Help Patients Overcome Hurdles With GLP-1 Agonists

Rxs are rolling in for GLP-1 agonists...liraglutide (Victoza, etc), semaglutide (Ozempic, etc), dulaglutide (Trulicity), etc.

It’s partly because these injectable meds are a first-line option for type 2 diabetes in patients who also have certain medical conditions...such as heart or kidney disease.

Plus injectable semaglutide (Wegovy) or tirzepatide (Zepbound) seem to be the most effective Rxs for managing overweight or obesity.

But side effects or other problems often get in the way of therapy. Help navigate common hurdles with GLP-1 agonist Rxs.

Shortages. Expect shortages to continue...due to high demand.

Work with the patient and your pharmacist to find solutions.

Some patients may need to temporarily step down to a lower dose...or switch to a comparable dose of another GLP-1 agonist given at the same time interval.

For example, if a patient using injectable 0.5 mg semaglutide weekly for type 2 diabetes can’t get it due to shortages...they may be able to switch to dulaglutide 1.5 mg weekly when the next dose is due.

Help request new Rxs as appropriate. To limit confusion, add notes to the patient’s profile about any med change...and consider discontinuing the old Rx to avoid accidentally dispensing it.

Interactions. Continue to ask patients for their current meds and add these to med profiles...even if they get the Rx elsewhere.

Risky interactions may fly under the radar...especially if patients get GLP-1 agonists from other sources (manufacturer, etc).

For instance, labeling for tirzepatide (Mounjaro, Zepbound) cautions about possible reduced efficacy of oral contraceptives.

To reduce the risk of unintended pregnancy, patients should use a non-oral method of contraception (ring, IUD, etc) or backup for 4 weeks after starting tirzepatide and after each dose increase.

Side effects. Watch strengths of GLP-1 agonists carefully.

Dosing should “start low and go slow” limit GI effects (nausea, vomiting, etc).

For example, patients getting tirzepatide should start at 2.5 mg weekly and increase by 2.5 mg every 4 weeks as tolerated...up to a max of 15 mg/week.

Pull in your pharmacist for counseling on other strategies to improve tolerability. To limit nausea, patients should eat smaller meals...consume food slowly...and stop eating before they feel full.

If needed, a short-term med may also be tried to relieve side effects...such as ondansetron for nausea or loperamide for diarrhea.

Listen for patients reporting severe gastrointestinal pain. This can be a red flag for rare pancreatitis, gallbladder issues, or bowel obstruction...and patients will need medical evaluation.

Use our resources, Drugs for Type 2 Diabetes and Weight Loss Products, to compare costs, doses, etc.

And find best practices for billing, storage, and more in our resource Dispensing Insulin and Other Injectable Diabetes Meds.

Key References

  • American Diabetes Association Professional Practice Committee. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2024. Diabetes Care. 2024 Jan 1;47(Suppl 1):S158-S178.
  • Almandoz JP, Lingvay I, Morales J, Campos C. Switching Between Glucagon-Like Peptide-1 Receptor Agonists: Rationale and Practical Guidance. Clin Diabetes. 2020 Oct;38(4):390-402.
  • Anderson J, Gavin JR 3rd, Kruger DF, Miller E. Optimizing the Use of Glucagon-Like Peptide 1 Receptor Agonists in Type 2 Diabetes: Executive Summary. Clin Diabetes. 2022 Summer;40(3):265-269.
  • le Roux CW, Zhang S, Aronne LJ, et al. Tirzepatide for the treatment of obesity: Rationale and design of the SURMOUNT clinical development program. Obesity (Silver Spring). 2023 Jan;31(1):96-110.
  • Ruder K. As Semaglutide's Popularity Soars, Rare but Serious Adverse Effects Are Emerging. JAMA. 2023 Dec 12;330(22):2140-2142.
Pharmacy Technician's Letter. February 2024, No. 400216

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