From the FDA Drug Label
Laboratory Tests Bilirubin In the five adult glycemic control trials of at least 26 weeks duration, mildly elevated serum bilirubin concentrations (elevations to no more than twice the upper limit of the reference range) occurred in 4.0% of liraglutide injection-treated patients, 2.1% of placebo-treated patients and 3. 5% of active-comparator-treated patients. Calcitonin Calcitonin, a biological marker of MTC, was measured throughout the clinical development program At the end of the adult glycemic control trials, adjusted mean serum calcitonin concentrations were higher in liraglutide injection-treated patients compared to placebo-treated patients but not compared to patients receiving active comparator. Between group differences in adjusted mean serum calcitonin values were approximately 0. 1 ng/L or less. Among adult patients with pretreatment calcitonin <20 ng/L, calcitonin elevations to >20 ng/L occurred in 0.7% of liraglutide injection-treated patients, 0.3% of placebo-treated patients, and 0. 5% of active-comparator-treated patients. Lipase and Amylase In one adult glycemic control trial in renal impairment patients, a mean increase of 33% for lipase and 15% for amylase from baseline was observed for liraglutide injection-treated patients while placebo-treated patients had a mean decrease in lipase of 3% and a mean increase in amylase of 1%
The labs to be monitored for patients on GLP-1 medication, specifically liraglutide, include:
- Bilirubin: to check for mildly elevated serum bilirubin concentrations
- Calcitonin: as a biological marker of MTC
- Lipase and Amylase: to check for elevations in these enzymes, which may indicate pancreatitis The frequency of monitoring is not explicitly stated in the provided drug label. 1
From the Research
Laboratory monitoring for patients on GLP-1 receptor agonist medications should include baseline and periodic assessment of renal function, pancreatic enzymes, and blood glucose levels, with a focus on HbA1c, fasting glucose, comprehensive metabolic panel (CMP), and lipid profiles, as evidenced by recent studies 2, 3, 4.
Key Laboratory Tests
- Baseline comprehensive metabolic panel (CMP) including creatinine, BUN, and liver function tests
- HbA1c and fasting glucose
- Lipid profiles, including LDL-C, total cholesterol, and triglycerides ### Monitoring Frequency
- For most patients, labs should be repeated at 3-6 month intervals during the first year of treatment, then annually if stable
- More frequent monitoring (every 3 months) is recommended for patients with pre-existing renal impairment (eGFR <60 mL/min/1.73m²) ### Additional Considerations
- If pancreatitis is suspected based on symptoms like severe abdominal pain, check lipase and amylase levels immediately
- For patients with type 2 diabetes, regular self-monitoring of blood glucose is important, especially during dose titration periods
- Thyroid function tests should be obtained at baseline and periodically for patients taking semaglutide, particularly those with thyroid disease history, due to rare reports of medullary thyroid carcinoma, as noted in studies 2, 3 ### Rationale The recommended laboratory monitoring schedule is based on the potential effects of GLP-1 receptor agonists on kidney function, pancreatitis risk, and lipid profiles, as well as the importance of monitoring therapeutic efficacy and potential adverse effects, as highlighted in recent studies 2, 3, 4.