From the Guidelines
GLP-1 receptor agonists for weight loss are contraindicated in patients with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2, history of pancreatitis, severe gastrointestinal disease, pregnant or breastfeeding women, and those with a history of severe allergic reactions to any components of these medications. The most recent and highest quality study, published in 2023 in the journal Obesity Reviews 1, provides a comprehensive overview of the contraindications and precautions for GLP-1 receptor agonists. According to this study, patients with a history of medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome type 2 should not use these medications due to increased thyroid cancer risk observed in animal studies. Additionally, those with a history of pancreatitis should avoid GLP-1 agonists as they may increase inflammation of the pancreas.
Some key points to consider when prescribing GLP-1 receptor agonists for weight loss include:
- Contraindications: personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2, history of pancreatitis, severe gastrointestinal disease, pregnancy, and breastfeeding
- Precautions: severe kidney disease, diabetic retinopathy, and history of severe allergic reactions to any components of these medications
- Common side effects: nausea, vomiting, diarrhea, constipation, headache, fatigue, dyspepsia, dizziness, abdominal distension, eructation, gastroenteritis, and gastroesophageal reflux disease
- Monitoring and indication/use: chronic weight management in adults without type 2 diabetes, and adults with type 2 diabetes
It is essential to carefully evaluate the potential benefits and risks of GLP-1 receptor agonists for weight loss in each patient, taking into account their individual medical history and current health status, as recommended by the 2023 study in Diabetes Care 1 and the 2018 study in the Journal of the American College of Cardiology 1.
From the FDA Drug Label
OZEMPIC is contraindicated in patients with: • A personal or family history of medullary thyroid carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) • Known hypersensitivity to semaglutide or to any of the product components
The contraindications to Glucagon-like peptide (GLP) for weight loss, specifically semaglutide, are:
- Personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
- Known hypersensitivity to semaglutide or to any of the product components 2
From the Research
Contraindications to GLP-1 Receptor Agonists for Weight Loss
The following are contraindications to GLP-1 receptor agonists for weight loss:
- History of medullary thyroid cancer 3
- Patients with a history of pancreatitis of a known cause should use GLP-1 receptor agonists with caution 3
- Other potential contraindications and precautions may include gastrointestinal symptoms, such as nausea and vomiting, which are common adverse events associated with GLP-1 receptor agonists 4, 5, 6
- GLP-1 receptor agonists should be used with caution in patients with a history of diabetic ketoacidosis, particularly when used in combination with SGLT2 inhibitors 3
Special Considerations
- GLP-1 receptor agonists may have limited data in certain populations, such as the geriatric population 4
- Clinicians should consider the cost, route of administration, and concomitant drug therapy when deciding which patients are appropriate candidates for GLP-1 receptor agonist therapy 4
- The use of GLP-1 receptor agonists for weight loss may be limited by their high cost 7, 5