TOXICOLOGY
Navigating the Rise of GLP-1 RA Exposures: What Emergency Physicians Need to Know SAEM PULSE | SEPTEMBER-OCTOBER 2024
By Helena Kons, MD; Jessica Rivera Pescatore, PharmD; Stacy Marshall, MD; and Sukhshant Kaur Atti (Sukhi), MD
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Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are approved by the Food and Drug Administration (FDA) for treating type 2 diabetes mellitus. They work by activating pancreatic GLP-1 receptors, which stimulates glucose-dependent insulin release. Recently, the use of GLP-1 RAs has expanded due to their additional benefits such as cardioprotection, stroke reduction, and prevention of chronic kidney disease progression, especially in individuals with obesity. Beyond their role in managing obesity, there has been a surge in the use of injectable GLP-1 RA preparations for routine weight loss, driven by
sensationalized testimonials. Several of these drugs have recently received FDA approval specifically for weight loss. Consequently, prescriptions for GLP-1 RAs have skyrocketed over the past decade. A recent infodemiolgocial study reported a 221% increase in GLP-1 RA prescriptions from January 2016 to December 2021. As the demand for agents like semaglutide (Ozempic, Wegovy), liraglutide (Saxenda), exenatide (Byetta), and tirzepatide (Mounjaro) has grown, supply has struggled to keep up, leading to national shortages. These shortages have led to an emergence of compounded products, further
contributing to therapeutic errors due to varying concentrations, multi-dose preparations, and instructions or education on proper use. The rise in therapeutic use and related errors has led to increased calls to poison centers and visits to emergency departments (EDs) nationwide. Between January 2017 and December 202, U.S. poison centers reported over 5,700 singlesubstance exposures to GLP-1 RAs. While most cases had minimal effects requiring no medical treatment, many patients presented to the ED, and a small number required hospitalization. Despite the increase in exposures, often from supratherapeutic dosing,