What are the available GLP-1 (Glucagon-like peptide-1) agonist brands, such as Victoza (liraglutide), Byetta (exenatide), and Trulicity (dulaglutide), in India?

GLP-1 Receptor Agonist Brands Available in India

Based on the available evidence, the GLP-1 receptor agonists currently available in India include Victoza (liraglutide), Trulicity (dulaglutide), Byetta (exenatide), and Mounjaro (tirzepatide).

Available GLP-1 Receptor Agonists in India

Short-Acting GLP-1 RAs

• Exenatide (Byetta)
  • Administration: Twice daily subcutaneous injection
  • Dosage: 10 μg twice daily
  • Primary effect: Stronger postprandial glucose control
  • Half-life: 2.4 hours 1

Once-Daily GLP-1 RAs

• Liraglutide (Victoza)
  • Administration: Once daily subcutaneous injection
  • Dosage: 0.6-1.8 mg daily
  • Half-life: 13 hours
  • Cardiovascular benefit: 13% reduction in MACE 1, 2

Once-Weekly GLP-1 RAs

• Dulaglutide (Trulicity)
  • Administration: Once weekly subcutaneous injection
  • Dosage: 0.75-4.5 mg weekly
  • Half-life: 4.7 days
  • Cardiovascular benefit: 12% reduction in MACE 1, 2

Dual GIP and GLP-1 RA

• Tirzepatide (Mounjaro)
  • Administration: Once weekly subcutaneous injection
  • Dosage: Up to 15 mg weekly
  • Half-life: 5 days 1

Comparative Features

Efficacy Profile

• Glycemic Control: Semaglutide > Dulaglutide > Liraglutide > Exenatide 3
• Weight Loss: Long-acting agents generally provide greater weight loss than short-acting agents 3
• Postprandial Control: Short-acting agents (exenatide) have stronger effects on postprandial glucose 3
• Fasting Glucose Control: Long-acting agents (liraglutide, dulaglutide) have more profound effects on fasting plasma glucose 3

Administration Considerations

• Injection Frequency: Weekly options (dulaglutide, tirzepatide) offer greater convenience compared to daily (liraglutide) or twice-daily (exenatide) options 3
• Patient Compliance: In the Indian setting, liraglutide has shown superior compliance compared to exenatide 4

Side Effect Profile

• Gastrointestinal Effects: All GLP-1 RAs may cause nausea, vomiting, and diarrhea, particularly during initiation
• Tolerability: Long-acting agents typically have better gastrointestinal tolerability profiles 5
• Hypoglycemia Risk: Low when used as monotherapy, but increased when combined with sulfonylureas or insulin 6

Clinical Considerations for Indian Patients

• Efficacy: Indian patients show similar glycemic responses to GLP-1 RAs compared to global data 4
• Weight Loss: Benefits are consistent with global findings 4
• Cost Barrier: The high cost of these medications represents a significant barrier to widespread use in India 4
• Blood Pressure: In a single-center Indian study, liraglutide reduced the need for antihypertensive medications 4

Important Caveats

• Not all GLP-1 RAs available globally may be marketed or widely available in India
• Cost considerations may limit accessibility for many patients
• Proper storage requirements (refrigeration) may present challenges in certain settings
• Gastrointestinal side effects, while typically transient, may affect adherence during initial treatment phases
• Patients with personal or family history of medullary thyroid carcinoma should not use these medications 2

When selecting a GLP-1 RA for Indian patients, consider frequency of administration, cost, storage requirements, and individual patient factors such as the need for postprandial versus fasting glucose control.