Peptide Therapy

Lindee Abe, APRN

Peptide therapy is becoming more popular.  Over the past year, I have noticed advertisements everywhere for peptide therapy. At the time, I thought it was just another fad involving vitamins or supplements. It wasn’t until I was talking to a friend doing pre-op physicals that recounted a story of having to cancel a surgery the day of due to peptide therapy that I put it together that peptide therapy was semaglutide and tirzepatide. With the increased popularity of glucagon-like-peptide-1 (GLP-1) receptor agonist medications, educating clinicians on where people are going for these medications, how they are prescribed, and the potential side effects is important. 

Semaglutide

Ozempic, the name brand for semaglutide, has been all over the news this past year. Celebrities are getting excellent results from using it, which has become a part of pop culture. While Ozempic is the name typically used in media coverage, Wegovy is the brand name for the FDA-approved semaglutide for weight loss. Ozempic is the brand name for the FDA-approved semaglutide to treat Diabetes mellitus Type II. Liraglutide (Saxenda) is also another GLP-1 receptor agonist that is FDA- approved for weight loss. Liraglutide (Saxenda) requires daily dosing vs. weekly dosing with Wegovy, making it less appealing to most patients. The most recent addition to the GLP-1 receptor agonists FDA- approved for weight loss came in November 2ti23 with tirzepatide (Zepbound).

Zepbound is also a glucose-dependent insulinotropic polypeptide (GIP), meaning some patients may have beWer weight loss results with Zepbound. GLP-1 receptor agonists work through several different mechanisms to help patients lose weight: delayed gastric emptying, increased satiety, inhibited release of glucagon aYer meals, and stimulation insulin release. GLP-1 receptor agonists will also require titration based on tolerability of medication and results, with patients being started on a low dose and titrating up every four weeks on average until therapeutic response is achieved or the patient has reached the maximum dose. 

Shortages Prompt Reporting Deficiency

The shortage of Ozempic and Monjaro has also been in the news, with diabetic patients upset that they can no longer access the medication needed for the treatment of their condition. With the Ozempic shortage that occurred, patients and prescribers began using compounded semaglutide for weight loss. 

Because it is a compounded medication and not FDA-approved, many clinics now refer to both semaglutide and tirzepatide as peptides. The problem with labeling these medications as peptides is some patients will not realize that they are medications and should be reported as such. That is where patients may run into issues, like the pre-op patient who did not report the compounded semaglutide on their H&P for their surgery because they didn’t realize it was a medication. It wasn’t until discussing their weight and recent weight loss that it was discovered that the patient was also taking semaglutide. This oversight resulted in a cancellation of the surgery because of the increased risk of aspiration if the medication isn’t stopped seven days before surgery. 

Cost, Indications, and Benefits of Peptide Therapy

In addition to drug shortages, the cost of LGP-1 agonists has also led patients to turn to compounding pharmacies. The cost of these medications is generally around $1,000 or more per month without insurance. Insurance coverage is not typical, with only 43% of employer-sponsored plans covering GLP-1 receptor agonists for weight loss. Medicare will only cover GLP-1 receptor agonists for weight loss if there is a risk of heart disease, in addition to meeting the FDA weight requirements for prescription. Currently, Medicare does not cover medications solely for weight loss purposes. Medicaid provides coverage for GLP-1 receptor agonists for the same criteria as Medicare in all states and for weight loss alone in nine states.

Even with insurance, the average cost of Zepbound is still over $300 per month. Manufacturer coupons are available, but they typically only last up to two years. The manufacturer coupons can bring the cost of Wegovy down to under $100 per month for some patients, depending on their insurance coverage. 

In the end of 2025 the shortage ended, prompting speculation about the future of compounding drug availability and costs.  Around the same time, Tirzepatide was listed as the first peptide approved for use to treat sleep apnea.  Given the benefits of this class of medication, it is likely more approvals for more indications will be on the horizon.

Multiple Benefits

There is no denying the tremendous results from these medications. With all the risk factors associated with obesity, like cardiovascular disease and diabetes, decreasing obesity in patients results in improvement in many comorbid conditions. However, these medications must be used under the supervision of a licensed provider and used in patients who meet the treatment recommendations. Social media has frequent advertising for providers prescribing these medications with minimal history and no physical exam. Med spas are pushing it for patients who don’t meet the criteria and are only looking to lose an extra 10 lbs. The current recommendation for treatment with GLP-1 receptor agonists is for patients with a BMI > 30 or a BMI > 27 with comorbid conditions. Contraindications for GLP-1 receptor agonists are pancreatitis, family history of medullary thyroid cancer, pancreas or kidney dysfunction, and diabetic retinopathy. 

Side Effects

There are side effects with GLP-1 receptor agonists. Statistically, most patients will experience some side effects. The most common side effects are gastrointestinal, which makes sense since these medications slow the digestive system. Nausea, vomiting, diarrhea, and constipation are all side effects that patients can experience. Patients can also experience increased heart rate due to sympathetic nervous system stimulation by GLP-1 receptor agonists. Additionally, patients taking GLP-1 receptor agonists are recommended to have monitoring for depression and suicidal thoughts. 

More serious side effects of GLP-1 receptor agonists include pancreatitis, gallbladder disease, and renal dysfunction. Pancreatitis is a rare side effect, and patients with a history of pancreatitis should not be prescribed GLP-1 receptor agonists. Gallbladder disease is more likely to occur with a longer duration of therapy. Gallbladder disease may be a result of the degree of weight loss that occurs, not just the GLP- 1 receptor agonist. Renal dysfunction is more likely to occur if the patient is dehydrated from vomiting and diarrhea. 

Need for Monitoring

Patients on GLP-1 receptor agonists should have frequent follow-up visits to assess for side effects of medications and degree of weight loss. Patients can be taken off GLP-1 receptor agonists when they achieve goal weight, but doing so is associated with weight gain. The use of GLP-1 receptor agonists for weight loss is still relatively new, and there isn’t much data on how to help patients manage the weight gain that typically happens aYer the cessation of medication. 

More data on the long-term effects of GLP-1 receptor agonists and how best to use them for patients will likely come in the future. In the meantime, we must be aware of the number of patients using GLP-1 receptor agonists, where they are getting them from, and the potential side effects that can result from their use. 

References:

Billingsley, M. (2ti24). Zepbound vs. Wegovy for weight loss: 5 differences to consider. Retrieved from https://www.goodrx.com/conditions/weight-loss/zepbound-vs-wegovy?label_override=undefined

Guinan, S. (2ti24). Costs and insurance coverage for Ozempic, Wegovy, and weight loss drugs. Retrieved from https://www.valuepenguin.com/weight-loss-drug-cost-health-insurance 

Perreault, L., Reid, T.J. (2ti24). Obesity in adults: drug therapy. Retrieved from https://www.uptodate.com/contents/obesity-in-adults-drug- therapy?search=zepbound&source=search_result&selectedTitle=3%7E21&usage_type=default&display_ rank=2#H1ti93288196 

Possible side effects of Ozempic (semaglutide) injection. (2ti24). Retrieved from https://www.ozempic.com/how-to-take/ozempic-dosing.html

U.S. Food and Drug Administration. (2ti23). FDA approves a new medication for chronic weight management. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management

Lindee Abe, APRN, FNP-C, ENP-C

Lindee earned her Associate of Science Health Science Laboratory Technology from George Washington University in 2006. She earned a Bachelor of Science and Masters of Science in Nursing from the College of Saint Mary in 2009 and 2011, respectively. She was awarded her Post Masters Certificate as a Family Nurse Practitioner from Clarkson College in 2015. She is dual certified as a Family and Emergency Nurse Practitioner through the American Academy of Nurse Practitioners. She serves as the Nebraska state representative for the American Academy of Emergency Nurse Practitioners. She has worked as a contractor for the VA, urgent care, and emergency medicine. She has served in the Army Reserves for 19 years in varying capacities, including lab tech, emergency room nurse, case manager, and nurse practitioner.