Endocrinology: GLP-1 Prescription Guidance
GLP-1 Prescription Guidance in Case of Adverse Side Effects
Summary
- 26 yo Male PMHx HTN, Morbid Obesity
- Patient experiences nausea from a GLP-1 agonist
- PCP seeks GLP-1 medication review
eConsult Transcript
PCP submission
26 yo Male PMHx HTN, Morbid Obesity. Patient has trialled Ozempic previously, but reports N/V with use.
Any recommendations on medications with less GI upset to help patient with weight loss?
PCP submission
Thank you for this very interesting consult. If I were to evaluate this patient in clinic, I would consider the following: After performing thorough chart review, completing evaluation of the available medications, vitals, comorbid conditions and acute on chronic clinical conditions for this patient:
Highly recommend immediate referral to the RubiconMD Nutrition team to assist in weight loss diet plan and complex obesity management. Tirzepatide is a dual glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 receptor agonist (GLP-1 RA) approved by the US Food and Drug Administration in May 2022 for patients with type 2 diabetes mellitus (T2DM). Overall, tirzepatide appears to have a relatively low side effect profile. References below, but in pooled studies: Drug discontinuation due to AEs was highest with the 15 mg dose of tirzepatide (10%). Most common side effects are of the gastrointestinal tract. Ref- https://dom-pubs.onlinelibrary.wiley.com/doi/full/10.1111/dom.13979 https://academic.oup.com/jes/article/7/4/bvad016/7005432 recommend consider this medicine.
The indications to undergo bariatric surgery, are based on body mass index (BMI) as well as the presence of comorbidity. Patients with a BMI of 40 kg/m2 or greater without coexisting medical problems, and for whom bariatric surgery would not carry an excessive risk, should be candidates for one of the surgeries mentioned above. Patients with a BMI greater than or equal to 35 kg/m2 and 1 or more severe obesity-related comorbidities, including type 2 diabetes, hypertension, hyperlipidemia, obstructive sleep apnea (OSA), non-alcoholic fatty liver disease (NAFLD), GERD, asthma, venous stasis disease, severe urinary incontinence, debilitating arthritis, or considerably impaired quality of life, would also qualify as surgical candidates. Ref-Ref-Garvey, W. Timothy, et al. “American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity.” Endocrine Practice 22 (2016): 1-203.
