From the Guidelines
GLP-1 receptor agonist medications should not be started in patients with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2, as these medications may increase the risk of thyroid C-cell tumors, as stated in the most recent and highest quality study 1.
Contraindications for GLP-1 Medications
The following are contraindications for starting GLP-1 medications:
- Personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2, due to the increased risk of thyroid C-cell tumors 1
- History of serious hyper-sensitivity reaction to the drug, as indicated in the 2018 ACC expert consensus decision pathway 1
- Severe renal impairment or end-stage renal disease (ESRD), particularly for exenatide and lixisenatide, as noted in the 2018 ACC expert consensus decision pathway 1
- Pregnancy and breastfeeding, due to insufficient safety data, as mentioned in the 2023 Obesity Reviews study 1
Cautions for GLP-1 Medications
The following are cautions for starting GLP-1 medications:
- Use with caution in patients with a history of pancreatitis, as indicated in the 2023 Obesity Reviews study 1
- Use with caution in patients with severe renal impairment or ESRD, particularly for liraglutide and semaglutide, as noted in the 2018 ACC expert consensus decision pathway 1
- Use with caution in patients with a history of diabetic retinopathy, as rapid improvement in glucose control may temporarily worsen retinopathy, as mentioned in the 2018 Journal of the American College of Cardiology study 1
- Use with caution in patients with prior gastric surgery, as GLP-1RAs may delay gastric emptying, as stated in the 2018 Journal of the American College of Cardiology study 1
From the FDA Drug Label
Personal or family history of MTC or in patients with MEN 2 (4). Serious hypersensitivity reaction to semaglutide or any of the excipients in OZEMPIC (4). TRULICITY is contraindicated in patients with a previous serious hypersensitivity reaction to dulaglutide or to any of the components of TRULICITY. SAXENDA is contraindicated during pregnancy because weight loss offers no potential benefit to a pregnant woman and may result in fetal harm [see Clinical Considerations].
The contraindications for starting GLP-1 medications are:
- Personal or family history of Medullary Thyroid Carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
- Serious hypersensitivity reaction to the medication or any of the excipients
- Pregnancy, as weight loss offers no potential benefit to a pregnant woman and may result in fetal harm 2, 3, 4
From the Research
Contraindications for Starting GLP-1 Medications
- GLP-1 receptor agonists are contraindicated in those with a history of medullary thyroid cancer 5
- GLP-1 receptor agonists should be used with caution in patients with a history of pancreatitis of a known cause 5
- The use of GLP-1 receptor agonists may increase the risk of pancreatitis, although some studies suggest that this risk may be lower than previously thought 6, 7
- The risk of pancreatitis associated with GLP-1 agonists may be dose-dependent, with higher cumulative doses associated with a higher risk of developing pancreatitis 8
- GLP-1 receptor agonists may also increase the risk of thyroid cancer, although the evidence for this is still limited and inconclusive 6
- Patients with a history of diabetic ketoacidosis should avoid using SGLT2 inhibitors, which are often used in conjunction with GLP-1 receptor agonists 5
Special Considerations
- Patients at risk for deterioration of existing diabetic retinopathy should be carefully monitored if treated with semaglutide, a type of GLP-1 receptor agonist 9
- GLP-1 receptor agonists may increase the risk of biliary disease, such as cholelithiasis 9
- Patients with a history of pancreatitis or pancreatic cancer should be carefully evaluated before starting GLP-1 receptor agonist therapy 6, 7, 8