● Benefits: Reductions in CV death & MI. Wt loss. Cognitive improvement?

● All once weekly subcutaneous injections

● Can use with insulin (lower the insulin dose)

● Can use with SGLT2 (like empagliflozin (Jardiance), canagliflozin (Invokana), and dapagliflozin (Farxiga))

● Don't add onto DPP-4 agents (sitagliptin (Januvia), linagliptin (Tradjenta), alogliptin (Nesina))

● Low risk for hypoglycemia

● Side effects: Most common are GI (nausea, vomiting, gas, diarrhea) which resolves with time. Start low dose and increase once a month to minimize GI side effects. Other rare side effects to counsel: pancreatitis, thyroid cancer, worsening retinopathy/vision loss (specific to semaglutide/ozempic, NAION - nonarteritic anterior ischemic optic neuropathy)

● All brand names & expensive (high Tier). Medicare coverage: with a diagnosis of diabetes. If without a diagnosis of diabetes, then coverage if cardiovascular disease + BMI >30. Off label use to prevent cognitive decline

● Semaglutide (Ozempic (brand name approved for diabetes) & Wegovy (brand name approved for weight loss)

○ 15% wt loss in studies

○ no adjustment in renal impairment or ESRD/HD

● Tirzepatide (Mounjaro (brand name approved for diabetes) & Zepbound (brand name approved for wt loss)

○ 20% wt loss in studies

○ No adjustment in renal impairment or ESRD/HD

● Dulagludie(Trulicity)

○ no adjustment in renal impairment or ESRD/HD

● Liraglutide (Saxenda - weekly injection & Victoza - daily injection)

● Exanitide (Bydureon - weekly injection & Bydureon - twice daily)

● Semaglutide ORAL (Rybelsus - daily oral pill)

● Lixisenatide (Adlyxin)"

Version: YT 12/5/2024