GLP-1 ANALOG DOSING








Dulaglutide (Trulicity®)

Dosage forms

Single-dose pen
  • 0.75 mg
  • 1.5 mg
  • 3 mg
  • 4.5 mg
  • 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

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
  • Good until expiration date
Room temp pens/syringes
  • 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

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

Exenatide | Bydureon® | Bydureon BCise®

Dosage forms

Single-dose pen, Bydureon®
  • Each pen contains 2 mg
  • Comes in carton of 4 pens
Dosing tray, Bydureon®
  • Each dosing tray comes with a syringe, needle, and vial
  • 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.

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)
  • Good until expiration date
  • Bydureon BCise must be stored flat
Room temp (pens/trays)
  • Good for 4 weeks
  • 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

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

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

Semaglutide (Ozempic®)

Dosage forms

Multi-dose pen
  • 0.25/0.5 mg pen - delivers 0.25 or 0.5 mg per injection. Contains 2 mg total. Comes in carton with 1 pen.
  • 1 mg pen (2 mg/1.5 ml) - delivers 1 mg per injection. Contains 2 mg total. Comes in carton with 2 pens.
  • 1 mg pen (4 mg/3 ml) - delivers 1 mg per injection. Contains 4 mg total. Comes in carton with 1 pen.

Dosing

Type 2 diabetes
  • Starting: 0.25 mg SQ once weekly for 4 weeks
  • Maintenance: 0.5 - 1 mg SQ once weekly
  • Max: 1 mg SQ once weekly
  • After 4 weeks of 0.5 mg, increase to 1.0 mg if additional control is needed
  • The 0.25 mg dose is for titration only and is not effective for glycemic control
  • 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 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.
  • May administer without regard to food

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

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.

Other

  • Do not split, crush, or chew tablets
  • Leave tablets in blister pack until ready for use

Generic / Price

- NO/$$$$


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
  • 1 - 3 hours
Duration of action
  • 24+ hours
Peak effect
  • No peak

Mixing

- DO NOT MIX with other insulins

Dosing

  • 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
  • Store in refrigerator
  • Good until expiration date on product
After first use
  • Store at room temperature
  • 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
  • 1 - 3 hours
Duration of action
  • 24+ hours
Peak effect
  • No peak

Mixing

- DO NOT MIX with other insulins

Dosing

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









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