Drug-Drug Interactions Between Glucagon-Like Peptide 1 Receptor Agonists and Oral Medications: A Systematic Review.
Level 1 - systematic review of randomized trials
Systematic review of pharmacokinetic drug-drug interaction studies
PubMed 38273155 · doi:10.1007/s40264-023-01392-3
What was done
Authors systematically searched PubMed and EMBASE through November 1, 2023, for pharmacokinetic interaction studies and product prescribing sheets evaluating injectable glucagon-like peptide 1 receptor agonists (GLP1RAs) co-administered with oral medications. Two authors independently extracted pharmacokinetic parameters across multiple drug classes (including warfarin, oral contraceptives, acetaminophen, ACE inhibitors, statins, and digoxin).
What was found
Across 22 reports and six prescribing sheets, GLP1RAs led to unaffected or reduced Cmax and delayed tmax across drugs regardless of solubility or permeability characteristics. The abstract provides no specific numerical values or effect sizes. GLP1RA co-administration did not produce clinically significant changes in overall drug exposure (AUC) or differences in clinically relevant clinical endpoints.
Why it matters
As GLP1RAs delay gastric emptying, understanding their impact on oral medication absorption is critical. These findings suggest that routine dose adjustments of oral drugs are generally unnecessary during GLP1RA therapy.
Limits
Most included studies evaluated healthy subjects rather than patients with diabetes, obesity, or clinical comorbidities. Data are limited for conditions altering pharmacokinetics (such as renal impairment) and for oral medications with a narrow therapeutic index.
Cited by
- contradicts The delay in gastric emptying caused by GLP-1 receptor agonists can prevent oral medications, such as birth control pills, from being effectively absorbed.