glp-1 sglt2 Diabetic Agents, From Metformin to Inhibitors and GLP1 Receptor Agonists: JACC Focus Seminar Common systemic effects of either

(2014) 134:154e60e

Once youve reached your desired weight, you can choose to stop taking GLP-1s like semaglutide with the help of your healthcare providers but its not always ideal

Oral semaglutide acts as a keystone therapy because treating obesity often leads to significant improvements in these other conditions

The CVS Caremark standard step therapy protocol for obesity medications follows this sequence: Step 1: Generic oral weight-loss medications (must try for 90 days minimum) Phentermine 37.5 mg daily, OR Orlistat 120 mg three times daily, OR Naltrexone/bupropion ER (Contrave) Step 2: Preferred GLP-1 agonist (if Step 1 fails or contraindicated) Depends on plan formulary Some plans require trying Ozempic off-label before Wegovy Others require trying liraglutide (Saxenda) first Step 3: Wegovy (if Steps 1 and 2 fail) Requires documentation of inadequate response (less than 5% body weight loss after 90 days) OR intolerable side effects OR documented contraindication "Failure" is defined as: Less than 5% total body weight loss after 90 consecutive days at therapeutic dose, OR Intolerable side effects documented by prescriber, OR Medical contraindication (documented allergy, drug interaction, or condition that contraindicates use) You cannot skip steps by saying you don't want to try phentermine

Pfeffer MA, Claggett B, Diaz R, ELIXA Investigators, et al

[DOI] [PubMed] [Google Scholar] 28.Wagner S, Brierley DI, Leeson-Payne A, Jiang W, Chianese R, Lam BY, et al