GLP-1 Contraindications
Not everyone is eligible to use GLP-1 medications
If you have one or more existing contraindications, you are not eligible for a GLP-1 treatment
Hypersensitivity
Do not use if you have a severe allergic reaction (hypersensitivity) to the GLP-1 RA.
People with hypersensitivity should avoid GLP-1 receptor agonists (GLP-1 RAs) because they may experience severe and potentially life-threatening allergic reactions, such as anaphylaxis, angioedema, or serious skin reactions, including rash and hives. GLP-1 RAs are synthetic peptides that can sometimes trigger an immune response leading to these hypersensitivity reactions, and a history of allergy to any of the drug’s ingredients or a previous severe reaction to a GLP-1 RA makes it a contraindication for the medication.
Pregnancy and Breastfeeding
People with pregnancy or breastfeeding should avoid GLP-1s (glucagon-like peptide-1 receptor agonists) due to limited human safety data, with animal studies showing potential risks to fetal development, including reduced fetal growth and skeletal issues. While human data is scarce, a large observational study found no increased risk of major birth defects from GLP-1 exposure, though it did not assess fetal growth or other complications. For breastfeeding, there is also a lack of human data on the medication’s effects on the infant, leading to a recommendation to avoid it during this time. It is advised to stop GLP-1s at least two months before conception and immediately upon learning of a pregnancy.
Pancreatitis History
People with pancreatitis should exercise caution with GLP-1 agonists (like Ozempic) because of a potential, though not fully confirmed, increased risk of acute pancreatitis, potentially due to overstimulation of the pancreas. While some studies suggest GLP-1 RAs may lower the recurrence risk in certain patients, others link them to a higher risk, especially for weight loss purposes. Given the conflicting data, doctors often include a warning in prescribing information and monitor patients closely for pancreatitis symptoms.
Thyroid Cancer History
People with a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia type 2 (MEN2) should avoid GLP1’s.
People with a personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN2) should avoid GLP-1 medications because of a boxed warning from the FDA that emerged from rodent studies showing a potential risk for thyroid tumors. While newer data from large human studies suggest this risk may not be significant in humans, the potential for thyroid tumors remains a contraindication for individuals with a history of these conditions.
Renal Impairment
People with severe renal impairment should be cautious with GLP-1 receptor agonists because they may experience more severe gastrointestinal side effects, such as nausea, vomiting, and diarrhea, which can lead to dehydration and acute kidney injury (AKI). While some GLP-1s are safe for people with normal kidney function and even mild renal impairment, certain types, particularly exendin-4 analogs, have contraindications in moderate to severe chronic kidney disease (CKD) due to a risk of accumulation and toxicity. However, it’s important to note that some guidelines actually recommend GLP-1s for people with CKD, especially for weight loss in those with an eGFR of ≥30 mL/min/1.73 m², highlighting the need for careful individual assessment.
Severe Gastric/GI Issues
People with severe gastrointestinal (GI) issues should avoid GLP-1 agonists because the medications slow down stomach emptying, which can worsen pre-existing conditions like gastroparesis and increase the risk of serious complications such as bowel obstruction. GLP-1s are known to be a risk factor for these conditions, and a history of severe GI issues makes an individual more susceptible to these severe, potentially dangerous, side effects.