What are examples of GLP-1 (Glucagon-like peptide-1) receptor agonists, including their doses?

GLP-1 Receptor Agonist Examples with Doses

The FDA-approved GLP-1 receptor agonists include semaglutide, liraglutide, dulaglutide, exenatide, and lixisenatide, with semaglutide demonstrating the greatest efficacy for both glycemic control and weight loss. 1, 2

Common GLP-1 Receptor Agonists and Their Dosing

Weekly Administration

• Semaglutide (Ozempic/Wegovy)

  • Weight loss: 2.4 mg weekly (Wegovy) 1
  • Type 2 diabetes: 0.5-1.0 mg weekly (Ozempic) 1, 3
  • Demonstrated 14.9% mean weight loss from baseline in non-diabetic, overweight or obese patients in the STEP trial 1
  • Available in injectable and oral formulations (Rybelsus) 3, 4

• Dulaglutide (Trulicity)

  • Type 2 diabetes: 0.75-4.5 mg weekly 5, 6
  • Used off-label for obesity in Australia 1
  • Higher doses (3.0-4.5 mg) show better weight loss outcomes 6

• Exenatide once weekly (Bydureon)

  • Standard dose: once weekly injection 2, 7
  • Less potent for weight loss compared to newer agents like semaglutide 7

Daily Administration

• Liraglutide (Saxenda/Victoza)

  • Weight loss: 3.0 mg daily (Saxenda) 1, 3
  • Type 2 diabetes: 1.2-1.8 mg daily (Victoza) 6, 3
  • FDA approved in 2014 for people with BMI > 30, or > 27 with comorbidities 1

• Lixisenatide (Adlyxin)

  • Standard dose: once daily injection 2, 7
  • Short-acting agent with pronounced effects on gastric emptying 2

• Exenatide twice daily (Byetta)

  • Standard dose: twice daily injection 2
  • First GLP-1 RA approved in 2005 2

Dual GIP/GLP-1 Receptor Agonist

• Tirzepatide
  • Demonstrated mean weight loss of 15% at 72 weeks in non-diabetic obese patients 1
  • Higher doses (15 mg) achieved 20.9% weight reduction in body weight 1

Clinical Considerations

Efficacy Differences

• Long-acting GLP-1 RAs (weekly formulations) have more profound effects on fasting plasma glucose and HbA1c 2
• Short-acting agents (exenatide b.i.d., lixisenatide) better maintain their effect on gastric emptying during long-term treatment 2
• Semaglutide consistently demonstrates superior efficacy for both glycemic control and weight reduction compared to other GLP-1 RAs 7, 6

Cardiovascular Benefits

• Liraglutide reduced cardiovascular events by 13% in the LEADER trial 1
• Semaglutide reduced cardiovascular events by 26% in the SUSTAIN 6 trial 1
• Weekly semaglutide 2.4 mg reduced cardiovascular endpoints in non-diabetic patients with pre-existing cardiovascular disease and BMI > 27 1

Common Adverse Effects and Management

• Gastrointestinal effects (most common) 1:

  • Nausea/vomiting: Avoid in gastroparesis
  • Dyspepsia: Start at low dose and titrate slowly
  • Diarrhea: Reduce meal size
  • GERD: Limit alcohol and carbonated drinks
  • Constipation: Avoid high-fat diet

• Other potential adverse effects 1, 3:

  • Gallbladder disorders (rarely symptomatic)
  • Cardiac arrhythmia/tachycardia (monitor if symptomatic)
  • Pancreatitis (rare but serious)
  • Diabetic retinopathy (particularly with semaglutide) 6

Practical Prescribing Tips

• Start at the lowest dose and titrate upward slowly to minimize gastrointestinal side effects 1
• Consider patient preference regarding injection frequency (daily vs. weekly) 7
• For weight loss, higher doses generally produce better results (e.g., semaglutide 2.4 mg weekly, liraglutide 3.0 mg daily) 1, 6
• Use with caution in patients with history of pancreatitis 1
• Monitor for hypoglycemia when used with sulfonylureas or insulin 3

Remember that GLP-1 receptor agonists are now recommended as preferred first injectable glucose-lowering therapy for type 2 diabetes, even before insulin treatment, due to their efficacy, weight reduction benefits, and low intrinsic risk of hypoglycemia 2.