TABLE 8.

Contraindications and Cautions for GLP-1RAs

Contraindications	Cautions
■ History of serious hyper-sensitivity reaction to drug	■ Use liraglutide with caution in patients with history of pancreatitis.
■ Severe renal impairment or ESRD (exenatide, lixisenatide) ■ Personal or family history of medullary thyroid cancer	■ Use liraglutide and semaglutide with caution in patients with severe renal impairment or ESRD
■ MEN2	■Hypoglycemia risk increased with insulin and insulin secretagogues (e.g., sulfonylureas); a Lower dose of insulin or the insulin secretagogue may be required.
	■ Shorter-acting agents may delay gastric emptying, so may slow absorption of concomitantly administered oral medications and are not recommended in patients with clinically meaningful gastroparesis. This effect is usually transient with longer-acting GLP-1RA
	■ Care should be taken in patients with prior gastric surgery
	■ Semaglutide has been associated with diabetic retinopathy complications which may be related to its associated rapid and marked glucose and A1C reductions

A1C = hemoglobin A1C; ESRD = end-stage renal disease; GLP-1RA = glucagon-like peptide-1 receptor agonists; MEN2 = multiple endocrine neoplasia syndrome type 2.