Practical Information When Prescribing GLP-1s
Savranthi Madala, MD, PhD. Endocrinology Specialist at AristaMD
Practical Information when Prescribing GLP’1s:
So practical info, when prescribing Trulicity, it comes in 0.75 milligrams, 1.53 or 4.5. Again, slow up titration. Start at the lowest dose. It’s four pens per month that comes with the prescription. They’re single use pens. There is no way, don’t, no, you don’t need to reconstituted anything like you need to with the zaine and the older GLP ones, and the needle is already on, you titrate the dose after four weeks if tolerated. With the ozempic, it comes in the ozempic is the this eight milligrams of the wegovy dose, but it comes in 0.5, 0.25, 0.51, and two. For the diabetes doses, it’s dosed weekly. And the higher pens for marking have markings only for one milligram, two of milligram doses. And the lower dose pen has 0.25, 0.5 milligram doses. And again, this is titrated every four weeks. You dial the dose as you do with insulin.
The pen needles are included with the pen, the Victoza, which is a daily GLP one. You need to prescribe separate pen needles for this, it’s dose daily. The pen is dialed, marked for 0.6 milligrams, 1.2 milligrams or 1.8 milligrams. That’s the Victoza part of it. And the higher doses, the um, and saxenda, the weight loss medication doses go up to 2.4 and three. Again, each click is 0.6 milligrams. And then the bydureon, which is one of the older ones, not as, um, widely used, but with the shortages going on, there are, um, more prescriptions for bydureon going out because they just, the drug manufacturing companies just can’t keep up with all the different med spas and everything else popping up that are using these at a wholesale rate necessarily. But also there’s just so much demand for these, especially from a weight loss perspective, that the shortages are astronomical. And any given day, the pharmacy might be outta one, have another in stock, et cetera, et cetera. This one you do, for the bydureon, you do need to reconstitute it, and it’s dosed weekly.
And Rybelsus is the oral form. This is the only oral GLP one receptor agonist. It’s for mainly those patients that can’t do needles, but, and it’s rybelsus three milligrams, seven milligrams, or 14 milligram tablets. This one is not as efficacious as any of the injectables, but it is still better than, um, having to go on any of the medications that increase hypoglycemia or have weight gain potential. And then lastly, manjaro, which is the dual GLP one, GIP. It’s four pens a month. It’s very similar to Trulicity in how it’s set up. There’s no weight. Again, it’s the same manufacturer. It’s just a different color pen titrated before weeks as tolerated.
Five Ways eConsults Support Value-Based Care
Combine your referral management platform with an eConsult solution to reduce patient wait times and the cost of care. Learn five ways our eConsults support value-based care by allowing primary care physicians, nurse practitioners or PAs to submit electronic requests for patient advice to our team of specialists to manage low-acuity patients.
#1 Help Patients Avoid Unnecessary Face-to-Face Specialty Visits
About 70% of eConsults can address what physicians typically send for a face-to-face specialty visit. As a web-based physician-to-physician consultation, there is no need for any particular technology or integration — the PCP orders the referral the same way they would traditionally order one. Or suppose the patient was to go face-to-face for a specialty consult with the provider using our referral nurse coordination, RNN service, and nurse navigators. In that case, our nurse will curate the eConsults by grabbing all of the data needed for the patient from the chart. Private health information is then sent to our specialist, who reviews the data and provides an evidence-based response on that patient’s best practice and management. Within four to six hours, the primary care provider receives a notification and can view the eConsult specialist’s recommendations.
The bottom line — for every specialty visit where we serve the patient using an eConsult and address issues through the primary care provider, we can fend off the need for three face-to-face visits. Also, once you gain specific knowledge from a specialist on a particular condition, you have the answer to the same question when it comes up again.
Savranthi Madala, MD, PhD
Endocrinology Specialist at AristaMD
Savranthi Madala, MD, PhD, is Board Certified in Internal Medicine and fellowship-trained in endocrinology. She attended medical school at the Medical College of Virginia followed by residency at the University of Connecticut Medical Center. Dr. Madala completed her fellowship in endocrinology at the Warren Alpert Medical School of Brown University.