What other medications are in the same category as Victoza (liraglutide) and Trulicity (dulaglutide), which are glucagon-like peptide-1 (GLP-1) receptor agonists?

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GLP-1 Receptor Agonists: Medications in the Same Category as Victoza and Trulicity

The medications in the same category as Victoza (liraglutide) and Trulicity (dulaglutide) include semaglutide (Ozempic/Wegovy), tirzepatide (Mounjaro), exenatide (Byetta/twice daily and extended-release), lixisenatide (Lyxumia), and albiglutide (Eperzan), all of which are glucagon-like peptide-1 (GLP-1) receptor agonists. 1, 2

Classification of GLP-1 Receptor Agonists

GLP-1 receptor agonists can be categorized based on their duration of action:

Short-Acting GLP-1 RAs (Daily or Twice-Daily Administration)

  • Exenatide (Byetta) - twice daily administration
  • Liraglutide (Victoza) - once daily administration
  • Lixisenatide (Lyxumia) - once daily administration

Long-Acting GLP-1 RAs (Weekly Administration)

  • Dulaglutide (Trulicity) - once weekly administration
  • Semaglutide (Ozempic/Wegovy) - once weekly administration (injectable) or daily (oral)
  • Exenatide extended-release (Byetta) - once weekly administration
  • Albiglutide (Eperzan) - once weekly administration
  • Tirzepatide (Mounjaro) - once weekly administration (dual GLP-1/GIP receptor agonist)

Structural and Pharmacological Differences

The GLP-1 receptor agonists differ in their molecular structure and pharmacological properties:

  • Liraglutide (Victoza): 97% homologous to native human GLP-1 with a C-16 fatty acid (palmitic acid) attachment 3
  • Exenatide: Synthetic peptide with 50% homology to human GLP-1 2
  • Dulaglutide: Conjugated with fragment crystallizable region of immunoglobulin G 2
  • Semaglutide: Liraglutide analogue with greater albumin affinity 2
  • Albiglutide: Non-covalently conjugated with albumin 2
  • Tirzepatide: Unique as a dual GLP-1/GIP (glucose-dependent insulinotropic polypeptide) receptor agonist 2

Pharmacokinetic Properties

The medications have varying pharmacokinetic profiles affecting their dosing frequency:

Medication Elimination Half-Life Major Elimination Route
Tirzepatide 5 days Metabolized
Semaglutide 7 days Metabolized
Dulaglutide 4.5-4.7 days Metabolized
Albiglutide 5 days Metabolized
Liraglutide 13 hours Metabolized
Lixisenatide 3 hours Renal/proteolysis
Exenatide (twice daily) 2.4 hours Renal/proteolysis
Exenatide (once weekly) 2.4 hours (as for exenatide) Renal/proteolysis

1

Clinical Differences Between Short-Acting and Long-Acting GLP-1 RAs

The primary pharmacodynamic differences between these two categories include:

  • Short-acting agents (exenatide twice daily, lixisenatide):

    • Primarily delay gastric emptying
    • More effective at lowering postprandial glucose
    • Higher incidence of gastrointestinal side effects

  • Long-acting agents (albiglutide, dulaglutide, exenatide once weekly, liraglutide, semaglutide, tirzepatide):

    • Affect both fasting and postprandial glucose
    • Enhanced glucose-dependent insulin secretion
    • Reduced glucagon secretion
    • Smaller fluctuations in plasma drug concentrations
    • Improved gastrointestinal tolerability
    • More convenient administration schedules
    • Potentially better treatment adherence and persistence

4

Efficacy Differences

  • Tirzepatide demonstrates greater HbA1c reductions and weight loss compared to semaglutide, with weight loss of up to 20.9% at 15mg dose over 72 weeks 2
  • Liraglutide has shown a 13% relative risk reduction in cardiovascular death, non-fatal myocardial infarction, or stroke in patients with established cardiovascular disease 2
  • Semaglutide has demonstrated significant weight loss benefits, though less than tirzepatide 2

Common Side Effects and Safety Considerations

All GLP-1 receptor agonists share common adverse effects:

  • Gastrointestinal issues (nausea, vomiting, diarrhea, constipation)
  • Potential for gallbladder disorders
  • Risk of cardiac arrhythmia/tachycardia
  • Potential risk of thyroid C-cell tumors

Long-acting agents typically have lower rates of nausea but increased incidence of injection site reactions 1, 2

Perioperative Considerations

Due to their effect on delaying gastric emptying, GLP-1 receptor agonists may increase the risk of pulmonary aspiration during anesthesia. The American Society of Anesthesiologists recommends:

  • For once-daily doses (liraglutide, lixisenatide): Stop the day before procedure
  • For once-weekly injections (dulaglutide, semaglutide, exenatide LAR, albiglutide, tirzepatide): Stop the week before procedure

1

GLP-1 receptor agonists represent an important class of medications for managing type 2 diabetes, with varying pharmacokinetic profiles, administration schedules, and clinical effects that allow for personalized treatment approaches.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Cardiovascular Disease Management

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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