At what age is it safe to use Glucagon-like peptide-1 (GLP-1) analogs, such as liraglutide (Victoza) (liraglutide) or semaglutide (Ozempic) (semaglutide), in patients?

Safe Age for Using GLP-1 Receptor Agonists

GLP-1 receptor agonists are safe to use in adults aged 18 years and older, but are not currently approved or established as safe for pediatric patients under 18 years of age. 1, 2

Age-Based Recommendations

• Adults (18+ years): GLP-1 receptor agonists like liraglutide and semaglutide are approved and considered safe for use in adults with appropriate indications 1
• Older adults (65+ years): No dose adjustment needed based on age alone, though clinical trials have shown no significant differences in safety or efficacy between older and younger patients 1
• Very elderly (75+ years): Can be used with caution, with greater sensitivity possible in some individuals 2
• Pediatric patients (<18 years): Safety and efficacy have not been established 2

Special Considerations for Different Age Groups

Older Adults (65+ years)

• In clinical trials, 23.6% of semaglutide-treated patients were 65 years or older, and 3.2% were 75 years or older 2
• In cardiovascular outcome trials, 48% of semaglutide-treated patients were 65 years or older 2
• No overall differences in safety or efficacy were detected between older and younger patients 2
• However, greater sensitivity in some older individuals cannot be ruled out 1, 2

Considerations for Prescribing in Older Adults

1. Renal function: No dose adjustment needed for renal impairment, including end-stage renal disease 2
2. Hepatic function: No dose adjustment needed for hepatic impairment 2
3. Polypharmacy: Consider medication interactions and overall medication burden 1
4. Cognitive status: Ensure patient can manage medication administration 1
5. Risk of hypoglycemia: GLP-1 RAs have lower risk compared to sulfonylureas 3

Dosing and Titration Considerations

• Initial dosing: Start with lower doses and titrate gradually to minimize gastrointestinal side effects 4

  • For oral semaglutide: Start with 3 mg daily for one month before increasing to 7 mg 4
  • For injectable semaglutide: Start with 0.25 mg once weekly for 4 weeks, then titrate to 0.5 mg and then 1.0 mg as tolerated 4

• Monitoring: After initiating therapy, assess:

  • Gastrointestinal tolerability at 2-4 weeks
  • Glycemic control after 30 days before considering dose increase
  • Weight changes
  • Kidney function, particularly in patients with renal impairment 4

Common Pitfalls and Caveats

1. Pregnancy and breastfeeding: GLP-1 RAs should be discontinued at least 2 months before a planned pregnancy 2

2. Gastrointestinal side effects: Common adverse events include nausea, vomiting, and diarrhea (15-20% of patients), which typically abate over several weeks to months 4, 5

3. Discontinuation rates: Real-world studies show high discontinuation rates (20-50%) within the first year, often due to GI side effects or cost issues 5

4. Contraindications:

   • Personal or family history of medullary thyroid carcinoma or MEN2
   • Severe hypersensitivity to the drug
   • Active acute pancreatitis 4

5. Age-related considerations: While safe in adults 18 and older, the Mexican clinical practice guidelines specifically address GLP-1 agonists for adults 18 years or older with overweight or obesity without diabetes 1

By following these guidelines and considering patient-specific factors, GLP-1 receptor agonists can be safely and effectively used in adult patients 18 years and older, with appropriate monitoring and dose adjustments as needed.