GLP-1 agonists - Revision history

Danbot: Strip excess bold

2026-03-22T09:11:19Z

Strip excess bold

Danbot: Formatting: removed bold

2026-03-19T16:15:38Z

Formatting: removed bold

Ostermayer at 20:46, 16 March 2026

2026-03-16T20:46:01Z

← Older revision		Revision as of 20:46, 16 March 2026
Line 1:		Line 1:
	==Background==		==Background==
	*~~Synthetic glucagon~~-like peptide-1 (GLP-1) receptor agonists		*Glucagon-like peptide-1 (GLP-1) receptor agonists are synthetic analogs of the incretin hormone GLP-1
	*~~Released~~ by L-cells ~~of the small intestine~~ in response to ~~the presence~~ of ~~nutrients~~		*Endogenous GLP-1 is released by intestinal L-cells in response to nutrient intake
	*~~Stimulate insulin release from pancreatic islet cells. It does this by stimulating~~ glucose-dependent insulin ~~release in the islet~~ cells ~~of the pancreas~~		*'''Mechanism of action''':
	*Slows gastric emptying ~~times~~		**Stimulates glucose-dependent insulin secretion from pancreatic beta cells (minimal hypoglycemia risk as monotherapy)
	*Increases satiety, ~~which decreases drive for~~ food intake		**Suppresses glucagon secretion
			**Slows gastric emptying
			**Increases central satiety signaling, reducing food intake
			*'''~1 in 8 US adults''' now use a GLP-1 RA for diabetes, weight loss, or cardiovascular risk reduction<ref name="ASA2024">Multisociety Clinical Practice Guidance for the Safe Use of Glucagon-like Peptide-1 Receptor Agonists in the Perioperative Period. Clin Gastroenterol Hepatol. 2024. doi:10.1016/j.cgh.2024.10.012</ref>
			*Two structural categories:
			**'''Exendin-4 based''' (exenatide, lixisenatide) — derived from Gila monster saliva peptide
			**'''Human GLP-1 based''' (liraglutide, semaglutide, dulaglutide) — modified human GLP-1 with extended half-life
			*'''Tirzepatide''' is a dual GLP-1/GIP receptor agonist (not a pure GLP-1 RA)

	{{GLP-1 Agonist Types}}		{{GLP-1 Agonist Types}}

	==~~Indication~~==		==Indications==
	*[[~~Diabetes Mellitus~~]], ~~Type 2~~		*'''Type 2 [[diabetes mellitus]]''' — all GLP-1 RAs are approved; recommended as first-line pharmacotherapy (alongside metformin) for patients with established ASCVD or high CV risk per ADA guidelines<ref>American Diabetes Association Professional Practice Committee. Standards of Care in Diabetes—2025. Diabetes Care. 2025;48(Suppl 1).</ref>
			*'''Obesity/overweight''' — FDA-approved agents:
			**Semaglutide 2.4 mg SC weekly (Wegovy) and oral semaglutide 25 mg (Wegovy Pill, approved December 2025)
			**Liraglutide 3.0 mg SC daily (Saxenda)
			**Tirzepatide (Zepbound) — approved for obesity
			*'''Cardiovascular risk reduction''' — semaglutide (Wegovy) approved for CV event reduction in patients with CVD and obesity/overweight; liraglutide and dulaglutide have demonstrated CV benefit<ref>Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med. 2023;389(24):2221-2232. doi:10.1056/NEJMoa2307563</ref>
			*'''Chronic kidney disease''' — semaglutide (Ozempic) approved January 2025 for CKD risk reduction in T2DM
			*'''Obstructive sleep apnea''' — tirzepatide (Zepbound) approved 2024 for moderate-to-severe OSA with obesity

	==Adverse Reactions==		==Adverse Reactions==
	*[[Nausea]], [[vomiting]], [[diarrhea]]		===Common===
	*Acute [[pancreatitis]]		*'''GI effects''' (most common, dose-dependent, usually improve with time):
	*~~Exenatide should not be used~~ in ~~patients with creatinine clearance below 30mL~~/~~min~~		**[[Nausea]], [[vomiting]], [[diarrhea]], [[constipation]], abdominal pain
	*~~Should not be used if personal~~ of family history of medullary thyroid ~~cancer~~ or ~~MEN 2A~~/2B		**Typically worst during dose initiation and up-titration
			*Injection site reactions
			*Headache

			===Serious===
			*'''Acute [[pancreatitis]]''' — rare but potentially fatal (including hemorrhagic and necrotizing); discontinue if suspected and do not restart if confirmed<ref name="StatPearls">Shaefer CF Jr, Engel SS, Engel JR, et al. Glucagon-Like Peptide-1 Receptor Agonists. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.</ref>
			*'''Cholelithiasis / acute [[cholecystitis]]''' — increased incidence reported, especially with higher doses and rapid weight loss
			*'''Acute kidney injury''' — reported in setting of severe GI symptoms (dehydration from nausea/vomiting/diarrhea)
			*Medullary thyroid carcinoma risk (observed in rodent studies; clinical significance uncertain)
			*'''Ileus / [[bowel obstruction]]''' — case reports of GI dysmotility
			*Hypoglycemia — low risk as monotherapy; '''increased risk when combined with [[sulfonylurea]] or [[insulin]]'''

			===Contraindications===
			*Personal or family history of medullary thyroid carcinoma (MTC)
			*MEN type 2
			*History of [[pancreatitis]] (relative; use with caution)
			*'''Exenatide (Byetta)''' specifically: avoid if CrCl <30 mL/min
			*''Semaglutide and dulaglutide do not require renal dose adjustment, but monitor renal function with GI side effects''

			==ED-Relevant Considerations==
			===Aspiration Risk During Procedural Sedation and Intubation===
			*GLP-1 RAs delay gastric emptying, leading to potential '''retained gastric contents''' despite standard fasting<ref name="ASA2024"/>
			*'''For urgent/emergent procedures: treat as full stomach''' and proceed with rapid sequence intubation<ref name="ASA2023">Joshi GP, Abdelmalak BB, Weigel WA, et al. American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients on Glucagon-Like Peptide-1 Receptor Agonists. ASA. June 2023.</ref>
			*The 2024 multisociety guidance (ASA, AGA, ASMBS) advises most patients may '''continue GLP-1 RAs''' before elective surgery, with individualized risk assessment<ref name="ASA2024"/>
			**If GI symptoms suggest delayed emptying: consider liquid diet for 24h prior to procedure, or gastric POCUS to assess stomach contents
			**Meta-analyses (>300,000 patients) show retained gastric contents are significantly increased in GLP-1 RA users, but actual aspiration rates remain low (0.1-0.2%)<ref>Perioperative Management of GLP-1 Receptor Agonists: Balancing Aspiration Risk with Therapeutic Benefit. SN Compr Clin Med. 2025. doi:10.1007/s42399-025-02079-9</ref>
			*'''Practical ED approach''': Ask about GLP-1 RA use when planning procedural sedation; consider gastric POCUS; have suction ready; use RSI if intubating

			===Other ED Considerations===
			*GLP-1 RA use may cause '''dehydration and AKI''' in patients with severe GI side effects — check renal function, resuscitate appropriately
			*May present with '''hypoglycemia''' if combined with sulfonylureas or insulin — treat per standard protocol
			*Severe '''nausea/vomiting''' may be the primary complaint — consider GLP-1 RA as contributing cause; may require IV fluids, antiemetics, and medication adjustment by prescriber
			*'''Pancreatitis workup''': maintain high index of suspicion for pancreatitis in patients on GLP-1 RAs presenting with severe abdominal pain
			*'''Altered drug absorption''': delayed gastric emptying may affect timing and absorption of co-administered oral medications

	==See Also==		==See Also==
	*[[GLP-1 receptor agonist toxicity]]		*[[GLP-1 receptor agonist toxicity]]
	*[[Diabetes medications]]		*[[Diabetes medications]]
	*[[~~Tirzepatide~~]]		*[[Hypoglycemia]]
			*[[Pancreatitis]]
			*[[Pneumonia\|Aspiration pneumonia]]
			*[[Procedural sedation]]

			==External Links==
			*[https://www.asahq.org/about-asa/newsroom/news-releases/2024/10/new-multi-society-glp-1-guidance ASA 2024 Multisociety GLP-1 Perioperative Guidance]
			*[https://emcrit.org/ibcc/ EMCrit IBCC]

	==References==		==References==
	~~#Epocrates~~		<references/>
	~~#http:~~/~~/www.uptodate.com/contents/glucagon-like-peptide-1-receptor-agonists-for-the-treatment-of-type-2-diabetes-mellitus?source=see_link&sectionName=GLUCAGON-LIKE+PEPTIDE-1&anchor=H2#H619400~~

	[[Category:Pharmacology]]		[[Category:Pharmacology]]
	[[Category:Endocrinology]]		[[Category:Endocrinology]]

Rossdonaldson1 at 20:35, 31 January 2024

2024-01-31T20:35:07Z

← Older revision		Revision as of 20:35, 31 January 2024
Line 1:		Line 1:
	==Background==		==Background==
	*Synthetic glucagon-like peptide-1 (GLP-1) receptor agonists		*Synthetic glucagon-like peptide-1 (GLP-1) receptor agonists
	*Released by L-cells of the small ~~intestinge~~ in response to the presence of nutrients		*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		*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		*Slows gastric emptying times
Line 12:		Line 12:

	==Adverse Reactions==		==Adverse Reactions==
	*Nausea, vomiting, diarrhea		*[[Nausea]], [[vomiting]], [[diarrhea]]
	*Acute pancreatitis		*Acute [[pancreatitis]]
	*Exenatide should not be used in patients with creatinine clearance below 30mL/min		*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		*Should not be used if personal of family history of medullary thyroid cancer or MEN 2A/2B
Line 23:		Line 23:

	==References==		==References==
	1.Epocrates		#Epocrates
			#http://www.uptodate.com/contents/glucagon-like-peptide-1-receptor-agonists-for-the-treatment-of-type-2-diabetes-mellitus?source=see_link&sectionName=GLUCAGON-LIKE+PEPTIDE-1&anchor=H2#H619400
	2.http://www.uptodate.com/contents/glucagon-like-peptide-1-receptor-agonists-for-the-treatment-of-type-2-diabetes-mellitus?source=see_link&sectionName=GLUCAGON-LIKE+PEPTIDE-1&anchor=H2#H619400

	[[Category:Pharmacology]]		[[Category:Pharmacology]]
	[[Category:Endocrinology]]		[[Category:Endocrinology]]

Rossdonaldson1 at 20:33, 31 January 2024

2024-01-31T20:33:58Z

← Older revision		Revision as of 20:33, 31 January 2024
Line 6:		Line 6:
	*Increases satiety, which decreases drive for food intake		*Increases satiety, which decreases drive for food intake

	~~==Types==~~		{{GLP-1 Agonist Types}}
	{~~\| class="wikitable"~~
	\|-
	~~! Short Acting !! Dose~~
	\|-
	~~\| Exenatide(Byetta) \|\| 5-10 mcg SC bid~~
	\|-
	~~\| Liraglutide(Victoza) \|\| 0.6~~-1~~.8 mg SC daily~~
	\|-
	~~! Long Acting !!~~
	\|-
	~~\| Exenatide(Bydureon) \|\| 2 mg SC qwk~~
	\|-
	~~\| Albiglutide(Tanzeum) \|\| 30-50 mg SC qwk~~
	\|-
	~~\| Dulaglutide(Trulicity) \|\| 0.75-1.5 mg qwk~~
	\|}

	==Indication==		==Indication==
	*Diabetes Mellitus, Type 2		*[[Diabetes Mellitus]], Type 2

	==Adverse Reactions==		==Adverse Reactions==

Rossdonaldson1: /* See Also */

2024-01-31T20:32:53Z

Kfarzam: /* See Also */

2022-08-20T05:24:37Z

Kfarzam: /* See Also */

2022-08-20T05:24:22Z

ClaireLewis: /* References */

2019-09-22T20:10:26Z

References

← Older revision		Revision as of 20:10, 22 September 2019
Line 42:		Line 42:

	[[Category:Pharmacology]]		[[Category:Pharmacology]]
			[[Category:Endocrinology]]

Neil.m.young: Text replacement - "* " to "*"

2016-10-27T15:49:07Z

Text replacement - "* " to "*"

← Older revision		Revision as of 15:49, 27 October 2016
Line 1:		Line 1:
	==Background==		==Background==
	* Synthetic glucagon-like peptide-1 (GLP-1) receptor agonists		*Synthetic glucagon-like peptide-1 (GLP-1) receptor agonists
	* Released by L-cells of the small intestinge in response to the presence of nutrients		*Released by L-cells of the small intestinge 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		*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		*Slows gastric emptying times
	* Increases satiety, which decreases drive for food intake		*Increases satiety, which decreases drive for food intake

	==Types==		==Types==
Line 25:		Line 25:

	==Indication==		==Indication==
	* Diabetes Mellitus, Type 2		*Diabetes Mellitus, Type 2

	==Adverse Reactions==		==Adverse Reactions==
	* Nausea, vomiting, diarrhea		*Nausea, vomiting, diarrhea
	* Acute pancreatitis		*Acute pancreatitis
	* Exenatide should not be used in patients with creatinine clearance below 30mL/min		*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		*Should not be used if personal of family history of medullary thyroid cancer or MEN 2A/2B

	==See Also==		==See Also==

← Older revision		Revision as of 09:11, 22 March 2026
Line 39:		Line 39:
	*Medullary thyroid carcinoma risk (observed in rodent studies; clinical significance uncertain)		*Medullary thyroid carcinoma risk (observed in rodent studies; clinical significance uncertain)
	*Ileus / [[bowel obstruction]] — case reports of GI dysmotility		*Ileus / [[bowel obstruction]] — case reports of GI dysmotility
	*Hypoglycemia — low risk as monotherapy; ~~'''~~increased risk when combined with [[sulfonylurea]] or [[insulin]]~~'''~~		*Hypoglycemia — low risk as monotherapy; increased risk when combined with [[sulfonylurea]] or [[insulin]]

	===Contraindications===		===Contraindications===
Line 50:		Line 50:
	==ED-Relevant Considerations==		==ED-Relevant Considerations==
	===Aspiration Risk During Procedural Sedation and Intubation===		===Aspiration Risk During Procedural Sedation and Intubation===
	*GLP-1 RAs delay gastric emptying, leading to potential ~~'''~~retained gastric contents~~'''~~ despite standard fasting<ref name="ASA2024"/>		*GLP-1 RAs delay gastric emptying, leading to potential retained gastric contents despite standard fasting<ref name="ASA2024"/>
	*~~'''~~For urgent/emergent procedures: treat as full stomach~~'''~~ and proceed with rapid sequence intubation<ref name="ASA2023">Joshi GP, Abdelmalak BB, Weigel WA, et al. American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients on Glucagon-Like Peptide-1 Receptor Agonists. ASA. June 2023.</ref>		*For urgent/emergent procedures: treat as full stomach and proceed with rapid sequence intubation<ref name="ASA2023">Joshi GP, Abdelmalak BB, Weigel WA, et al. American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients on Glucagon-Like Peptide-1 Receptor Agonists. ASA. June 2023.</ref>
	*The 2024 multisociety guidance (ASA, AGA, ASMBS) advises most patients may ~~'''~~continue GLP-1 RAs~~'''~~ before elective surgery, with individualized risk assessment<ref name="ASA2024"/>		*The 2024 multisociety guidance (ASA, AGA, ASMBS) advises most patients may continue GLP-1 RAs before elective surgery, with individualized risk assessment<ref name="ASA2024"/>
	**If GI symptoms suggest delayed emptying: consider liquid diet for 24h prior to procedure, or gastric POCUS to assess stomach contents		**If GI symptoms suggest delayed emptying: consider liquid diet for 24h prior to procedure, or gastric POCUS to assess stomach contents
	**Meta-analyses (>300,000 patients) show retained gastric contents are significantly increased in GLP-1 RA users, but actual aspiration rates remain low (0.1-0.2%)<ref>Perioperative Management of GLP-1 Receptor Agonists: Balancing Aspiration Risk with Therapeutic Benefit. SN Compr Clin Med. 2025. doi:10.1007/s42399-025-02079-9</ref>		**Meta-analyses (>300,000 patients) show retained gastric contents are significantly increased in GLP-1 RA users, but actual aspiration rates remain low (0.1-0.2%)<ref>Perioperative Management of GLP-1 Receptor Agonists: Balancing Aspiration Risk with Therapeutic Benefit. SN Compr Clin Med. 2025. doi:10.1007/s42399-025-02079-9</ref>
Line 58:		Line 58:

	===Other ED Considerations===		===Other ED Considerations===
	*GLP-1 RA use may cause ~~'''~~dehydration and AKI~~'''~~ in patients with severe GI side effects — check renal function, resuscitate appropriately		*GLP-1 RA use may cause dehydration and AKI in patients with severe GI side effects — check renal function, resuscitate appropriately
	*May present with ~~'''~~hypoglycemia~~'''~~ if combined with sulfonylureas or insulin — treat per standard protocol		*May present with hypoglycemia if combined with sulfonylureas or insulin — treat per standard protocol
	*Severe ~~'''~~nausea/vomiting~~'''~~ may be the primary complaint — consider GLP-1 RA as contributing cause; may require IV fluids, antiemetics, and medication adjustment by prescriber		*Severe nausea/vomiting may be the primary complaint — consider GLP-1 RA as contributing cause; may require IV fluids, antiemetics, and medication adjustment by prescriber
	*Pancreatitis workup: maintain high index of suspicion for pancreatitis in patients on GLP-1 RAs presenting with severe abdominal pain		*Pancreatitis workup: maintain high index of suspicion for pancreatitis in patients on GLP-1 RAs presenting with severe abdominal pain
	*Altered drug absorption: delayed gastric emptying may affect timing and absorption of co-administered oral medications		*Altered drug absorption: delayed gastric emptying may affect timing and absorption of co-administered oral medications

← Older revision		Revision as of 16:15, 19 March 2026
Line 2:		Line 2:
	*Glucagon-like peptide-1 (GLP-1) receptor agonists are synthetic analogs of the incretin hormone GLP-1		*Glucagon-like peptide-1 (GLP-1) receptor agonists are synthetic analogs of the incretin hormone GLP-1
	*Endogenous GLP-1 is released by intestinal L-cells in response to nutrient intake		*Endogenous GLP-1 is released by intestinal L-cells in response to nutrient intake
	*~~'''~~Mechanism of action~~'''~~:		*Mechanism of action:
	**Stimulates glucose-dependent insulin secretion from pancreatic beta cells (minimal hypoglycemia risk as monotherapy)		**Stimulates glucose-dependent insulin secretion from pancreatic beta cells (minimal hypoglycemia risk as monotherapy)
	**Suppresses glucagon secretion		**Suppresses glucagon secretion
	**Slows gastric emptying		**Slows gastric emptying
	**Increases central satiety signaling, reducing food intake		**Increases central satiety signaling, reducing food intake
	*~~'''~~~1 in 8 US adults~~'''~~ now use a GLP-1 RA for diabetes, weight loss, or cardiovascular risk reduction<ref name="ASA2024">Multisociety Clinical Practice Guidance for the Safe Use of Glucagon-like Peptide-1 Receptor Agonists in the Perioperative Period. Clin Gastroenterol Hepatol. 2024. doi:10.1016/j.cgh.2024.10.012</ref>		*~1 in 8 US adults now use a GLP-1 RA for diabetes, weight loss, or cardiovascular risk reduction<ref name="ASA2024">Multisociety Clinical Practice Guidance for the Safe Use of Glucagon-like Peptide-1 Receptor Agonists in the Perioperative Period. Clin Gastroenterol Hepatol. 2024. doi:10.1016/j.cgh.2024.10.012</ref>
	*Two structural categories:		*Two structural categories:
	**~~'''~~Exendin-4 based~~'''~~ (exenatide, lixisenatide) — derived from Gila monster saliva peptide		**Exendin-4 based (exenatide, lixisenatide) — derived from Gila monster saliva peptide
	**~~'''~~Human GLP-1 based~~'''~~ (liraglutide, semaglutide, dulaglutide) — modified human GLP-1 with extended half-life		**Human GLP-1 based (liraglutide, semaglutide, dulaglutide) — modified human GLP-1 with extended half-life
	*~~'''~~Tirzepatide~~'''~~ is a dual GLP-1/GIP receptor agonist (not a pure GLP-1 RA)		*Tirzepatide is a dual GLP-1/GIP receptor agonist (not a pure GLP-1 RA)

	{{GLP-1 Agonist Types}}		{{GLP-1 Agonist Types}}

	==Indications==		==Indications==
	*~~'''~~Type 2 [[diabetes mellitus]]~~'''~~ — all GLP-1 RAs are approved; recommended as first-line pharmacotherapy (alongside metformin) for patients with established ASCVD or high CV risk per ADA guidelines<ref>American Diabetes Association Professional Practice Committee. Standards of Care in Diabetes—2025. Diabetes Care. 2025;48(Suppl 1).</ref>		*Type 2 [[diabetes mellitus]] — all GLP-1 RAs are approved; recommended as first-line pharmacotherapy (alongside metformin) for patients with established ASCVD or high CV risk per ADA guidelines<ref>American Diabetes Association Professional Practice Committee. Standards of Care in Diabetes—2025. Diabetes Care. 2025;48(Suppl 1).</ref>
	*~~'''~~Obesity/overweight~~'''~~ — FDA-approved agents:		*Obesity/overweight — FDA-approved agents:
	**Semaglutide 2.4 mg SC weekly (Wegovy) and oral semaglutide 25 mg (Wegovy Pill, approved December 2025)		**Semaglutide 2.4 mg SC weekly (Wegovy) and oral semaglutide 25 mg (Wegovy Pill, approved December 2025)
	**Liraglutide 3.0 mg SC daily (Saxenda)		**Liraglutide 3.0 mg SC daily (Saxenda)
	**Tirzepatide (Zepbound) — approved for obesity		**Tirzepatide (Zepbound) — approved for obesity
	*~~'''~~Cardiovascular risk reduction~~'''~~ — semaglutide (Wegovy) approved for CV event reduction in patients with CVD and obesity/overweight; liraglutide and dulaglutide have demonstrated CV benefit<ref>Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med. 2023;389(24):2221-2232. doi:10.1056/NEJMoa2307563</ref>		*Cardiovascular risk reduction — semaglutide (Wegovy) approved for CV event reduction in patients with CVD and obesity/overweight; liraglutide and dulaglutide have demonstrated CV benefit<ref>Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med. 2023;389(24):2221-2232. doi:10.1056/NEJMoa2307563</ref>
	*~~'''~~Chronic kidney disease~~'''~~ — semaglutide (Ozempic) approved January 2025 for CKD risk reduction in T2DM		*Chronic kidney disease — semaglutide (Ozempic) approved January 2025 for CKD risk reduction in T2DM
	*~~'''~~Obstructive sleep apnea~~'''~~ — tirzepatide (Zepbound) approved 2024 for moderate-to-severe OSA with obesity		*Obstructive sleep apnea — tirzepatide (Zepbound) approved 2024 for moderate-to-severe OSA with obesity

	==Adverse Reactions==		==Adverse Reactions==
	===Common===		===Common===
	*~~'''~~GI effects~~'''~~ (most common, dose-dependent, usually improve with time):		*GI effects (most common, dose-dependent, usually improve with time):
	**[[Nausea]], [[vomiting]], [[diarrhea]], [[constipation]], abdominal pain		**[[Nausea]], [[vomiting]], [[diarrhea]], [[constipation]], abdominal pain
	**Typically worst during dose initiation and up-titration		**Typically worst during dose initiation and up-titration
Line 34:		Line 34:

	===Serious===		===Serious===
	*~~'''~~Acute [[pancreatitis]]~~'''~~ — rare but potentially fatal (including hemorrhagic and necrotizing); discontinue if suspected and do not restart if confirmed<ref name="StatPearls">Shaefer CF Jr, Engel SS, Engel JR, et al. Glucagon-Like Peptide-1 Receptor Agonists. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.</ref>		*Acute [[pancreatitis]] — rare but potentially fatal (including hemorrhagic and necrotizing); discontinue if suspected and do not restart if confirmed<ref name="StatPearls">Shaefer CF Jr, Engel SS, Engel JR, et al. Glucagon-Like Peptide-1 Receptor Agonists. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.</ref>
	*~~'''~~Cholelithiasis / acute [[cholecystitis]]~~'''~~ — increased incidence reported, especially with higher doses and rapid weight loss		*Cholelithiasis / acute [[cholecystitis]] — increased incidence reported, especially with higher doses and rapid weight loss
	*~~'''~~Acute kidney injury~~'''~~ — reported in setting of severe GI symptoms (dehydration from nausea/vomiting/diarrhea)		*Acute kidney injury — reported in setting of severe GI symptoms (dehydration from nausea/vomiting/diarrhea)
	*Medullary thyroid carcinoma risk (observed in rodent studies; clinical significance uncertain)		*Medullary thyroid carcinoma risk (observed in rodent studies; clinical significance uncertain)
	*~~'''~~Ileus / [[bowel obstruction]]~~'''~~ — case reports of GI dysmotility		*Ileus / [[bowel obstruction]] — case reports of GI dysmotility
	*Hypoglycemia — low risk as monotherapy; '''increased risk when combined with [[sulfonylurea]] or [[insulin]]'''		*Hypoglycemia — low risk as monotherapy; '''increased risk when combined with [[sulfonylurea]] or [[insulin]]'''

Line 45:		Line 45:
	*MEN type 2		*MEN type 2
	*History of [[pancreatitis]] (relative; use with caution)		*History of [[pancreatitis]] (relative; use with caution)
	*~~'''~~Exenatide (Byetta)~~'''~~ specifically: avoid if CrCl <30 mL/min		*Exenatide (Byetta) specifically: avoid if CrCl <30 mL/min
	*''Semaglutide and dulaglutide do not require renal dose adjustment, but monitor renal function with GI side effects''		*''Semaglutide and dulaglutide do not require renal dose adjustment, but monitor renal function with GI side effects''

Line 55:		Line 55:
	**If GI symptoms suggest delayed emptying: consider liquid diet for 24h prior to procedure, or gastric POCUS to assess stomach contents		**If GI symptoms suggest delayed emptying: consider liquid diet for 24h prior to procedure, or gastric POCUS to assess stomach contents
	**Meta-analyses (>300,000 patients) show retained gastric contents are significantly increased in GLP-1 RA users, but actual aspiration rates remain low (0.1-0.2%)<ref>Perioperative Management of GLP-1 Receptor Agonists: Balancing Aspiration Risk with Therapeutic Benefit. SN Compr Clin Med. 2025. doi:10.1007/s42399-025-02079-9</ref>		**Meta-analyses (>300,000 patients) show retained gastric contents are significantly increased in GLP-1 RA users, but actual aspiration rates remain low (0.1-0.2%)<ref>Perioperative Management of GLP-1 Receptor Agonists: Balancing Aspiration Risk with Therapeutic Benefit. SN Compr Clin Med. 2025. doi:10.1007/s42399-025-02079-9</ref>
	*~~'''~~Practical ED approach~~'''~~: Ask about GLP-1 RA use when planning procedural sedation; consider gastric POCUS; have suction ready; use RSI if intubating		*Practical ED approach: Ask about GLP-1 RA use when planning procedural sedation; consider gastric POCUS; have suction ready; use RSI if intubating

	===Other ED Considerations===		===Other ED Considerations===
Line 61:		Line 61:
	*May present with '''hypoglycemia''' if combined with sulfonylureas or insulin — treat per standard protocol		*May present with '''hypoglycemia''' if combined with sulfonylureas or insulin — treat per standard protocol
	*Severe '''nausea/vomiting''' may be the primary complaint — consider GLP-1 RA as contributing cause; may require IV fluids, antiemetics, and medication adjustment by prescriber		*Severe '''nausea/vomiting''' may be the primary complaint — consider GLP-1 RA as contributing cause; may require IV fluids, antiemetics, and medication adjustment by prescriber
	*~~'''~~Pancreatitis workup~~'''~~: maintain high index of suspicion for pancreatitis in patients on GLP-1 RAs presenting with severe abdominal pain		*Pancreatitis workup: maintain high index of suspicion for pancreatitis in patients on GLP-1 RAs presenting with severe abdominal pain
	*~~'''~~Altered drug absorption~~'''~~: delayed gastric emptying may affect timing and absorption of co-administered oral medications		*Altered drug absorption: delayed gastric emptying may affect timing and absorption of co-administered oral medications

	==See Also==		==See Also==

← Older revision		Revision as of 20:32, 31 January 2024
Line 34:		Line 34:

	==See Also==		==See Also==
			*[[GLP-1 receptor agonist toxicity]]
	*[[Diabetes medications]]		*[[Diabetes medications]]
	*[[Tirzepatide]]		*[[Tirzepatide]]

← Older revision		Revision as of 05:24, 20 August 2022
Line 34:		Line 34:

	==See Also==		==See Also==
	[[Diabetes medications]]		*[[Diabetes medications]]
	[[Tirzepatide]]		*[[Tirzepatide]]

	==References==		==References==

← Older revision		Revision as of 05:24, 20 August 2022
Line 35:		Line 35:
	==See Also==		==See Also==
	[[Diabetes medications]]		[[Diabetes medications]]
			[[Tirzepatide]]

	==References==		==References==