GLP-1 Receptor Agonists

Emergency & Prehospital

• No acute emergency indication: these are chronic home medicines. EMS and ED teams meet them through the complications. Vomiting or dehydration. Low glucose on insulin or a sulfonylurea. Aspiration risk at airway management.

ED / ICU / Transport

• Type 2 diabetes: adjunct to diet and exercise for glycemic control. Ages 10 and older for liraglutide (Victoza), dulaglutide (Trulicity) and tirzepatide (Mounjaro).
• Cardiovascular risk reduction: adults with type 2 diabetes and established cardiovascular disease (semaglutide, liraglutide, dulaglutide, tirzepatide at high risk); adults with established cardiovascular disease and obesity or overweight (Wegovy).
• Kidney disease (Ozempic): adults with type 2 diabetes and chronic kidney disease, to reduce sustained eGFR decline, end-stage kidney disease and cardiovascular death. Check the current label for the full indication list.
• Chronic weight management: adults with obesity or overweight with a weight-related comorbidity (Wegovy, Zepbound, Saxenda); ages 12 and older with obesity (Wegovy; Saxenda only above 60 kg).
• Obstructive sleep apnea with obesity: moderate to severe OSA in adults (Zepbound).
• Noncirrhotic MASH: metabolic dysfunction-associated steatohepatitis (Wegovy injection).

Doses vary by protocol; follow local protocols and medical direction. The doses below are the labeled regimens for each product. Pin down the exact product and pen strength first. Then read the dose.

Available Forms

• Semaglutide injection (Ozempic): single-patient pens of 0.68 mg/mL (2 mg/3 mL, delivers 0.25 or 0.5 mg), 1.34 mg/mL (4 mg/3 mL, delivers 1 mg) and 2.68 mg/mL (8 mg/3 mL, delivers 2 mg); single-dose prefilled syringes of 0.25, 0.5 and 1 mg per 0.5 mL.
• Semaglutide tablet (Rybelsus): 3 mg, 7 mg and 14 mg tablets, taken once daily.
• Semaglutide tablet (Ozempic tablets): 1.5 mg, 4 mg and 9 mg tablets, taken once daily. Not mg-for-mg interchangeable with Rybelsus.
• Semaglutide tablet (Wegovy tablets): 1.5 mg, 4 mg, 9 mg and 25 mg tablets, taken once daily (adult cardiovascular risk reduction or weight reduction).
• Tirzepatide (Mounjaro, Zepbound): single-dose pens and vials of 2.5 to 15 mg per 0.5 mL. Multi-dose vials and single-patient KwikPens contain 4 doses each, and each dose is drawn or dialed in 0.6 mL (4.17 to 25 mg/mL). Unlike the 0.5 mL single-dose products, check the syringe volume against the product.
• Liraglutide (Victoza): 18 mg/3 mL (6 mg/mL) prefilled pen that delivers 0.6, 1.2 or 1.8 mg.
• Liraglutide (Saxenda): 3 mL prefilled pen (6 mg/mL) that delivers 0.6, 1.2, 1.8, 2.4 or 3 mg.
• Semaglutide injection (Wegovy): single-dose pens of 0.25, 0.5, 1, 1.7 and 2.4 mg per 0.5 or 0.75 mL; WEGOVY HD single-dose pen of 7.2 mg per 0.75 mL; single-patient FlexTouch pen with 4 doses of 2.4 mg; single-dose syringes of 0.25 to 2.4 mg.
• Dulaglutide (Trulicity): single-dose pens of 0.75, 1.5, 3 and 4.5 mg per 0.5 mL.
• EMS / transport: EMS and transport teams rarely stock these agents. Patients usually bring their own pens. Ask for the product name, pen strength, dose frequency and date of the last injection.

Adult Dosing

Pediatric Dosing

Preparation & Administration

• Route: subcutaneous injection in the abdomen, thigh or upper arm, rotating sites. Oral route only for the tablet. Inspect the solution before use. It should be clear and colorless.
• Pen and needle: single-patient use. Never share a pen between patients. A new needle does not make it safe.
• Oral semaglutide: swallow whole with up to 4 oz of water on an empty stomach in the morning.
• Weekly dosing: you can move the weekday, as long as doses stay at least 2 days apart for semaglutide or 3 days apart for tirzepatide, per label.
• Storage: unused Ozempic and Mounjaro pens are refrigerated at 2 to 8 °C (36 to 46 °F); do not freeze. In-use Ozempic pens last 56 days at room temperature or in the refrigerator. Ozempic prefilled syringes may be kept at 8 to 30 °C (46 to 86 °F) for up to 28 days.

Contraindications

• Personal or family history of medullary thyroid carcinoma (MTC): absolute (all labeled products on this page).
• Multiple endocrine neoplasia syndrome type 2 (MEN 2): absolute.
• Serious hypersensitivity to the product or its excipients, including anaphylaxis or angioedema.

Precautions

• Pancreatitis: acute pancreatitis has occurred, including fatal and necrotizing cases. If you suspect it, stop the drug.
• Gallbladder disease: acute gallbladder disease has been reported.
• Severe GI disease: semaglutide is not recommended in severe gastroparesis. Post-marketing reports include ileus and intestinal obstruction.
• Volume depletion: acute kidney injury has been reported, some needing dialysis. It mainly followed vomiting, diarrhea or poor intake.
• Diabetic retinopathy (semaglutide): in a 2-year trial of patients with type 2 diabetes and high cardiovascular risk, complications ran higher than placebo: 3.0% vs 1.8%.

Hold / Reassess If

• Suspected pancreatitis: discontinue promptly and start usual management (labels).
• Vomiting, diarrhea or inability to keep fluids down: assess volume status and kidney function. The labels say to monitor renal function. They give no numeric hold threshold.
• Low glucose on insulin or a sulfonylurea: the labels advise lowering the sulfonylurea or insulin dose.
• Planned surgery or sedation: tell the anesthesia team (see the aspiration warning below).

Common

• GI effects: nausea, vomiting, diarrhea, constipation and abdominal pain are the most frequent adverse reactions. They cluster during dose escalation.
• Heart rate increase (semaglutide, Wegovy): mean increases of 1 to 4 beats per minute in trials.

Serious / Life-Threatening

Overdose & Toxicity Management

• Labeled overdose effects: severe nausea, severe vomiting and severe hypoglycemia (liraglutide label).
• Management: supportive care, guided by the clinical signs. The labels name no specific antidote. For advice, call Poison Help at 1-800-222-1222 or reach a medical toxicologist.
• Observation: the labels call for prolonged observation because the half-life is long. Semaglutide's half-life is about 1 week, and tirzepatide's is about 5 days.
• Hypoglycemia: treat per protocol with dextrose or glucagon, and recheck glucose during the observation period.

Clinically Significant Interactions

No IV line, no compatibility question. Every product on this page goes in under the skin or by mouth.

• Pediatrics: labeled for ages 10 and older (diabetes) or 12 and older (weight management), depending on the product. The Ozempic, Zepbound and Rybelsus labels say pediatric safety and efficacy are not established. Check the Pediatric Dosing table.
• Pregnancy: semaglutide labels say to stop at least 2 months before a planned pregnancy, because the washout is long. Animal studies showed embryofetal harm with semaglutide and malformations with tirzepatide at high exposures. Human data are limited. Pregnancy does not change emergency care. Bring in the prescriber and obstetric team.
• Lactation: there are no human milk data for semaglutide or liraglutide. Animal data show transfer into milk. In a single-dose study, tirzepatide was undetectable or low in breast milk. Weigh the benefits of breastfeeding against maternal need.
• Older Adults: older trial patients on semaglutide or tirzepatide showed no overall difference in safety or efficacy. Greater sensitivity in some older patients cannot be ruled out.
• Renal Impairment: none of these four needs a dose adjustment. The risk that matters is volume depletion. After GI losses, it can progress to acute kidney injury.
• Hepatic Impairment: semaglutide and tirzepatide need no dose adjustment.
• Obesity / Dosing Weight: every product on this page uses a fixed milligram dose. Dosing is not by weight.
• Gastroparesis: semaglutide is not recommended in severe gastroparesis. Expect more GI symptoms and a higher aspiration concern.

• Scope: EMS and critical-care transport usually treat the complications, not the drug. How you manage hypoglycemia, dehydration, vomiting and airway risk varies by state and agency protocol.
• Storage & Stability: unused Ozempic and Mounjaro pens are refrigerated at 2 to 8 °C; do not freeze. An in-use Ozempic pen is good for 56 days at room temperature. An Ozempic prefilled syringe may be kept at 8 to 30 °C for up to 28 days. A Mounjaro single-dose pen can stay unrefrigerated at up to 30 °C for a total of 21 days.
• Carried Concentration: pen strengths differ by product. Ozempic comes at 0.68, 1.34 and 2.68 mg/mL. Compounded products may be labeled in units or milliliters, not milligrams. Confirm the dose in mg.
• Infusions in Transport: not applicable. These go subcutaneous or by mouth only, so there is no drip to run.
• Handoff Essentials: product and pen strength; weekly or daily; date and time of the last dose; GI symptoms and oral intake; glucose; insulin or sulfonylurea use; and whether the patient is planning pregnancy.

Mechanism of Action

• GLP-1 receptor: activating it raises insulin secretion and lowers glucagon secretion. Both depend on glucose.
• Delayed gastric emptying: the stomach empties more slowly. That blunts the rise in glucose after a meal, and it also explains the GI effects and the aspiration risk.
• Tirzepatide: it activates two receptors: GIP and GLP-1.
• Half-life extension: fatty-acid chains latch onto albumin. Semaglutide is more than 99% bound, and that binding allows weekly dosing.

Pharmacokinetics

• Half-life: semaglutide about 1 week; tirzepatide about 5 days; dulaglutide about 5 days; liraglutide 13 hours.
• Metabolism: two routes clear semaglutide and tirzepatide: proteolytic cleavage of the peptide backbone, and beta-oxidation.
• Protein binding: semaglutide more than 99% and tirzepatide about 99%, both bound to albumin.

Generic Name

Semaglutide; tirzepatide; liraglutide; dulaglutide (class page). Exenatide and lixisenatide are not covered here; they share class cautions and are not dosed on this page.

Brand Names

Ozempic (injection and tablets), Wegovy (injection and tablets), Rybelsus (oral semaglutide), Mounjaro, Zepbound, Victoza, Saxenda, Trulicity

Pharmacologic Class

GLP-1 receptor agonist (incretin mimetic); tirzepatide is a GIP and GLP-1 receptor agonist

Therapeutic Class

Antidiabetic (incretin-based); anti-obesity agent

Controlled Substance

Not controlled

ISMP High-Alert

No

Look-Alike / Sound-Alike

None confirmed for this class. The practical confusion is weekly versus daily dosing and product strength.

Error-Prone Abbreviations to Avoid

qd and qw (write "once daily" or "once weekly"); milligram doses written as units or milliliters on compounded products