126.96.36.199 GLP-1 Receptor Agonists
There are currently very limited, intermittent supplies of all glucagon-like peptide-1 receptor agonists (GLP-1 RAs). Supplies are not expected to stabilise to meet full market demand until at least mid-2024. Please refer to HSS(MD) 38/2023 and SPPG correspondence for further information.
|1st choice||Liraglutide (Victoza®) injection 6mg/ml|
Prescribe by Brand Name
|Dulaglutide (Trulicity®) 0.75mg/0.5ml, 1.5mg/0.5ml, 3mg/0.5ml, 4.5mg/0.5ml solution for injection|
Prescribe by Brand Name
Add-on therapy: 1.5 mg once weekly; increased if necessary to 3 mg once weekly after at least 4 weeks, then increased if necessary to 4.5 mg once weekly after another 4 weeks, a starting dose of 0.75 mg once weekly may be considered for potentially vulnerable patients; maximum 4.5 mg per week.
Renal impairment – see BNF
- Prescribe as per NICE Guideline NG28 recommendations. See also NICE visual summary for blood glucose lowering therapy in adults with type 2 diabetes.
- To prevent waste, please avoid prescribing large quantities – GLP-1 receptor agonists require refrigeration and are expensive. One month’s supply should be adequate for most patients.
- Stopping rules with GLP-1 receptor agonists: NICE state only continue GLP‑1 receptor agonist therapy if the person with type 2 diabetes has had a beneficial metabolic response (a reduction of at least 11 mmol/mol [1.0%] in HbA1c and a weight loss of at least 3% of initial body weight in 6 months).
- Gastric emptying may be delayed. Therefore the rate and extent of absorption of other oral drugs administered at the same time may be affected.
- Doses of concomitant sulfonylurea may need to be reduced when a GLP-1 receptor agonist is started.
- Upper gastrointestinal side effects such as nausea are common with GLP-1 receptor agonist therapy.
- There are rare reports of acute pancreatitis in patients using these drugs. GLP-1 receptor agonists should be avoided in patients considered to be at high risk of pancreatitis. Patients and their carers should be told how to recognise signs and symptoms of pancreatitis.
- Thyroid adverse events, including increased blood calcitonin, goitre and thyroid neoplasm, have been rarely reported in clinical trials with liraglutide, particularly in patients with pre-existing thyroid disease.
- Diabetic ketoacidosis has been reported in patients with type 2 diabetes on a combination of a GLP-1 receptor agonist and insulin who had doses of concomitant insulin rapidly reduced or discontinued. See MHRA for further details