Should I continue taking my GLP-1 (Glucagon-like peptide-1) agonist medication, such as liraglutide (Victoza) or semaglutide (Ozempic), if I'm diagnosed with a mild case of dengue?

GLP-1 Receptor Agonist Management During Mild Dengue Infection

GLP-1 receptor agonist medications should be temporarily suspended during a dengue infection, even if mild, due to the risk of dehydration and potential complications.

Rationale for Suspension

GLP-1 receptor agonists (such as semaglutide, liraglutide, dulaglutide) work through several mechanisms that could potentially worsen a dengue infection:

1. Delayed gastric emptying: GLP-1 RAs significantly slow gastric emptying 1, which could:

   • Worsen nausea and vomiting commonly experienced with dengue
   • Increase risk of dehydration
   • Potentially complicate oral rehydration therapy

2. Gastrointestinal side effects: GLP-1 RAs commonly cause:

   • Nausea
   • Vomiting
   • Diarrhea 2

These side effects could compound the similar symptoms often present in dengue infection, potentially worsening dehydration and electrolyte imbalances.

Clinical Decision Algorithm

1. For mild dengue infection:

   • Temporarily suspend GLP-1 RA medication
   • Focus on adequate hydration
   • Monitor blood glucose levels more frequently
   • Resume medication after recovery from acute infection (typically 7-10 days)

2. For moderate to severe dengue:

   • Immediately discontinue GLP-1 RA
   • Consider hospital admission for monitoring
   • Implement alternative glucose management strategies if needed

Important Considerations

Medication-Specific Factors

Different GLP-1 RAs have varying half-lives that affect management:

• Once-daily medications (liraglutide, lixisenatide): Effects diminish within 24-48 hours after stopping 1
• Once-weekly medications (semaglutide, dulaglutide, exenatide extended-release): Effects may persist for 5-7 days after stopping 3

Monitoring During Suspension

• Check blood glucose levels 2-4 times daily
• Monitor for signs of dehydration (decreased urine output, dry mucous membranes)
• Watch for warning signs of severe dengue (severe abdominal pain, persistent vomiting, mucosal bleeding)

Alternative Glucose Management

If temporary alternative glucose management is needed:

• Consider short-acting insulin for significant hyperglycemia
• Metformin may be continued if kidney function remains stable and patient is not severely dehydrated 1
• Avoid SGLT2 inhibitors due to increased dehydration risk

Resuming Medication

• Resume GLP-1 RA therapy after:
  • Complete resolution of fever
  • Adequate oral intake is established
  • No evidence of bleeding or plasma leakage
  • Normal kidney function is confirmed

Common Pitfalls to Avoid

1. Continuing GLP-1 RAs during acute illness: This could worsen dehydration and gastrointestinal symptoms
2. Abrupt discontinuation without glucose monitoring: May lead to hyperglycemia in patients with diabetes
3. Failure to adjust other medications: Other diabetes medications may need adjustment during GLP-1 RA suspension
4. Restarting at full dose: Consider restarting at a lower dose and titrating up to reduce GI side effects

While GLP-1 RAs have significant benefits for glycemic control and cardiovascular risk reduction 1, the temporary risks during an acute dengue infection outweigh these benefits. Temporary suspension represents a prudent approach to minimize complications while managing the acute illness.