From the Guidelines
The microdose schedule for Glucagon-like peptide-1 (GLP-1) therapy is not a standard term in the context of GLP-1 receptor agonist (GLP-1RA) therapy, but the recommended dosing schedules for different GLP-1RAs are as follows:
- Dulaglutide: initiate 0.75 mg SC per week, titrate as tolerated to 1.5 mg or maximally tolerated dose based on prescribing information 1
- Exenatide: 2 mg SC per week, titrate slowly to 1.8 mg or maximally tolerated dose based on prescribing information 1
- Liraglutide: initiate 0.6 mg SC daily, titrate slowly to 1 mg daily or maximally tolerated dose based on prescribing information 1
- Lixisenatide: initiate 10 mcg SC daily, titrate slowly to 14 mg once weekly or maximally tolerated dose based on prescribing information 1
- Semaglutide SC: initiate 0.25 mg SC per week, after 4 weeks on 0.25-mg dose, increase to 0.5 mg SC per week; if additional glycemic control is required, can increase to 1 mg SC per week after 4 weeks of treatment with the 0.5-mg dose 1
Key Considerations
- The dosing schedules may vary depending on the specific indication, such as glycemic control or cardiovascular risk reduction
- Dose modifications may be necessary in patients with renal impairment, with specific recommendations varying by agent 1
- GLP-1RAs are contraindicated in patients with a history of serious hypersensitivity reaction, pregnancy or breastfeeding, severe renal impairment, or personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 1
From the Research
Microdose Schedule for GLP-1 Therapy
The microdose schedule for Glucagon-like peptide-1 (GLP-1) therapy is not explicitly stated in the provided studies. However, the studies discuss the administration schedules of various GLP-1 receptor agonists, which can be summarized as follows:
- Short-acting GLP-1 RAs, such as exenatide and liraglutide, are administered once or twice daily 2
- Long-acting GLP-1 RAs, such as albiglutide, dulaglutide, and exenatide extended release, are administered weekly 2, 3, 4
- Sustained-release GLP-1 RA-loaded microspheres are being explored to improve patient compliance, but their administration schedule is not specified in the provided studies 5
Key Points
- GLP-1 RAs have been shown to improve glycemic parameters, reduce body weight, and have a low risk of hypoglycemia 6, 2, 3, 4
- The most common adverse effects of GLP-1 RAs are gastrointestinal, which are transient and less common with long-acting agents 2, 3, 4
- GLP-1 RAs can be used as monotherapy or in combination with other medications, such as metformin, sulfonylureas, and basal insulin 2, 3