Examples: liraglutide, semaglutide (oral and injectable), dulaglutide, exenatide, lixisenatide
Mechanism: Promotes satiety, slows gastric emptying, weight loss
Efficacy: effective A1c lowering option, however, injectable options work better than oral. Evidence for improved cardiovascular and renal outcomes.
Dosing:
Oral semaglutide: once daily first thing in the morning, empty stomach, 30 minutes before any food or drink (except for water). No more than half a glass of water.
Injectables:
Lixisenatide: once daily before meals
Exenatide-daily formulation: twice daily before meals
Liraglutide: once daily without regard to meals
Semaglutide, dulaglutide, exenatide-once weekly formulation: once weekly
Adverse Effects:
-gastrointestinal: nausea, vomiting, diarrhea (mitigated by slow titration of dose)
-hypoglycemia is rare (usually when combined with other agents)
-pancreatitis risk
-contraindicated in some thyroid cancers
-weight loss
Drug Interactions:
Hypoglycemia when combined with other agents, particularly sulfonlyureas and insulin. The dose may need to be decreased when starting GLP-1 agents.