaldson1 (talk | contribs)
Background
- Synthetic glucagon-like peptide-1 (GLP-1) receptor agonists
- Released by L-cells of the small intestine in response to the presence of nutrients
- Stimulate insulin release from pancreatic islet cells. It does this by stimulating glucose-dependent insulin release in the islet cells of the pancreas
- Slows gastric emptying times
- Increases satiety, which decreases drive for food intake
GLP-1 Agonist Types
| Drug (Brand) | Class | Dose | Route | Frequency | Key Indications |
|---|---|---|---|---|---|
| Daily Dosing | |||||
| Exenatide (Byetta) | GLP-1 RA (exendin-4 based) | 5-10 mcg | SC | BID | T2DM |
| Lixisenatide (Adlyxin) | GLP-1 RA (exendin-4 based) | 10-20 mcg | SC | Daily | T2DM |
| Liraglutide (Victoza) | GLP-1 RA (human GLP-1 based) | 0.6-1.8 mg | SC | Daily | T2DM, CV risk reduction |
| Liraglutide (Saxenda) | GLP-1 RA (human GLP-1 based) | 3.0 mg | SC | Daily | Obesity/overweight |
| Weekly Dosing | |||||
| Semaglutide (Ozempic) | GLP-1 RA (human GLP-1 based) | 0.25-2 mg | SC | Weekly | T2DM, CV risk reduction, CKD |
| Semaglutide (Wegovy) | GLP-1 RA (human GLP-1 based) | 0.25-2.4 mg | SC | Weekly | Obesity/overweight, CV risk reduction |
| Semaglutide (Rybelsus) | GLP-1 RA (human GLP-1 based) | 3-14 mg | PO | Daily | T2DM |
| Semaglutide (Wegovy Pill) | GLP-1 RA (human GLP-1 based) | 1.5-25 mg | PO | Daily | Obesity/overweight |
| Dulaglutide (Trulicity) | GLP-1 RA (human GLP-1 based) | 0.75-4.5 mg | SC | Weekly | T2DM, CV risk reduction |
| Tirzepatide (Mounjaro) | Dual GLP-1/GIP RA | 2.5-15 mg | SC | Weekly | T2DM |
| Tirzepatide (Zepbound) | Dual GLP-1/GIP RA | 2.5-15 mg | SC | Weekly | Obesity/overweight, OSA |
- Albiglutide (Tanzeum) — discontinued 2017 (commercial reasons, not safety); removed from table
- Exenatide ER (Bydureon BCise) — discontinued 2023; brand Byetta discontinued 2024 (generic exenatide available)
ED-Relevant Considerations
- Delayed gastric emptying — all GLP-1 RAs slow gastric motility; important for:
- Aspiration risk during procedural sedation and intubation (consider NPO status unreliable)
- Altered absorption of co-administered oral medications
- 2023 ASA guidance recommends holding GLP-1 RAs prior to elective procedures requiring anesthesia
- Pancreatitis — rare but serious; discontinue if pancreatitis confirmed
- Hypoglycemia — low risk as monotherapy; increased risk when combined with sulfonylurea or insulin
- Nausea/vomiting — most common adverse effect; dose-dependent, typically improves with time
- Injection site reactions — generally mild
- Cholelithiasis/cholecystitis — increased incidence reported
- Contraindicated in personal/family history of medullary thyroid carcinoma or MEN type 2
Indication
- Diabetes Mellitus, Type 2
Adverse Reactions
- Nausea, vomiting, diarrhea
- Acute pancreatitis
- Exenatide should not be used in patients with creatinine clearance below 30mL/min
- Should not be used if personal of family history of medullary thyroid cancer or MEN 2A/2B