GLP-1 agonists are a class of injectable medications that are used for type 2 diabetes and weight management. Some of the agents have also been shown to reduce the risk of major adverse cardiovascular events such as cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. More recently, these agents have gained popularity in assisting in weight loss. If you missed a dose of GLP-1 medication and are unsure of what to do, see below the guidance for each GLP-1 medication available.
If you have additional questions about injectable GLP-1 agonist medications or what to do if you missed a dose of GLP-1 medication, you could always chat with a pharmacist online 24/7.
Missed a Dose of GLP-1 Medication: By Medication
Missed a dose of GLP-1 medication Mounjaro (tirzepatide):
Available Strengths: 2.5mg, 5mg, 7.5mg 10mg, 12.5mg, 15mg Who manufactures Mounjaro? Eli Lilly Missed a dose of Mounjaro (tirzepatide)? For any strength: Dose should be administered as soon as possible within 4 days (96 hours) after the missed dose. If more than 4 days have passed, skip the missed dose and administer the next dose on the regularly scheduled day. In each case, patients can then resume their regular once weekly dosing schedule. Keep in mind that the weekly administration day can be changed as long as the time between doses is a least 3 days (72 hours).
Missed a dose of GLP-1 medication Ozempic (semaglutide):
Available Strengths: 0.25mg, 0.5mg, 1mg, 2mg Who manufactures Ozempic? Novo Nordisk Missed a dose of Ozempic (semaglutide)? For any strength: Dose should be administered as soon as possible within 5 days (120 hours) after the missed dose. If more than 5 days have passed, skip the missed dose and administer the next dose on the regularly scheduled day. In each case, patients can then resume their regular once weekly dosing schedule. Keep in mind that the weekly administration day can be changed as long as the time between doses is a least 2 days (48 hours).
Missed a dose of GLP-1 medication Trulicity (dulaglutide):
Available Strengths: 0.75mg, 1.5mg, 3mg, 4.5mg Who manufactures Trulicity? Eli Lilly Missed a dose of Trulicity (dulaglutide)? For any strength: Dose should be administered as soon as possible within 3 days (72 hours) after the missed dose. If more than 3 days have passed, skip the missed dose and administer the next dose on the regularly scheduled day. In each case, patients can then resume their regular once weekly dosing schedule. Keep in mind that the weekly administration day can be changed as long as the time between doses is a least 3 days (72 hours).
Missed a dose of GLP-1 medication Victoza (liraglutide):
Available Strengths: 0.6mg, 1.2mg, 1.8mg Who manufactures Victoza (liraglutide)? Novo Nordisk Missed a dose of Victoza (liraglutide)? For any strength: Instruct patients who miss a dose of liraglutide injection to resume the once daily dosage regimen as prescribed with the next scheduled dose. Do not administer an extra dose or increase the dose to make up for the missed dose.
Ask A Pharmacist Online About GLP-1 Medications
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Disclaimer: This website does not provide medical advice. No content on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment. All content on this site is for educational and informational purposes only, does not constitute medical advice, and does not establish any kind of patient-provider or client-professional relationship by your use of this website. Although we strive to strictly provide accurate and up to date general information, content available on this site is not a substitute for professional medical advice, and you should not rely solely on the information provided here. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding medical conditions, treatments, or medications.
GLP-1 medications like Ozempic (semaglutide) and Mounjaro (tirzepatide) have recently been gaining popularity and media attention for their beneficial effects in treating diabetes and promoting weight loss. This article will provide a comprehensive guide from a pharmacist to anyone on a GLP-1 medication or thinking about starting one.
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What are GLP-1 medications?
GLP-1 is an abbreviation for Glucagon-Like Peptide-1 receptor agonist, which is a class of medications commonly used to treat diabetes and to assist with weight loss in patients with or without diabetes. This class of medications contains the popular semaglutide (Ozempic®, Wegovy®, Rybelsus®), tirzepatide (Mounjaro®, Zepbound®), liraglutide (Victoza®, Saxenda®), dulaglutide (Trulicity®), and exenatide (Byetta®, Bydureon®). Only semaglutide, tirzepatide, and liraglutide are FDA approved for weight loss, but all of these medications are approved to treat type 2 diabetes.
How do GLP-1 medications work?
GLP-1 medications have multiple different mechanisms in the body that help with diabetes and weight loss, including:
Increasing the amount of insulin made by the pancreas, which helps control blood sugar in patients with diabetes
Decreasing the amount of excess sugar made by the pancreas, which helps control blood sugar in patients with diabetes
Slowing down digestion from the stomach, which results in feeling full for longer after eating
Signaling to your brain that you are full after eating, which helps suppress appetite and control cravings
Tirzepatide contains an extra mechanism of action that other GLP-1 medications do not, known as GIP (glucose-dependent insulinotropic polypeptide) agonism. This extra mechanism provides the following benefits:
Greater appetite suppression and glucose control due to additive effects when combined with GLP-1 agonism
Improving how fat cells respond to insulin, which provides more effective blood sugar control
Promoting the breakdown of fat cells resulting in more effective weight loss
How effective are GLP-1 medications?
All GLP-1 medications have been proven to be effective for diabetes, and some have been studied and proven to be effective for weight loss as well. Below are details regarding their effectiveness in clinical trials.
GLP-1s for Weight loss
GLP-1s were studied for weight loss in patients 18 years old or older who are obese (BMI > 30 kg/m2) or overweight (BMI > 27 kg/m2) with at least one weight-associated condition, such as cardiovascular disease, high cholesterol, high blood pressure, obstructive sleep apnea, or type 2 diabetes.
In a study of 1,961 patients assigned to take either semaglutide or placebo for 68 weeks, 86.4% of the patients on semaglutide achieved at least 5% weight loss. In addition, 69.1% achieved at least 10% weight loss, and 50.5% achieved at least 15% weight loss. The most frequently reported side effects in this study were mild to moderate nausea, diarrhea, vomiting, and constipation.
In a study of 2,539 patients assigned to take either tirzepatide or placebo for 72 weeks, the average weight loss achieved for patients taking tirzepatide 5 mg was 15%. Patients taking tirzepatide 10 mg achieved an average of 19.5% weight loss, and patients taking tirzepatide 15 mg achieved an average of 20.9% weight loss. The most frequently reported side effects were mild to moderate nausea, diarrhea, and constipation.
In a study of 3,731 patients assigned to take either liraglutide or placebo, 63.2% of patients taking liraglutide lost at least 5% of their body weight and 33.1% of patients lost at least 10% of their body weight. The most frequently reported side effects were mild to moderate nausea and diarrhea.
In a study comparing the effects of semaglutide and tirzepatide for weight loss, those receiving tirzepatide were more likely to achieve 5% or greater, 10% or greater, and 15% or greater weight loss and experienced larger reductions in body weight at 3, 6, and 12 months. Rates of reported side effects were similar between the two groups.
GLP-1s for Diabetes
While the American Diabetes Association (ADA) recommends personalized goals for the care of diabetes, all GLP-1 medications have shown to be effective. The 2024 Standards of Care in Diabetes does emphasize use of certain GLP-1 medications over others for certain goals. Semaglutide, liraglutide, and dulaglutide have all shown to reduce the occurrence of major cardiovascular events like heart attack, stroke, and death in patients with diabetes, while tirzepatide is currently being studied for the same. Semaglutide, tirzepatide, and high dose dulaglutide have been deemed to have very high likelihood of achieving adequate blood sugar control, while other GLP-1s have been deemed highly likely. GLP-1 medications are recommended in the ADA Standards of Care for those with cardiovascular disease, heart failure, and/or kidney disease to reduce the risk of adverse events due to these conditions. GLP-1s are also recommended for blood sugar control in those who have a goal of weight loss in addition to managing their diabetes.
Who should not take GLP-1 medications?
GLP-1 medications should not be taken by anyone with a personal history or family history of medullary thyroid cancer, as development of these tumors were noted during early animal studies. These medications should also be avoided in anyone with multiple endocrine neoplasia syndrome type 2 due to increased risk. GLP-1 medications should be stopped if pancreatitis develops, and should likely be avoided in anyone with pre-existing gastroparesis.
What are the side effects of GLP-1 medications?
The most commonly reported side effects of GLP-1 medications are gastrointestinal symptoms like nausea, abdominal pain, and constipation. These are usually observed at the beginning of treatment and after dose increases, but typically go away with time. Acute pancreatitis, gallbladder disease, and stomach paralysis have also been rarely reported with GLP-1 use.
How are GLP-1 medications taken?
Most GLP-1 medications are given via subcutaneous injection, which means an injection under the skin but not in the muscle. Most injectable GLP-1s are given once per week, while liraglutide is given once per day. Semaglutide is also available as a once-daily oral capsule (Rybelsus®) for the treatment of diabetes.
Lifestyle tips to get the best results
For the best results while taking any GLP-1 medication, a healthy diet and adequate exercise are recommended. The American Heart Association specifically recommends consuming a diet that emphasizes intake of vegetables, fruits, whole grains, legumes, and healthy protein. They also recommend limiting intake of saturated fat, sweets, sugar-sweetened beverages, and red meat. For exercise, the American Heart Association recommends three to four 40-minute sessions of moderate to vigorous intensity exercise per week for most adults. These lifestyle modifications will help with both weight loss and diabetes in addition to GLP-1s.
Conclusion
GLP-1 medications have proven to be effective for management of diabetes as well as for weight loss in those without diabetes, especially when combined with a healthy diet and adequate exercise. GLP-1 medications should not be taken by people with a history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2. GLP-1s are generally well tolerated, with most gastrointestinal side effects subsiding over time.
Min T, Bain SC. The Role of Tirzepatide, Dual GIP and GLP-1 Receptor Agonist, in the Management of Type 2 Diabetes: The SURPASS Clinical Trials. Diabetes Ther. 2021 Jan;12(1):143-157. doi: https://doi.org/10.1007/s13300-020-00981-0
Pirro V, Roth KD, Lin Y, et al. Effects of Tirzepatide, a Dual GIP and GLP-1 RA, on Lipid and Metabolite Profiles in Subjects With Type 2 Diabetes. J Clin Endocrinol Metab. 2022 Jan 18;107(2):363-378. doi: https://doi.org/10.1210/clinem/dgab722
Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar 18;384(11):989-1002. doi: https://doi.org/0.1056/NEJMoa2032183
Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216. doi: https://doi.org/10.1056/NEJMoa2206038
Pi-Sunyer X, Astrup A, Fujioka K, et al. A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management. N Engl J Med. 2015 Jul 2;373(1):11-22. doi: https://doi.org/10.1056/NEJMoa1411892
Rodriguez PJ, Goodwin Cartwright BM, Gratzl S, et al. Semaglutide vs Tirzepatide for Weight Loss in Adults With Overweight or Obesity. JAMA Intern Med. 2024;184(9):1056–1064. doi: https://doi.org/10.1001/jamainternmed.2024.2525
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. doi: https://doi.org/10.2337/dc24-S009
Disclaimer: This website does not provide medical advice. No content on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment. All content on this site is for educational and informational purposes only, does not constitute medical advice, and does not establish any kind of patient-provider or client-professional relationship by your use of this website. Although we strive to strictly provide accurate and up to date general information, content available on this site is not a substitute for professional medical advice, and you should not rely solely on the information provided here. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding medical conditions, treatments, or medications.