TABLE 2.

Considerations for Resuming a GLP-1 Receptor Agonist After a Prolonged Lapse in Therapy

Agent	Last Dose Administered	Recommendation(s) for Resuming Therapy
Dulaglutide*	1.5 mg once weekly	Resume at 1.5 mg once-weekly dose. Expect comparable tolerability to that experienced prior to dose interruption.
	3 or 4.5 mg once weekly	Use best judgment if ≥3 doses are missed. It is unknown whether tolerance to the GI adverse events will remain if reinitiated at the higher dose after ≥3 missed doses. Decision can be informed by patient’s prior GI tolerability. In consideration of the above, clinicians may consider reinitiating at 1.5 mg once weekly.
Injectable semaglutide†	1 mg once weekly	If ≤2 doses are missed, reinitiate at 1 mg once weekly. If 3–4 doses are missed, reinitiate at 0.5 mg weekly. If ≥5 doses are missed, reinitiate at 0.25 mg once weekly.
Tirzepatide‡	≥5 mg once weekly	If ≤2 doses are missed, reinitiate at the same dose (provided the dose was adequately tolerated). If ≥3 doses are missed, reinitiate at 5 mg once weekly.

^*Based on manufacturer-provided information (20).

^†Based on personal communication with C. Wong on 27 February 2023.

^‡Based on supplementary material published with ref. 21.