Management of GLP-1 Receptor Agonists During Mild Dengue Infection in Non-Diabetic Patients
GLP-1 receptor agonists should be temporarily suspended during mild dengue infection in non-diabetic patients using them for weight management, with consideration for resumption after recovery from the acute illness. 1
Assessment and Risk Stratification
When a patient on GLP-1 receptor agonists (such as semaglutide/Ozempic or liraglutide/Saxenda) presents with mild dengue infection, evaluate:
- Current GLP-1 receptor agonist dose and regimen
- Duration of therapy and last dose taken
- Presence of gastrointestinal symptoms (nausea, vomiting, abdominal distention)
- Hydration status and ability to maintain oral intake
- Severity of dengue symptoms
Management Algorithm
1. Acute Management During Dengue Infection
- Temporarily suspend GLP-1 receptor agonist therapy during the acute phase of dengue infection 1
- This recommendation differs from diabetic patients, where the benefits of glycemic control may outweigh risks
- For non-diabetic patients using GLP-1 agonists for weight management, the risks outweigh the benefits during acute infection
2. Rationale for Suspension
- GLP-1 receptor agonists delay gastric emptying and can cause gastrointestinal side effects (nausea, vomiting, diarrhea) 1
- These effects may:
- Worsen dehydration, which is already a concern in dengue infection
- Complicate fluid management, which is critical in dengue
- Exacerbate gastrointestinal symptoms that may occur with dengue
- Increase risk of aspiration if vomiting occurs
3. Duration of Suspension
- Continue suspension until recovery from acute dengue symptoms
- For short-acting GLP-1 agonists (daily liraglutide): Resume after resolution of acute symptoms
- For long-acting GLP-1 agonists (weekly semaglutide): Consider waiting 1-2 weeks after symptom resolution before resuming
4. Monitoring During Infection
- Monitor hydration status closely
- Ensure adequate fluid intake
- Watch for warning signs of severe dengue requiring hospitalization
- Monitor for hypoglycemia (although risk is low in non-diabetic patients)
5. Resumption of Therapy
- Resume at a lower dose than maintenance dose when restarting
- For semaglutide: Consider restarting at 0.25mg weekly and titrating up
- For liraglutide: Consider restarting at 0.6mg daily and titrating up
- Monitor for tolerability when resuming therapy
Special Considerations
- Hydration is critical: GLP-1 agonists can cause dehydration through gastrointestinal side effects, which can worsen dengue-related dehydration 2
- Medication adherence: Document the interruption in therapy to ensure proper follow-up
- Weight management impact: Brief interruption of therapy is unlikely to significantly impact long-term weight management goals
Pitfalls to Avoid
- Don't continue GLP-1 therapy without assessment: Even mild dengue can progress to more severe disease
- Don't restart at full dose: Gastrointestinal tolerance may be reduced after illness
- Don't ignore hydration status: Both dengue and GLP-1 agonists can affect fluid balance
- Don't assume all symptoms are dengue-related: Some symptoms may be medication side effects
Evidence Quality Assessment
The recommendation to suspend GLP-1 receptor agonists during acute illness is based on clinical practice guidelines 1 that prioritize patient safety, though specific evidence for dengue infection is limited. The general principle of avoiding medications that may worsen dehydration or gastrointestinal symptoms during acute infections is well-established in clinical practice.
The most recent clinical practice recommendations from Anaesthesia (2024) provide the strongest guidance on temporary suspension of GLP-1 receptor agonists during acute illness 1, which can be reasonably applied to dengue infection scenarios.