Stretched Thin On GLP-1/GIP Agonists: Tips for navigating the national shortages
By: Bharathi Ravikumar, PharmD and Kaitlyn Craddock, PharmD, BCACP
GLP-1 agonists and GLP-1/GIP agonist injectable medications have exploded in popularity across the nation. It seems like everyone from family members to next door neighbors to celebrities are on these medications for weight loss and/or type 2 diabetes treatment. The effectiveness of these medications, once weekly dosing, and ease of administration have made these injections an ideal choice to incorporate into busy lifestyles. With the rise in usage came the subsequent national shortages of these medications. Here’s a quick recap about this issue:
- Who is impacted? Patients with type 2 diabetes and/or obesity
- Which medications are impacted? Supply is constantly changing, but medications such as Trulicity, Mounjaro, Wegovy, Ozempic, Zepbound, and Saxenda have all been affected. Check the ASHP Drug Shortage and FDA Drug Shortages websites for real-time updates regarding shortages.
- Why are these medications on shortage? Some manufacturers do not disclose the reason for shortage while other pharmaceutical manufacturers report they cannot keep up with the demand for these medications.
- When will the shortage end? Currently, most pharmaceutical companies do not have a projected end date.
- Where can i find these medications? Don’t stick to one pharmacy – call other pharmacies in the area or consider a mail order pharmacy
What can healthcare professionals do to help our patients?
· Communicate that there is a shortage and consider other options before starting a patient on one of these medications. If a patient is already on one of these medications, be transparent about their options.
· Troubleshoot together:
o Call multiple pharmacies: don’t wait on one pharmacy. Supply fluctuates and other pharmacies nearby may have what the patient needs.
o Consider a mail order pharmacy: Some mail order pharmacies may be able to provide a 3-month supply if the patient is on a stable dose.
o Ask about more than one strength: If a patient’s current dose isn’t available, check to see if other doses are available. If clinically appropriate, the dose can be adjusted to ensure they receive a consistent supply.
o Consider switching to a medication not on shortage: Consider switching patients to a medication that they can get more consistently, whether that is an alternative GLP-1 or GLP-1/GIP agonist or an entirely different class. See equivalent doses in Table 1 below if transitioning to an alternative GLP-1 or GLP-1/GIP agonist.
Table 1: Suggested Equivalent Doses of GLP-1 and GLP-1/GLP Products
*From MCT2D GLP1 shortages
Resuming treatment once shortages improve
It’s important to resume these medications appropriately if patients have been unable to access their medication for a substantial period of time. Resuming their medication at their previous stable dose could result in unpleasant and intolerable adverse effects. Depending on the amount of time without the medication and the half-life of the medication, resuming at a lower dose and titrating back up may be appropriate. See Table 2 for recommendations for resuming these medications below.
Table 2: Dosing Recommendations for Resuming Therapy
|
Agent
|
Last Dose Administered
|
Recommendations for Resuming Therapy
|
|
Trulicity (dulaglutide)
|
1.5 mg once weekly
|
· Resume at 1.5 mg once-weekly dose.
· Expect comparable tolerability to that experienced prior to dose interruption.
|
|
3 or 4.5 mg once weekly
|
· Use best judgment if ≥ 3 doses are missed. It is unknown whether tolerance to the GI adverse events will remain if reinitiated at the higher dose after ≥3 missed doses.
· Patient’s prior GI tolerability can help the provider make an informed decision.
· In consideration of the above, clinicians may consider reinitiating at 1.5 mg once weekly.
|
|
Ozempic and Wegovy (semaglutide)
|
1 mg once weekly
|
· If ≤ 2 doses are missed, reinitiate at 1 mg once weekly.
· If 3–4 doses are missed, reinitiate at 0.5 mg weekly.
· If ≥ 5 doses are missed, reinitiate at 0.25 mg once weekly.
|
|
Mounjaro and Zepbound (tirzepatide)
|
≥ 5 mg once weekly
|
· If ≤ 2 doses are missed, reinitiate at the same dose (provided the dose was adequately tolerated).
· If ≥ 3 doses are missed, reinitiate at 5 mg once weekly.
|
|
Victoza and Saxenda (liraglutide)
|
|
· If ≤ 3 doses are missed, reinitiate at the same dose (provided the dose was adequately tolerated).
· If ≥ 4 doses are missed, reinitiate at 0.6 mg once weekly.
|
*Adapted from Whitley et al 2023
Conclusion
GLP-1 and GLP-1/GIP agonists have been life-changing for many patients struggling with chronic diseases, and reasonably, the shortages have been a frustrating issue for patients and providers alike. As diabetes care and education specialists, these are a few tools we can use to help our patients navigate this issue.
References:
1. American Society of Health-System Pharmacists. Current drug shortages. https://www.ashp.org/drug-shortages/current-shortages?loginreturnUrl=SSOCheckOnly
2. Michigan Collaborative for Type 2 Diabetes. Supporting patients during GLP-1 Receptor Agonist shortages. Updated Jan 2023. Accessed Mar 29, 2024. https://assets.ctfassets.net/1p0t6jhbvwk9/nfGRbeVaKRxZJ5UaCStVl/3a67f6553dc6cd704f813e927faa72a6/MCT2D-GLP1-shortages-02232023__1_.pdf
3. US Food and Drug Administration. Drug shortages. https://www.fda.gov/drugs/drug-safety-and-availability/drug-shortages
4. Whitley HP, Trujillo JM, Neumiller JJ. Special Report: Potential Strategies for Addressing GLP-1 and Dual GLP-1/GIP Receptor Agonist Shortages. Clin Diabetes 1 July 2023;41(3):467–73. doi: 10.2337/cd23-0023