From the Guidelines
You can switch from Ozempic (semaglutide) to another GLP-1 receptor agonist, such as Trulicity (dulaglutide) or Victoza/Saxenda (liraglutide), if you're experiencing persistent vomiting. The most recent and highest quality study 1 suggests that GLP-1 receptor agonists have established cardiovascular and renal benefits, and switching to a different agent in this class may be beneficial for individuals with type 2 diabetes. Some key points to consider when switching to a different GLP-1 receptor agonist include:
- Starting at the lowest dose of the new medication and gradually increasing it to minimize side effects
- Considering alternative agents if you have a history of pancreatitis, gastroparesis, or MEN2 1
- Being aware of the potential for gastrointestinal side effects, such as nausea and vomiting, which are common with GLP-1 medications 1
- Consulting with your healthcare provider to determine the most appropriate alternative based on your specific needs. It's also important to note that individual responses to different medications in this class can vary significantly, so it may be necessary to try a few different options to find the one that works best for you 1.
From the Research
GLP-1 Receptor Agonists
- GLP-1 receptor agonists (GLP-1 RAs) are a well-established class of glucose-lowering agents, with various compounds and preparations available, including exenatide, lixisenatide, liraglutide, dulaglutide, albiglutide, and semaglutide 2.
- These agents share common mechanisms of action, including augmentation of hyperglycemia-induced insulin secretion, suppression of glucagon secretion, deceleration of gastric emptying, and reduction in calorie intake and body weight.
Switching between GLP-1 Receptor Agonists
- Switching between GLP-1 RAs may be beneficial in clinical practice, with triggers for switching including unmet HbA1c targets, desire for additional weight loss, poor adherence, increased CV risk status, and adverse effects with the current GLP-1 RA 3.
- A individualised approach is recommended when switching between GLP-1 RAs, considering factors such as reimbursement requirements, treatment duration and dose of previous GLP-1 RA, patient experience, concomitant treatment, and clinical characteristics.
Adverse Effects and Tolerability
- GLP-1 RAs can cause adverse effects, including gastrointestinal symptoms such as vomiting, which may be transient and can be reduced by slow up-titration and advising patients to reduce food portion sizes and fat intake 3.
- The safety and tolerability of oral semaglutide were similar to subcutaneous liraglutide in a clinical trial, with adverse events more frequent with oral semaglutide and subcutaneous liraglutide than with placebo 4.
Clinical Guidance
- Clinical guidance on switching between GLP-1 RAs is lacking, and data from clinical trials are limited, but expert consensus and practical guidance are available to support clinical decision-making 3.
- Switching from one GLP-1 RA to another, such as once weekly semaglutide, can provide clinical benefits and may delay the need for treatment intensification 3.