Incretins: GLP-1 receptor agonists marketed in the United States
| Dosing (subcutaneous) | Renal dosing | Half-life; peak | Side effects | |
|---|---|---|---|---|
| Short-acting (4–6 hours) | ||||
| Exenatide (Byetta) | 5 μg twice daily; may increase to 10 μg twice daily after 4 weeks; take within 60 minutes of morning and evening meals; at least 6 hours apart | Not recommended if CrCl < 30 mL/min | 2.4 hours Peak: 2.1 hours | Weight loss, GI upset |
| Intermediate-acting (24 hours) | ||||
| Liraglutide (Victoza) | Initial: 0.6 mg/day for 7 days Maintenance: 1.2 mg/day; may increase to 1.8 mg/day, if needed Body weight affects dosing: 1.2 mg and 1.8 mg doses provide adequate exposure for body weight ranges between 40–160 kg; has not been studied in body weight > 160 kg | No dose adjustment required but caution needed in patients with renal impairment | ~13 hours Peak: 8–12 hours | Weight loss, nausea |
| Long-acting (7 days) | ||||
| Exenatide extended- release (Bydureon) | 2 mg once/week | Not recommended if CrCl < 30 mL/min | Not available Peaks: week 2 and week 6–7 (~10 weeks after discontinuation, plasma concentrations fall below minimal detectable levels) | Weight loss, nausea |
| Albiglutide (Tanzeum) | Initial: 30 mg once/week; may increase to 50 mg once/week, if response inadequate | Not recommended if eGFR < 15 mL/min/1.73 m2; use with caution in patients with renal impairment | ~5 days Peak: 3–5 days | Weight loss, nausea |
| Dulaglutide (Trulicity) | 0.75 mg once/week; may increase to 1.5 mg once/week, if needed Available as prefilled pen or syringe | No dose adjustment required | ~5 days Peak: 24–72 hours | Weight loss, nausea |
CrCl = creatinine clearance; eGFR = estimated glomerular filtration rate; GI = gastrointestinal; GLP-1 = glucagon-like peptide-1.
Based on information in Tran L, Zielinski A, Roach AH, et al. Pharmacologic treatment of type 2 diabetes: injectable medications. Ann Pharmacother 2015; 49:700–714.