Straight Healthcare

GLP-1 ANALOG DOSING

EXPAND ALL ACRONYMS AND DEFINITIONS

TOP
CrCl - Creatinine clearance
ACRONYMS AND DEFINITIONS
GLP-1 - Glucagon-Like Peptide-1
GLP-1 ANALOGS
P = Drugs with pediatric dosing
GLP-1 ANALOG + INSULIN
KIDNEY DISEASE DOSING
GLP-1 ANALOGS
LIVER DISEASE DOSING
DRUG INTERACTIONS
PRICE ($) INFO / ASSISTANCE
DULAGLUTIDE (TRULICITY®)
BIBLIOGRAPHY
DOSAGE FORMS
OTHER RELATED PAGES
GLP-1 analog review Single-dose pen
Tirzepatide (Mounjaro®) 0.75 mg
Saxenda® review 1.5 mg
Insulin chart 3 mg
Type two diabetes 4.5 mg
Diabetes management Comes in carton with 4 pens

DOSING

Type 2 diabetes
Starting: 0.75 mg once weekly
Maintenance: 0.75 - 4.5 mg once weekly
Max: 4.5 mg once weekly
Increase to next higher dose if needed at intervals of 4 weeks
May administer without regard to food
If a dose is missed, administer ASAP if there are at least 3 days until the next scheduled dose
If less than 3 days remain before the next scheduled dose, skip the missed dose and administer the next dose on
the regularly scheduled day
In each case, patients can then resume their regular once weekly dosing schedule
The day of weekly administration can be changed if necessary as long as the last dose was administered 3 or
more days before

Kidney disease
No dose adjustment is recommended in patients with renal impairment including end-stage renal disease
Gastrointestinal side effects may be worse in patients with kidney disease

Liver disease
In a study of patients with varying degrees of liver disease, no clinically relevant change in dulaglutide
pharmacokinetics was observed. However, there is limited clinical experience with dulaglutide in liver disease so
caution should be used.

OTHER

Inject subcutaneously in thigh, abdomen, or upper arm

If adding to insulin or sulfonylurea, consider lowering dose of these drugs when initiating to prevent hypoglycemia

GENERIC / PRICE - NO/$$$$

STORAGE

Refrigerated pens/syringes Room temp pens/syringes

Good until expiration date Good for 14 days

EXENATIDE (BYETTA®)

DOSAGE FORMS

Multi-dose pen
5 mcg dose - 1.2 ml pen with 60 doses
10 mcg dose - 2.4 ml pen with 60 doses

DOSING

Type 2 diabetes (adults)

Starting: 5 mcg twice a day
Maintenance: 5 - 10 mcg twice a day
Max: 10 mcg twice a day
Increase dose at intervals of ≥ 4 weeks
Give within the 60-minute time period before the morning and evening meal

Kidney disease
CrCl > 50 ml/min: No dosage adjustment necessary
CrCl 30 - 50 ml/min: Starting dose 5 mcg twice a day. Caution should be used if increasing to 10 mcg.
CrCl < 30 ml/min: DO NOT USE

Liver disease
The manufacturer states that no studies have been performed on patients with significant liver disease
Because exenatide is cleared primarily by the kidneys, liver disease is not expected to affect its clearance

OTHER

Inject subcutaneously in thigh, abdomen, or upper arm

To limit GI side effects, the recommended starting dose is 5 mcg twice a day

GENERIC / PRICE - NO/$$$$

STORAGE

Unpunctured pens Punctured pens

Keep refrigerated Keep at temperature below 77° F (25°C)
Good until expiration date on product Good for 30 days
Do not freeze

EXENATIDE | BYDUREON® | BYDUREON BCISE®

DOSAGE FORMS

Single-dose pen, Bydureon® Dosing tray, Bydureon®

Each pen contains 2 mg Each dosing tray comes with a syringe, needle, and vial
Comes in carton of 4 pens Each vial has a 2 mg dose
Comes in carton of 4 trays

Autoinjector, Bydureon BCise®

Each pen contains 2 mg
Comes in carton of 4 pens

DOSING

Type 2 diabetes in adults and pediatric patients ≥ 10 years old

Dosing: 2 mg once weekly
Max: 2 mg once weekly
May administer at any time of day without regard to food
Inject subcutaneously in abdomen, thigh, or upper arm
Missed doses: administer missed dose ASAP, provided the next regularly scheduled dose is due at least 3 days
later. Thereafter, patients can resume their usual dosing schedule of once weekly. If a dose is missed and the next
regularly scheduled dose is due 1 or 2 days later, the patient should not administer the missed dose and instead
resume Bydureon with the next regularly scheduled dose. Do not take 2 doses within 3 days of each other.

Kidney disease
CrCl > 50 ml/min: No dosage adjustment necessary
CrCl 30 - 50 ml/min: Use caution
CrCl < 30 ml/min: DO NOT USE

Liver disease
The manufacturer states that no studies have been performed on patients with significant liver disease
Because exenatide is cleared primarily by the kidneys, liver disease is not expected to affect its clearance

OTHER

The exenatide in Bydureon BCise comes suspended in medium chain triglycerides, and the exenatide in
Bydureon comes as a powder that must be reconstituted. Bydureon BCise requires less mixing before
administration.
Bydureon BCise must be stored flat

GENERIC / PRICE - NO/$$$$

STORAGE

Refrigerated (pens/trays) Room temp (pens/trays)

Good until expiration date Good for 4 weeks
Bydureon BCise must be stored flat Bydureon BCise must be stored flat

Reconstituted doses of Bydureon

Use immediately

LIRAGLUTIDE (VICTOZA®)

DOSAGE FORMS

Multi-dose pen
Pen can be dialed to all 3 doses
For 1.8 mg dose has 10 doses
For 1.2 mg dose has 15 doses
For 0.6 mg dose has 30 doses
Comes in packages of 2 or 3 pens

DOSING

Type 2 diabetes (adults)

Starting: 0.6 mg once daily for 1 week
Maintenance: 1.2 - 1.8 mg once daily
Max: 1.8 mg once daily
To limit GI side effects, the recommended starting dose is 0.6 mg once daily
0.6 mg dose is not effective for blood sugar control
May be administered without regard to food

Type 2 diabetes (children ≥ 10 years old)

Starting: 0.6 mg once daily
Maintenance: 0.6 - 1.8 mg once daily
Max: 1.8 mg once daily
The dose may be increased by 0.6 mg every 7 days if necessary
Pediatric approval based on PMID 31034184
May be administered without regard to food

Kidney disease
No dose adjustment is recommended in patients with renal impairment
Use caution in patients with dehydration

Liver disease
The prescribing information states that liraglutide should be used with caution in patients with liver disease
The manufacturer does not recommend adjusting the dose in liver disease

OTHER

If adding to insulin or sulfonylurea, consider lowering dose of these drugs when initiating to prevent hypoglycemia
It is acceptable to inject Victoza and insulin in the same body region but the injections should not be adjacent to
each other
If > 3 days have elapsed since last dose, reinitiate at 0.6 mg dose

GENERIC / PRICE - NO/$$$$

STORAGE

Unpunctured pens Punctured pens

Keep refrigerated Keep at room temperature or refrigerate
Good until expiration date if refrigerated Good for 30 days
Do not freeze Do not freeze

LIXISENATIDE (ADLYXIN®)

DOSAGE FORMS

Multi-dose pen
Starter pen - delivers 14 doses of 10 mcg
Maintenance pen - delivers 14 doses of 20 mcg
Starter pen comes in package with one pen
Maintenance pen comes in package of 2 pens

DOSING

Type 2 diabetes
Starting: 10 mcg once daily for 14 days
Maintenance: 20 mcg once daily
Max: 20 mcg once daily
Administer within one hour before the first meal of the day preferably the same meal each day. If a dose is
missed, administer within one hour prior to the next meal

Kidney disease
CrCl ≥ 60 ml/min: No dosage adjustment necessary
CrCl 30 - 60 ml/min: No dose adjustment recommended. Monitor for increased GI and renal side effects.
CrCl 15 - 30 ml/min: Very limited data. No dose adjustment recommended. Monitor for increased GI and renal
side effects.
CrCl < 15 ml/min: DO NOT USE

Liver disease
Has not been studied
Hepatic dysfunction is not expected to affect the pharmacokinetics of lixisenatide

OTHER

Inject subcutaneously in thigh, abdomen, or upper arm

Rotate injection sites with each dose. Do not use the same site for each injection.

GENERIC / PRICE - NO/$$$$

STORAGE

Unused pens After first dose

Keep refrigerated Store below 86°F (30°C)
Good until expiration date Discard pen 14 days after first use
Do not freeze

SEMAGLUTIDE (OZEMPIC®)

DOSAGE FORMS

Multi-dose pen
2 mg pen - delivers 0.25 or 0.5 mg per injection. Can deliver four 0.25 mg doses or four 0.5 mg doses.
4 mg pen - delivers four 1 mg doses
8 mg pen - delivers four 2 mg doses

DOSING

Type 2 diabetes
Starting: 0.25 mg SQ once weekly for 4 weeks. After 4 weeks of 0.25 mg, increase dose to 0.5 mg once weekly.
The 0.25 mg dose is for titration only and is not effective for glycemic control.
Maintenance: 0.5 - 2 mg SQ once weekly
Max: 2 mg SQ once weekly
Dose may be increased to 1 mg and then 2 mg if necessary. Each dose should be given for at least 4 weeks
before increasing.
The day of weekly administration can be changed if necessary as long as the time between two doses is at least 2
days (> 48 hours)
If a dose is missed, administer it as soon as possible, within 5 days after the missed dose. If > 5 days have
passed, skip the missed dose and administer the next dose on the regularly scheduled day.
Inject subcutaneously in the thigh, abdomen, or upper arm. Rotate injection sites with each dose. Do not use the
same site for each injection.
May administer without regard to food

Kidney disease
No dose adjustment is necessary for any degree of renal impairment

Liver disease
No dose adjustment is necessary for any degree of hepatic impairment

GENERIC / PRICE - NO/$$$$

STORAGE

Unused pens After first dose

Keep refrigerated Store at room temperature or refrigerated
Good until expiration date Good for 56 days
Do not freeze

SEMAGLUTIDE (RYBELSUS®)

DOSAGE FORMS

Tablet
3 mg
7 mg
14 mg
Comes in blister pack of 30 tablets

DOSING

Type 2 diabetes
Starting: 3 mg once daily for 30 days
Maintenance: 7 mg once daily. 7 mg dose may be increased to 14 mg after at least 30 days.
Max: 14 mg once daily
The 3 mg dose is for titration only and is not effective for glycemic control
Taking two 7 mg tablets to achieve 14 mg dose is not recommended
If a dose is missed, the missed dose should be skipped, and the next dose should be taken the following day
Take at least 30 minutes before the first food, beverage, or other oral medications of the day with no more than 4
ounces of plain water only. Waiting less than 30 minutes, or taking with food, beverages (other than plain water) or
other oral medications will lessen the effect of Rybelsus by decreasing its absorption. Waiting more than 30
minutes to eat may increase the absorption of Rybelsus.

Switching between Ozempic and Rybelsus

Patients taking Rybelsus 14 mg daily can be switched to Ozempic 0.5 mg SQ once weekly. Ozempic may be
started the day after the last dose of Rybelsus.
Patients taking Ozempic 0.5 mg SQ once weekly can be switched to either Rybelsus 7 mg or 14 mg. Patients can
start Rybelsus up to 7 days after their last injection of Ozempic. There is no equivalent dose of Rybelsus for
Ozempic 1 mg.

Kidney disease
No dose adjustment is necessary for any degree of renal impairment

Liver disease
No dose adjustment is necessary for any degree of hepatic impairment

OTHER

Do not split, crush, or chew tablets

Leave tablets in blister pack until ready for use

GENERIC / PRICE - NO/$$$$

GLP-1 ANALOG + INSULIN

SOLIQUA® (INSULIN GLARGINE + LIXISENATIDE)

DOSAGE FORMS

Pen (100/33)
100 units/ml insulin glargine and 33 mcg/ml lixisenatide
Pens contain 3 ml
Comes in package of 5 pens
Pen window shows units of insulin glargine

PHARMACOKINETICS

NOTE: Parameters are for insulin glargine only

Onset of action Duration of action Peak effect

1 - 3 hours 24+ hours No peak

MIXING - DO NOT MIX with other insulins

DOSING

Type 2 diabetes
Insulin glargine is a long-acting insulin
Lixisenatide is a GLP-1 analog
Pen is dialed to units of insulin glargine. Minimum dose pen can deliver is 15 units and max is 60 units.
If inadequate control on < 30 units of basal insulin or lixisenatide, starting dose is 15 units once daily
If inadequate control on 30 - 60 units of basal insulin, starting dose is 30 units once daily
Titrate dose up or down by 2 - 4 units every week based on blood sugar goals
Max dose is 60 units
Administer once a day within the hour prior to the first meal of the day
See insulin dosing for more

OTHER

Soliqua should be clear and colorless to almost colorless

STORAGE

Unopened / Unused pens After first use

Store in refrigerator Store at room temperature
Good until expiration date on product Good for 28 days

XULTOPHY® (INSULIN DEGLUDEC + LIRAGLUTIDE)

DOSAGE FORMS

Pen (100/3.6)
100 units/ml insulin degludec and 3.6 mg/ml liraglutide
Pens contain 3 ml
Comes in package of 5 pens
Pen window shows units of insulin degludec

Needles
Recommended use with NovoFine®, Novofine® Plus or NovoTwist®

PHARMACOKINETICS

NOTE: Parameters are for insulin degludec only

Onset of action Duration of action Peak effect

1 - 3 hours 24+ hours No peak

MIXING - DO NOT MIX with other insulins

DOSING

Type 2 diabetes
Insulin degludec is a long-acting insulin
Liraglutide is a GLP-1 analog
Pen is dialed to units of insulin degludec. Minimum dose pen can deliver is 10 units and max is 50 units.
Recommended starting dose is 16 units once daily
Titrate dose up or down by 2 units every 3 - 4 days based on blood sugar goals
Max dose is 50 units
Administer at the same time each day with or without food
Patients who persistently require less than 16 units should discontinue Xultophy and use another product
See insulin dosing for more

OTHER

Xultophy should be clear and colorless

STORAGE

Unopened / Unused pens After first use

Store in refrigerator Store at room temperature or in a refrigerator
Good until expiration date on product Good for 21 days

Kidney disease dosing

Dulaglutide (Trulicity®)
No dose adjustment is recommended in patients with renal impairment including end-stage renal disease
Gastrointestinal side effects may be worse in patients with kidney disease
Exenatide (Byetta®)
CrCl > 50 ml/min: No dosage adjustment necessary
CrCl 30 - 50 ml/min: Starting dose 5 mcg twice a day. Caution should be used if increasing to 10 mcg.
CrCl < 30 ml/min: DO NOT USE
Exenatide (Bydureon®)
CrCl > 50 ml/min: No dosage adjustment necessary
CrCl 30 - 50 ml/min: Use caution
CrCl < 30 ml/min: DO NOT USE
Liraglutide (Victoza®)
No dose adjustment is recommended in patients with renal impairment
Use caution in patients with dehydration
Lixisenatide (Adlyxin®)
CrCl ≥ 60 ml/min: No dosage adjustment necessary
CrCl 30 - 60 ml/min: No dose adjustment recommended. Monitor for increased GI and renal side effects.
CrCl 15 - 30 ml/min: Very limited data. No dose adjustment recommended. Monitor for increased GI and renal side effects.
CrCl < 15 ml/min: DO NOT USE
Semaglutide (Ozempic®)
No dose adjustment is necessary for any degree of renal impairment
Semaglutide (Rybelsus®)
No dose adjustment is necessary for any degree of renal impairment

Liver disease dosing

Dulaglutide (Trulicity®)
In a study of patients with varying degrees of liver disease, no clinically relevant change in dulaglutide pharmacokinetics
was observed. However, there is limited clinical experience with dulaglutide in liver disease so caution should be used.
Exenatide (Byetta®)
The manufacturer states that no studies have been performed on patients with significant liver disease
Because exenatide is cleared primarily by the kidneys, liver disease is not expected to affect its clearance
Exenatide (Bydureon®)
The manufacturer states that no studies have been performed on patients with significant liver disease
Because exenatide is cleared primarily by the kidneys, liver disease is not expected to affect its clearance
Liraglutide (Victoza®)
The prescribing information states that liraglutide should be used with caution in patients with liver disease
The manufacturer does not recommend adjusting the dose in liver disease
Lixisenatide (Adlyxin®)
Has not been studied
Hepatic dysfunction is not expected to affect the pharmacokinetics of lixisenatide
Semaglutide (Ozempic®)
No dose adjustment is necessary for any degree of hepatic impairment
Semaglutide (Rybelsus®)
No dose adjustment is necessary for any degree of hepatic impairment

DRUG INTERACTIONS
NOTE: The drug interactions presented here are NOT all-inclusive. Other interactions may exist. Drug interaction checkers
provide the most efficient and practical way to check for interactions among multiple medications. A free interaction checker is
available from Drugs.com (see Drugs.com interactions checker).

All GLP-1 analogs

Insulin and insulin secretagogues - When GLP-1 analogs are used with insulin and insulin secretagogues (e.g.
sulfonylureas, meglitinides), the risk for hypoglycemia is increased. Monitor blood sugars closely when combining and
adjust medications as needed.
Drugs affected by decreased gastric emptying - see gastric emptying below
Drugs that alter gastrointestinal motility - Drugs that slow gastrointestinal motility may potentiate the gastric-slowing effects
of GLP-1 analogs
Examples include:
Anticholinergic medications
Opiate pain medications (hydrocodone, morphine, etc.)

Exenatide (Byetta®)
Oral contraceptives - Exenatide can affect the absorption of oral contraceptive pills (see gastric emptying below). Oral
contraceptives should be taken at least one hour before exenatide is injected.

Lixisenatide (Adlyxin®)
Oral contraceptives - Lixisenatide can affect the absorption of oral contraceptives. Oral contraceptives should be taken at
least 1 hour before lixisenatide administration or at least 11 hours after the last dose of lixisenatide.

Drugs affected by gastric emptying

When a person consumes food or medications, they are partially digested in the stomach
The stomach then "empties" food and medications into the small intestine
GLP-1 analogs slow the process of stomach emptying
Since most medications are absorbed in the small intestine, slowing of stomach emptying by GLP-1 analogs may affect the
absorption of some medications
In many cases, the overall effect on the drug's therapeutic effect is not significant
The large number of possible interaction has not been studied extensively
The effect of the medications listed below may be altered by decreased gastric emptying caused by GLP-1 analogs
Antibiotics
Antibiotics require rapid absorption to achieve their desired therapeutic effect
GLP-1 analogs may alter their absorption
Antibiotics should be taken at least 1 hour before GLP-1 analogs
Drugs with a narrow therapeutic index
Drugs with narrow therapeutic index may be affected by GLP-1 analogs
Taking these drugs at least 1 hour before GLP-1 analogs may help prevent an interaction
Examples of drugs with a narrow therapeutic index:
Carbamazepine (Tegretol®)
Cyclosporine (Neoral®)
Digoxin
Levothyroxine (Synthroid®)
Lithium
Phenytoin (Dilantin®)
Tacrolimus (Prograf®)
Theophylline (Theo-24®)
Warfarin (Coumadin®)

Metabolism and clearance

GLP-1 analogs do not undergo significant liver metabolism

PRICE ($) INFO

Pricing legend

$ = 0 - $50
$$ = $51 - $100
$$$ = $101 - $150
$$$$ = > $150

Pricing based on one month of therapy at standard dosing in an adult

Pricing based on information from GoodRX.com®
Pricing may vary by region and availability

Patient Assistance Programs for GLP-1 Analogs

Drug Manufacturer Ships to PAP info Application

Dulaglutide (Trulicity™) Lilly Patient or doctor Link Link

Exenatide (Bydureon®, Byetta®) AstraZeneca Patient or doctor Link Link

Liraglutide (Victoza®) Novo Nordisk Doctor Link Link

Liraglutide (Saxenda®) Novo Nordisk Doctor Link Link

Lixisenatide (Adlyxin®) Sanofi Doctor Link Link

Semaglutide (Ozempic®) Novo Nordisk Doctor Link Link

Semaglutide (Rybelsus®) Novo Nordisk Doctor Link Link

BIBLIOGRAPHY

Manufacturer's package insert

2 - North Carolina Pharmacy Practice Act. Article 4A. 90-85.28(b1).