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Formulary Strategy : Supporting formulary adjustments to balance compliance and cost containment

Key distinction: the licensed evidence concerns a defined afamelanotide implant

Despite the rise in demand, GLP-1 weight loss injections and tablets are not suitable for everyone

GLP-1 7-36 is a 30 amino acid peptide derived from the proglucagon molecule that is synthesised in intestinal L cells, as well as in alpha cells of the pancreas and in neuronal clusters of the central nervous system (CNS).2 It is a peptide with a short half-life (23 min), due to rapid renal clearance and degradation by the enzyme dipeptidyl peptidase-4 (DPP-4), which converts GLP-1 into GLP-1 9-36, a form that does not interact with the GLP-1 receptor.1 The GLP-1 receptor (GLP-1R) belongs to the class B G protein-coupled glucagon receptor family.2,3 Activation of the Gs subunit leads to stimulation of adenylate cyclase, synthesis of cyclic AMP, mobilisation of intracellular calcium, and glucose-dependent insulin release by pancreatic beta cells.2,3 Intracellular signalling also involves various additional pathways, such as recruitment of beta-arrestin-1, which modulates receptor internalisation and desensitisation, as well as the effects of certain GLP-1R agonists.3,4 Depending on the structure of the ligand, intracellular signalling pathways are modulated towards cyclic AMP generation, activation of kinase cascades (ERK), and beta-arrestin-1 recruitment, all of which influence the biological effect and desensitisation of the GLP-1 receptor.4 Some GLP-1R agonists exhibit biased agonism, favouring intracellular activation of cyclic AMP with reduced beta-arrestin recruitment, which results in less GLP-1R desensitisation and a more prolonged biological action (Table 1)

Why Rotating Peptide Injection Sites Matters Repeatedly injecting into the exact same location may increase tenderness, bruising, irritation, or tissue changes

Histamine activates immune cells (basophils & mast cells) while causing blood vessels to dilate so that immune cells can be quickly transferred to kill pathogens