GLP-1 Prescriber Guide: Clinical Reference for Semaglutide, Tirzepatide, and Retatrutide Prescribing
Comprehensive clinical prescribing reference for GLP-1 receptor agonists covering patient selection, titration protocols, monitoring, contraindications, and evidence-based management strategies.
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For Healthcare Providers
This clinical reference guide covers evidence-based prescribing of GLP-1 receptor agonists for obesity management. References include STEP, SURMOUNT, and TRIUMPH trial data. Last updated April 2026.
Patient Selection Criteria
| Criterion | Status | Notes |
|---|---|---|
| BMI >= 30 | Yes (primary indication) | Obesity without comorbidity |
| BMI >= 27 + comorbidity | Yes (secondary indication) | HTN, T2DM, dyslipidemia, OSA |
| Personal/family MTC or MEN2 | Contraindication | Absolute contraindication |
| Active pancreatitis | Contraindication | Resolve before initiating |
| Pregnancy/lactation | Contraindication | Discontinue 2+ months before conception |
| Gastroparesis | Relative contraindication | May worsen symptoms |
Titration Protocols Summary
Semaglutide (Compounded)
- Week 1-4: 0.25mg SC weekly
- Week 5-8: 0.5mg SC weekly
- Week 9-12: 1.0mg SC weekly
- Week 13-16: 1.7mg SC weekly
- Week 17+: 2.4mg SC weekly (max)
Extend any step if GI tolerability concerns. Available at Trimi: $99/mo.
Tirzepatide (Compounded)
- Week 1-4: 2.5mg SC weekly
- Week 5-8: 5.0mg SC weekly
- Week 9-12: 7.5mg SC weekly
- Week 13-16: 10mg SC weekly
- Week 17-20: 12.5mg SC weekly
- Week 21+: 15mg SC weekly (max)
Available at Trimi: $125/mo.
Monitoring Schedule
Baseline (Before Initiation)
Weight, BMI, waist circumference, blood pressure, heart rate. Labs: CMP, lipid panel, A1C, fasting glucose, TSH, CBC, urinalysis. Screen for contraindications (MTC/MEN2 family history, pancreatitis history, gastroparesis, pregnancy).
3-Month Follow-Up
Weight, blood pressure, heart rate. Labs: CMP, A1C, fasting glucose, hepatic panel. Assess side effects, adherence, dose optimization. Evaluate response (expect 5-10% weight loss). If less than 5% at 3 months on adequate dose, reassess.
6-Month and Annual
Full metabolic panel, lipids, A1C, TSH, CBC, vitamin B12. Body composition assessment if available. Medication review. Discuss maintenance vs. continued weight loss. Address comorbidity improvements (potential medication de-escalation for HTN, DM, lipids).
Key Clinical Pearls
Efficacy Optimization
- Emphasize protein intake (0.8-1.2g/lb body weight)
- Recommend resistance training to preserve lean mass
- Slow titration reduces discontinuation rates by 40%
- Not all patients need maximum dose for adequate response
Safety Alerts
- Hold GLP-1 1-3 weeks before procedures requiring anesthesia
- Monitor lithium levels closely if co-prescribed
- Adjust insulin/sulfonylurea doses to prevent hypoglycemia
- Counsel women of childbearing age on contraception
Clinical Disclaimer: This guide is intended as a clinical reference for licensed healthcare providers. It does not replace clinical judgment, current prescribing information, or individual patient assessment. Verify current FDA labeling and guidelines.
Frequently Asked Questions
What are the prescribing criteria for GLP-1 weight management?
FDA-approved indications: BMI 30+ (obesity) or BMI 27+ with at least one weight-related comorbidity (hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea). Off-label use may be considered for lower BMI with clinical justification. Compounded formulations follow similar clinical criteria.
Which GLP-1 agent should I prescribe first-line?
For most patients, semaglutide 2.4mg weekly is well-supported as first-line therapy based on STEP trial data. Tirzepatide may be preferred for patients with concurrent type 2 diabetes, insulin resistance, or PCOS, or when greater weight loss is needed (SURMOUNT data showing 20-22% mean loss).
What baseline workup is recommended before starting GLP-1?
Recommended baseline: BMI documentation, metabolic panel (CMP), lipid panel, A1C/fasting glucose, TSH, hepatic function (ALT/AST), renal function (eGFR, BUN/Cr), CBC. Personal/family history of MTC or MEN2 (contraindication). Pancreatitis history (relative contraindication).
When should I refer patients to Trimi for compounded GLP-1?
Trimi provides compounded semaglutide ($99/mo) and tirzepatide ($125/mo) with physician oversight for patients who cannot access brand-name medications due to cost, insurance barriers, or shortages. All patients receive medical evaluation, dose titration guidance, and ongoing monitoring.
Partner with Trimi for Patient Access
Compounded semaglutide from $99/mo or tirzepatide from $125/mo with physician oversight.
View Treatment OptionsMedical Disclaimer: This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting any medication or treatment program.