Questions continue to pour in about GLP-1 agonists (semaglutide, etc)...as meds are still hard to get despite resolved shortages.
Be ready to navigate options and guide appropriate use.
If possible, try to temporarily step down to a lower dose. For instance, suggest tirzepatide 10 mg if 15 mg isn’t available.
Or switch GLP-1 agonists if needed.
Advise titrating the new GLP-1 agonist from a lower dose if there’s a history of tolerability concerns...or the patient has missed several doses or has been on a GLP-1 agonist for less than a month.
Otherwise, lean toward a med given at the same interval...at a comparable dose. Also consider differences between injectable devices and compelling indications, such as CV or kidney disease.
For example, tirzepatide 2.5 mg weekly for diabetes may be switched to dulaglutide 1.5 mg weekly, starting when the next dose is due.
Use this table as a guide...keeping in mind that these comparisons aren’t based on robust data and individual response may vary.
Don’t recommend “stacking” doses...using 2 lower doses at once to replace a higher dose. It won’t likely be covered...it’s double the cost.
Continue to anticipate prior auths. For instance, for diabetes, payers may require type 2 diabetes diagnosis or other diabetes meds (metformin, etc) on record prior to GLP-1 agonist use.
Stay vigilant when prescribers send e-Rxs for different strengths of the same med. As a best practice, fill one Rx at a time...and put future doses on hold.
But if patients get more than one strength, such as with liraglutide titrated weekly, ensure your team flags will-call bags for a consult.
Be sure to counsel patients on proper use...especially if changing meds or type of device...to help avoid mishaps.
Document GLP-1s from other sources, such as from the manufacturer in a vial (Zepbound)...or from a compounding pharmacy...in patient profiles.
Advise to only buy compounded meds from a licensed US pharmacy, ideally accredited in compounding. Steer patients away from online sellers that don’t require an Rx, spas that tout “generic” GLP-1s, etc.
Use our Comparison of GLP-1 Agonists chart to see how meds stack up.
- Whitley HP, Trujillo JM, Neumiller JJ. Special Report: Potential Strategies for Addressing GLP-1 and Dual GLP-1/GIP Receptor Agonist Shortages. Clin Diabetes. 2023 Summer;41(3):467-473.
- 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.
- Jain AB, Ali A, Gorgojo Martínez JJ, et al. Switching between GLP-1 receptor agonists in clinical practice: Expert consensus and practical guidance. Int J Clin Pract. 2021 Feb;75(2):e13731.
- Trujillo JM, Nuffer W, Smith BA. GLP-1 receptor agonists: an updated review of head-to-head clinical studies. Ther Adv Endocrinol Metab. 2021 Mar 9;12:2042018821997320.
- Medication pricing by Elsevier, accessed November 2024.
- Chart: Comparison of GLP-1 Agonists