Drug interactions don’t come to the top of my mind when I see GLP-1 agonists in use. We are fortunate that they do not have a lot of significant interactions, but I don’t think you should forget about them altogether. I’ve provided a list below of my top 3 drug interactions with GLP-1 agonists.
Insulin and Sulfonylureas
Insulin and GLP-1 agonists are used together for some patients with type 2 diabetes. When a GLP-2 is added to a patient’s regimen, it is critical to monitor blood glucose and more specifically, watch out for hypoglycemia. This is common sense as we are trying to lower blood sugars by adding a GLP-1 agonist so naturally, we are going to be monitoring blood sugar.
Sulfonylureas stimulate the release of insulin and can ultimately have the same hypoglycemic type effect as giving insulin. Adding a GLP-1 agonist to a patient already taking a sulfonylurea can increase the risk of hypoglycemia.
Metoclopramide and Erythromycin
GLP-1 agonists are well known to slow the GI tract. Before considering the use of these agents, I definitely look to see if the patient has enough trouble with gastroparesis to be taking medications to manage it. Metoclopramide and erythromycin are the two most commonly used agents used to manage gastroparesis and there is potential that the GLP-1 agonists will oppose the prokinetic effects of these agents
Corticosteroids
Corticosteroids are notorious for raising blood sugars which could directly oppose the blood sugar lowering effects of GLP-1 agonists. Before questioning the benefits of GLP-1 agonists, be sure your patient is not taking a steroid burst such as prednisone which is causing hyperglycemia.
Would you add anything else to this list?
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