Paging Dr. Frischer: GLP

Early in my career, the rock stars of the pharmaceutical industry were the Viagra reps. They were treated like royalty when they visited medical offices, often because they left samples behind. There are new stars these days: the GLP reps. By now, almost everyone has heard of Ozempic, Mounjaro, Wegovy, or Zepbound. (These four names actually represent only two different drugs, as each drug uses a different name depending on whether it is intended to treat obesity or diabetes.) 

These new GLP medications come as injections, self-administered, and taken weekly. They mimic the action of the GLP-1 hormone, lowering blood glucose by triggering the pancreas to release more insulin, and suppressing the hormone glucagon. They also produce feelings of fullness by slowing gastric emptying and triggering the feeling of satiety.

In addition to treating obesity and diabetes, this class of medications already has FDA approval for cardiovascular risk reduction, reducing the risk of worsening kidney disease, and for treating moderate to severe obstructive sleep apnea. Recent large-scale studies have also found that the drugs have the potential to be used for many other disorders, including neurologic disorders like dementia, non-alcoholic fatty liver disease, addiction disorders, and even fertility disorders like polycystic ovary disease. 

GLP medications are expensive, and so far, most insurance providers are not covering the monthly costs of $350 to $1,250. Similar compounded medicines are being offered at lower costs through medical spas and other sources. The rush to purchase these new medicines outstripped the supply, and for some time they were quite difficult to find. A number of large pharmaceutical companies now have GLP medicines actively under development.

Note that this class of medications carries a “Boxed Warning,” the FDA’s most serious warning. Rodents studied showed an increased risk of thyroid C-cell tumors, so anyone with a family history of a certain type of thyroid cancer should not use them. In addition, those with a history of Multiple Endocrine Neoplasia Syndrome Type 2 (MEN 2), pancreatitis, and other severe intestinal issues should avoid GLPs. 

Evidence for the benefits of this class of drugs continues to expand. After many years of practice, this is the first time I’ve been excited to prescribe drugs for weight loss. GLP medications certainly have their risks; as always, speak with your primary care doctor about your own particular health needs.