From the Guidelines
Before prescribing GLP-1 receptor agonists for weight loss, healthcare providers should conduct comprehensive screening, including a detailed medical history, physical examination, and laboratory tests such as kidney function (eGFR), pancreatic enzymes (amylase, lipase), and thyroid function tests, and consider multiple contraindications, as recommended by the most recent guidelines 1.
Key Considerations
- A personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 represents an absolute contraindication.
- Relative contraindications include history of pancreatitis, gallbladder disease, diabetic retinopathy, inflammatory bowel disease, and personal or family history of thyroid C-cell tumors.
- Caution is warranted in patients with gastroparesis or other severe gastrointestinal disorders due to the medication's effects on gastric emptying.
- Pregnancy, breastfeeding, and severe renal impairment also require careful consideration.
Recommended Tests
- Kidney function (eGFR)
- Pancreatic enzymes (amylase, lipase)
- Thyroid function tests
- Detailed medical history and physical examination
Medication Initiation and Titration
- Medications like semaglutide (Wegovy, Ozempic) and tirzepatide (Mounjaro) should be initiated at low doses and gradually titrated to minimize gastrointestinal side effects, as supported by recent studies 1.
- The most recent and highest quality study recommends a gradual titration of semaglutide to minimize gastrointestinal side effects 1.
Important Safety Information
- GLP-1 agonists have been associated with an increased risk of pancreatitis, thyroid C-cell tumors, and gallbladder disease, as reported in recent studies 1.
- Patients should be monitored for signs and symptoms of these conditions and cautioned about the potential risks, as recommended by recent guidelines 1.
From the Research
Tests Prior to Prescribing GLP-1 for Weight Loss
- There is no specific mention of required tests prior to prescribing GLP-1 receptor agonists for weight loss in the provided studies 2, 3, 4, 5, 6.
- However, it is essential to evaluate the patient's overall health and medical history before initiating any new medication, including GLP-1 receptor agonists.
Relative Contraindications
- The studies do not provide a comprehensive list of relative contraindications for GLP-1 receptor agonists for weight loss 2, 3, 4, 5, 6.
- However, it is crucial to consider the patient's medical history, current medications, and potential interactions before prescribing GLP-1 receptor agonists.
- Absolute contraindications, such as personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2, are mentioned in study 5, but relative contraindications are not explicitly stated.
Considerations for Prescribing GLP-1 Receptor Agonists
- When prescribing GLP-1 receptor agonists for weight loss, consider the patient's individual needs, medical history, and potential benefits and risks 2, 3, 4, 5, 6.
- It is essential to discuss the potential adverse effects, such as gastrointestinal symptoms, and monitor the patient's response to the medication 5, 6.