From the Guidelines
Injectable GLP-1 agonists have varying side effect profiles, with gastrointestinal issues being the most common across all medications, as reported in the most recent study 1.
Side Effect Comparison
The side effects of these medications can be compared as follows:
- Semaglutide (Ozempic, Wegovy) typically causes nausea in 20-44% of patients, vomiting in 6-24%, and diarrhea in 9-30%, with higher rates at higher doses.
- Dulaglutide (Trulicity) shows similar rates with nausea affecting 12-21%, vomiting 5-13%, and diarrhea 8-12% of users.
- Liraglutide (Victoza, Saxenda) causes nausea in 20-40%, vomiting in 5-15%, and diarrhea in 10-20% of patients.
- Exenatide (Byetta, Bydureon) has nausea rates of 28-44%, vomiting 11-13%, and diarrhea 11-18%.
- Tirzepatide (Mounjaro, Zepbound), a dual GIP/GLP-1 agonist, causes nausea in 12-24%, vomiting in 2-10%, and diarrhea in 7-20% of patients.
Common and Serious Side Effects
These side effects typically occur during initiation and dose escalation, often diminishing over time. Other common side effects across these medications include:
- Injection site reactions (2-10%)
- Headache (5-15%)
- Decreased appetite (5-20%) Serious but rare side effects include:
- Pancreatitis (<1%)
- Thyroid C-cell tumors (animal studies only)
- Hypoglycemia when combined with insulin or sulfonylureas
Minimizing Side Effects
Gradual dose titration, taking with small meals, staying hydrated, and avoiding fatty foods can help minimize these side effects, as suggested by studies 1.
Key Considerations
It is essential to consider the potential risks and benefits of each medication, as well as individual patient factors, when selecting a treatment option. The most recent study 1 provides valuable insights into the side effect profiles of injectable GLP-1 agonists, which can inform clinical decision-making.
From the Research
Side Effect Profiles of Injectable GLP-1 Agonist Drugs
- The most frequently reported adverse events for semaglutide and dulaglutide were gastrointestinal disorders, occurring in 43% of patients receiving semaglutide 0.5 mg, 44% of patients receiving semaglutide 1.0 mg, 33% of patients receiving dulaglutide 0.75 mg, and 48% of patients receiving dulaglutide 1.5 mg 2.
- Gastrointestinal disorders were also the most common reason for discontinuing treatment with semaglutide and dulaglutide 2.
- Oral semaglutide increased the incidence of adverse events (nausea, diarrhoea, dyspeptid, and vomiting) compared to placebo, liraglutide (1.2 mg), exenatide (ER, 2.0 mg), and dulaglutide 1.5 mg but not compared to subcutaneous semaglutide 3.
- Exenatide and liraglutide cause a relatively high frequency of gastrointestinal disturbances, with some patients experiencing one or more episodes of nausea, vomiting, or diarrhea 4.
- Semaglutide had more pronounced glucose- and body mass index-lowering effects, but also had a higher incidence of gastrointestinal symptoms (46.3%) compared to dulaglutide (13.2%) 5.
Comparison of Side Effect Profiles
- Semaglutide and dulaglutide had similar safety profiles, with gastrointestinal disorders being the most frequently reported adverse event 2.
- Oral semaglutide had a similar safety profile to subcutaneous semaglutide, but had a higher incidence of adverse events compared to other GLP-1 RAs 3.
- Dulaglutide had a lower incidence of gastrointestinal symptoms compared to semaglutide, but had a similar effectiveness in reducing HbA1c levels 6, 5.
- Liraglutide and exenatide had a higher incidence of gastrointestinal disturbances compared to dulaglutide, but had a similar effectiveness in reducing HbA1c levels 6, 4.