GLP-1 agonist medications

The Glucagon-like peptide 1 agonist medications were initially used to treat diabetes type 2. They are also called GLP 1 agonist.

There are several commercially available GLP-1 agonists. The list includes but is not limited to:

• Semaglutide (Ozempic, Wegovy, and Rybelsus)
• Tirzepatide (Mounjaro, Zepbound)
• Dulaglutide (Trulicity)
• Exenatide (Bydureon Bcise, and Byetta)
• Liraglutide (Victoza, Saxenda)
• Lixisenatide (Adlyxin)
• Albiglutide (Tanzeum)

These medications will act like the hormone Glucagon-like peptide 1. As the sugar levels increase after eating, the hormone will cause the production of more insulin by the pancreatic beta-cells. It also slows the gastric emptying. The cumulative effect will lead to reduced blood glucose levels.

Patients were seen to reduce their weight, and soon the medication was extended to patients desiring weight loss.

The weight loss reduction associated with the medication is not well understood and is limited.

Unfortunately, there are several side effects associated with the GLP-1 agonist such as but not limited to:

• Nausea
• Diarrhea
• Vomiting
• Constipation
• Abdominal pain
• Headaches
• Fatigue
• Dyspepsia
• Eructation
• Bloating
• Abdominal distention
• Gastroparesis
• Gallstones
• Dyspepsia

Some of the above side-effects may improve after stopping the medication. Unfortunately, some of them have been seen to last months or years after the patient stop the use. Gastroparesis is seen when the stomach no longer contracts normally. The food stays in the stomach for longer periods of time. This is partially the reason for patients not being as hungrier. They feel bloated and nauseous, as patients with gastroparesis typically do report. Anesthesiologists across the US have required patients on GLP-1 agonist to stop it, at least one week before anesthesia. The concern is during induction of anesthesia, patients could have significant food or liquids in the stomach due to gastroparesis. Aspiration pneumonia has been reported.

Patients with a personal or family history of medullary thyroid carcinoma (MTC) or patients with multiple endocrine neoplasia syndrome type 2, the GLP-1 agonist are CONTRAINDICATED. The concern is the development of thyroid cancer.

There are post marketing reports of acute kidney injury and worsening of chronic renal failure.

Putting the side-effects aside, the earlier reports are showing good but limited amount of weight loss. Some of the medications will need adjustment in subsequent months. The medication cannot be stopped, since most studies have shown weight regain when the patient stops using it. Not all insurance covers the cost of the medication.