GLP-1 receptor agonists — patient guide

This page covers all the medicines in the GLP-1 receptor agonist family — including the dual GLP-1 + GIP receptor agonist tirzepatide. If your medicine’s name is Ozempic, Wegovy, Rybelsus, Trulicity, Victoza, Saxenda, Byetta, Bydureon, or Mounjaro, this is your page.

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You’ve probably arrived here for one of several reasons, and they’re all reasonable places to be standing.

You’ve just been told you have type 2 diabetes and your GP has mentioned starting a weekly injection on top of (or instead of) metformin. Or your specialist has added Ozempic or Trulicity to your plan because your heart history makes the cardiovascular benefit worth it. Or you’ve been paying privately for Wegovy or Saxenda for a long-running struggle with weight and the cost is real and the conversations at the pharmacy have not always been kind. Or you’ve been using Ozempic for weight loss during a stretch when Wegovy wasn’t available, and you’ve been hearing on the news that this caused supply problems for people with diabetes and you’re not sure what to think. Or your specialist has just mentioned tirzepatide and you’re trying to work out how it’s different from the one you’ve already heard of.

None of those entry points is the wrong one. Let me give you the longer version of each conversation — and the parts that connect them.

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Find your medicine

Generic name	Common brand names	Strengths	How often	TGA indication
Semaglutide (injection)	Ozempic	0.25 / 0.5 / 1 / 2 mg	Once weekly	Type 2 diabetes
Semaglutide (injection)	Wegovy	0.25 / 0.5 / 1 / 1.7 / 2.4 mg	Once weekly	Chronic weight management (BMI ≥30, or ≥27 with comorbidity)
Semaglutide (oral)	Rybelsus	3 / 7 / 14 mg	Once daily	Type 2 diabetes
Dulaglutide	Trulicity	0.75 / 1.5 / 3 / 4.5 mg	Once weekly	Type 2 diabetes
Liraglutide	Victoza	0.6 / 1.2 / 1.8 mg	Once daily	Type 2 diabetes
Liraglutide	Saxenda	0.6 / 1.2 / 1.8 / 2.4 / 3 mg	Once daily	Chronic weight management
Exenatide	Byetta	5 / 10 mcg	Twice daily before meals	Type 2 diabetes
Exenatide (extended release)	Bydureon BCise	2 mg	Once weekly	Type 2 diabetes
Tirzepatide (dual GLP-1 + GIP)	Mounjaro	2.5 / 5 / 7.5 / 10 / 12.5 / 15 mg	Once weekly	Type 2 diabetes (and chronic weight management per current TGA scope — verify with your prescriber)

The brand-indication split is the most important table on the page. The molecule sits inside two different brands — and the brand is what carries the TGA-approved indication. Ozempic and Wegovy are both semaglutide; only Wegovy is approved for weight loss in someone without type 2 diabetes. Victoza and Saxenda are both liraglutide; only Saxenda is approved for weight loss in someone without type 2 diabetes. The TGA indication sits with the brand, not the molecule, and that is what the script writes against.

The Rybelsus rule. Oral semaglutide bioavailability collapses if it isn’t taken correctly. Swallow whole, on an empty stomach (first thing in the morning is easiest), with no more than 120 mL of plain water, then wait at least 30 minutes before any other food, drink, or oral medicine. If you can’t commit to that 30-minute window most days, the injectable form is the more reliable choice — discuss with your prescriber.

The Ozempic supply note. Ozempic 1 mg in particular has had extended periods of supply intermittency in Australia. The TGA medicine shortages reports database is the live source of truth — check there or with your pharmacist before assuming a particular dose will be available at refill time.

Closely related families. SGLT2 inhibitors (-flozin names: dapagliflozin / Forxiga, empagliflozin / Jardiance, ertugliflozin / Steglatro). Different mechanism, often paired with a GLP-1 in type 2 diabetes with cardiovascular or kidney complications. Metformin sits underneath all of this as the foundational oral agent in most type 2 diabetes regimens.

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What it treats

The honest answer is “more than one thing, and the picture depends on the brand.”

• Type 2 diabetes — the most common Australian prescription reason. Most brands in this class are TGA-approved for this. The medicine is usually added when metformin alone (with or without one other oral agent) isn’t getting blood glucose into the target range, or when there is a cardiovascular or kidney reason to bring it forward.
• Cardiovascular risk reduction in selected adults. Several brands have positive cardiovascular outcome trials — liraglutide in LEADER, semaglutide injection in SUSTAIN-6, dulaglutide in REWIND, and semaglutide in adults with overweight or obesity and established cardiovascular disease without diabetes in SELECT. The TGA indication for each brand is brand-specific — your prescriber will tell you which one applies.
• Chronic weight management in obesity. TGA-approved for Wegovy and Saxenda only at time of drafting (and for tirzepatide / Mounjaro per current TGA scope — verify). The TGA-approved population is adults with BMI ≥30, or BMI ≥27 with at least one weight-related comorbidity (high blood pressure, dyslipidaemia, obstructive sleep apnoea, established cardiovascular disease). Funding: both brands have been private cost, but the PBAC recommended a first PBS listing for Wegovy (December 2025) for adults with a prior cardiovascular event plus BMI ≥35 (≥32.5 for Asian, Aboriginal or Torres Strait Islander people) — expected to take effect around mid-2026 and not yet active at last review. The GLP-1 PBS eligibility checker walks you through which criteria group your numbers appear to fall in.
• Kidney protection in type 2 diabetes with chronic kidney disease. The FLOW trial (NEJM 2024) showed semaglutide slowed kidney function decline and reduced major kidney events in this group — labelling updates to reflect this are tracked over time; ask your prescriber whether this evidence applies to your situation.
• Emerging signals. Heart failure with preserved ejection fraction in obesity (STEP-HFpEF) and non-alcoholic fatty liver disease are areas of active research. Not currently TGA-approved indications.

The reason a particular brand was chosen for you depends on which of these the prescriber was solving for. If you’re not sure, ask — the answer is usually a clean one sentence.

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The basics

1. Take it on the same day each week (for weekly injectables) or the same time each day (for daily agents and Rybelsus). Miss a dose? For weekly agents, take it within 5 days of the missed dose if there’s still at least 3 days until the next scheduled dose — otherwise skip and resume on schedule. For Rybelsus, skip and resume the next morning. Don’t double up.
2. Seek urgent assessment for severe abdominal pain (especially if radiating to the back, with or without vomiting), or for any new significant facial / throat swelling. The first raises the pancreatitis question; the second is an allergic-reaction question. Don’t push through these.
3. Pause and contact us for severe vomiting, severe diarrhoea, or any illness where you can’t keep fluids down for more than a few hours. Sick-day rules apply.
4. Tell every doctor, dentist, and proceduralist that you’re on this medicine — particularly before any planned surgery, endoscopy, or sedation. The 7-day pre-procedure withhold for weekly agents (or 24-hour withhold for daily agents) is current ASA + ANZCA guidance.
5. Don’t stop on your own. If something feels off, message — there’s almost always an answer that doesn’t involve stopping cold.

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What to expect in the first 2-3 months

Week 1-2 (titration start)

• Mild to moderate nausea is common. Smaller meals, slower eating, less fat on the day after the injection helps. Stay hydrated.
• You may notice early appetite changes — earlier fullness, less interest in larger portions, sometimes food noise quieter.
• Don’t expect rapid weight change in the first weeks. The early phase is mostly the body adapting to the medicine.

Week 3-8 (dose climbing)

• Each dose step up usually brings a brief return of nausea for a few days that then settles.
• If nausea is persistent or severe, that’s the signal to slow the climb — not to push through. Message your prescriber.
• For type 2 diabetes use, you may see fasting glucose and post-meal numbers starting to drift downward. If you also take insulin or gliclazide, watch for lows and message early.

Beyond 8 weeks

• You’ll have settled at a working dose or be still climbing toward target.
• Foundational scaffolding starts to matter more visibly — protein adequacy, resistance training, sleep, hydration. The medicine works better with these. It does not replace them.
• Annual blood tests, foot checks (in diabetes), eye review (if pre-existing retinopathy), and bone density consideration (if rapid weight loss has happened) become part of normal monitoring.

Sick day rules — when to pause

If you have any of these for more than a few hours, pause the medicine and message us:

• Vomiting
• Severe diarrhoea
• Fever where you can’t keep fluids down
• Heavy sweating or heat illness with poor fluid intake
• Any acute hospitalisation

Two reasons. First, prolonged GI losses cause dehydration and acute kidney injury risk. Second, severe persistent abdominal pain on this class raises the pancreatitis question — and the conservative practice is to stop on the suspicion and seek assessment, not to push through. Restart once you’re eating, drinking, and well — usually 24-48 hours after symptoms settle. If you’re not sure, message.

One critical exception. If you have type 1 diabetes or insulin-dependent type 2 diabetes and you’re on insulin alongside the GLP-1, never stop insulin abruptly — the GLP-1 is not a substitute, and stopping insulin risks diabetic ketoacidosis. The pause rule is about the GLP-1, not the insulin. Insulin adjustments during illness are a separate conversation with your prescribing team.

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Tap any section below to expand the detail.

How does it work?

After a meal, your gut releases a hormone called glucagon-like peptide 1 (GLP-1). It tells the pancreas to release more insulin when glucose is high, tells the pancreas to release less glucagon (the hormone that pushes glucose up), slows the stomach so the meal arrives in the small bowel more gradually, and reduces appetite via central pathways in the brain.

These medicines are engineered analogues of that hormone — they bind the same receptor, but they don’t get broken down as fast, so they keep working for hours (daily agents) to a week (weekly agents). The effects layer:

• Better glycaemic control — without forcing insulin release when glucose isn’t high. That’s why hypoglycaemia is rare with these medicines on their own.
• Reduced appetite and slower gastric emptying — explains both the weight effect and the nausea.
• Cardiovascular and kidney effects — partly through better glycaemia, partly through direct effects on vessels and the kidney that aren’t fully explained yet.

Tirzepatide adds a second mechanism — it also binds the GIP receptor. GIP is a sibling gut hormone and the co-agonism appears to contribute additional glycaemic and weight-loss effect beyond pure GLP-1 (SURPASS programme in T2DM, SURMOUNT programme in obesity). It is reasonable to think of tirzepatide as related to but pharmacologically distinct from the rest of this class.

Side effects in detail

Common (usually settle with slow titration)

• Nausea — 30-50% in the first weeks, especially after dose climbs. Smaller meals, less fat on the day after the injection, slow eating, steady hydration. Settles for most people within 4-8 weeks at a steady dose.
• Vomiting, diarrhoea, or constipation — also common in the first weeks. Constipation can persist longer in some people.
• Reduced appetite, earlier fullness, quieter food noise — usually framed as desirable but worth watching if you have a history of disordered eating.
• Mild burping, reflux, or “food sits longer” feeling — this is gastric emptying slowing as designed. Smaller, more frequent meals help.
• Injection-site reactions — usually mild redness or itch. Rotate sites (abdomen, thigh, outer upper arm).
• Mild fatigue in the first weeks.

Uncommon but worth knowing

• Gallbladder problems — cholelithiasis and cholecystitis risk increases, particularly with rapid weight loss. New right-upper-quadrant pain, fever, or jaundice warrants urgent assessment.
• Hypoglycaemia when combined with sulfonylurea or insulin — see the dedicated FAQ above. The sulfonylurea or insulin dose usually needs to be reduced when the GLP-1 is started.
• Diabetic retinopathy progression — a modest signal in SUSTAIN-6 for semaglutide, particularly when HbA1c drops fast. If you have pre-existing retinopathy, ophthalmology review on starting and during dose escalation is part of normal practice.
• Acute kidney injury — usually secondary to volume depletion from prolonged vomiting or diarrhoea, not a direct kidney effect. Sick-day rules apply.

Rare but serious — stop and seek urgent assessment

• Pancreatitis — severe, persistent abdominal pain (often radiating to the back), with or without vomiting. The size of the risk has been debated across the trial data (LEADER, SUSTAIN-6) — the magnitude is contested but the conservative practice is to stop on suspicion and seek assessment.
• Severe allergic reaction / angioedema — sudden swelling of face, lips, tongue, or throat, or difficulty breathing. Call 000.
• Suspected medullary thyroid cancer signal — a new thyroid lump, persistent hoarseness, swallowing difficulty, or persistent neck discomfort. Assessment, not panic.
• New or worsening low mood or suicidal thoughts — a small post-marketing signal that has not been clearly causally linked but is being monitored by both FDA and TGA. Any new or worsening psychiatric symptoms should be discussed with your prescriber promptly.

Drugs, food, and alcohol

Tell us or your pharmacist before combining with:

• Sulfonylureas (gliclazide / Diamicron / Diamicron MR, glimepiride / Amaryl) — combined hypoglycaemia risk. The sulfonylurea dose usually needs to be reduced at the time the GLP-1 is started.
• Insulin (any basal or mealtime) — combined hypoglycaemia risk. The insulin dose usually needs to be reduced at the time the GLP-1 is started. Never stop insulin abruptly to start a GLP-1 in a type 1 or insulin-dependent type 2 diabetic.
• Oral contraceptives + tirzepatide — tirzepatide may reduce the effectiveness of oral contraceptives for the first 4 weeks after starting and for 4 weeks after each dose increase. Backup non-hormonal contraception during those windows is recommended per the current product information.
• Warfarin — INR can drift when starting or stopping a GLP-1, especially if GI side effects affect intake. More frequent INR monitoring at the transition.
• Levothyroxine — take levothyroxine on its own per the usual rules (empty stomach, water, wait 30-60 min). Slowed gastric emptying usually doesn’t require a dose change, but if thyroid blood tests drift after starting, re-check timing and dose.
• Other oral medicines with narrow therapeutic windows — slowed gastric emptying can alter absorption. Most are not clinically significant, but mention any medicine that depends on tight blood-level control.

Food. No specific food restrictions — but practical eating changes matter.

• Smaller, more frequent meals are usually better tolerated than three large ones in the first weeks.
• Higher-fat heavy meals on the day after the injection often trigger nausea — many people find it easier to keep that day lighter.
• Adequate protein intake matters more than usual — appetite is suppressed, so protein density per meal climbs in importance. Aim around 1.6 g/kg of reference body weight per day, spread across meals, particularly during active weight loss. This is the muscle-preservation lever.
• Stay genuinely hydrated. The biggest avoidable cause of feeling unwell on this class is dehydration.

Alcohol. Not a direct interaction, but heavy alcohol use amplifies nausea on this class and is an independent risk factor for pancreatitis. Light to moderate intake is usually fine. Heavy drinking on a GLP-1 is a poor combination on every axis.

Rybelsus administration rule. Repeating it because it’s the single most common reason oral semaglutide stops working: swallow whole, empty stomach, no more than 120 mL of plain water, wait 30 minutes minimum before anything else (food, drink, other tablets, coffee, supplements).

Pre-anaesthetic / elective procedures. Current ASA + ANZCA consensus is to withhold weekly GLP-1 agonists for 7 days before an elective procedure (or 24 hours for daily agents), and to consider 24+ hour clear-fluid-only fasting. The reason is gastroparesis-related aspiration risk. Tell the proceduralist. Tell us when you book.

Monitoring — what blood tests, scans, and reviews

For type 2 diabetes use:

• HbA1c every 3-6 months initially, then 6-monthly once stable.
• eGFR and electrolytes at baseline, then per your usual diabetes-review cadence (typically annually if stable; more often if CKD).
• Lipids and cardiovascular risk at baseline and annually.
• Annual foot check — sensation, circulation, skin.
• Eye review — annual (or 2-yearly per your optometrist / ophthalmologist), with more frequent review if pre-existing retinopathy and HbA1c is dropping fast.
• Vitamin B12 worth checking if also on long-term metformin (independent of GLP-1, but they often coexist).

For chronic weight management use:

• Weight, waist, BP at baseline and at each review.
• Lipids and HbA1c at baseline and periodically — both can improve with weight loss.
• Liver function at baseline if there’s a fatty-liver history.
• Bone density (DXA) worth considering at baseline if other risk factors are present, particularly for older adults or postmenopausal women, given the bone-loss signal in rapid weight loss.

For both:

• Mental health check-in at baseline and during titration. Body composition change is psychologically significant.

Message us if you: start a new medicine (prescription, over-the-counter, or supplement), get a gastro illness, lose weight rapidly with persistent vomiting, develop persistent abdominal pain or right-upper-quadrant pain, notice mood changes, plan a procedure or surgery.

Stopping or pausing

Don’t stop without talking to us first.

• If side effects are the problem, we usually slow the titration or swap to a different agent in the class — stopping outright is rarely necessary.
• Sick day rules (above) — a 24-48 hour pause during gastro or heat illness is normal use, not stopping.
• Before elective surgery, endoscopy, or sedation — withhold weekly agents 7 days prior, daily agents 24 hours prior, per ASA + ANZCA guidance. Restart when eating and drinking normally.
• Planning pregnancy — semaglutide and tirzepatide need to be stopped at least 2 months before conception due to long half-lives. Liraglutide can be stopped closer to conception. Plan ahead with your prescriber.
• Stopping for weight-management use — appetite suppression unwinds when the medicine stops, and roughly two thirds of weight loss is regained within a year (STEP 1 extension) if foundational scaffolding hasn’t been built underneath. This is biology, not character. It is worth knowing before you start, not after.
• Stopping cold turkey for type 2 diabetes — blood glucose will drift back up, and any cardiovascular or kidney protection benefit is lost. If you’re considering stopping, that’s a conversation worth having ahead of time.

Pregnancy and breastfeeding

Not recommended in pregnancy. Safety data is limited and the class is not first-line.

• Planning a pregnancy: tell us before trying. Semaglutide and tirzepatide both have long half-lives — stop at least 2 months before planned conception. Liraglutide can usually be stopped closer to conception. We swap to a pregnancy-appropriate plan first.
• Already on one and just found out you’re pregnant: contact us as soon as possible. Don’t take the next dose until we’ve talked.
• Tirzepatide and oral contraceptives: reduced effectiveness for the first 4 weeks after starting and for 4 weeks after each dose increase. Backup non-hormonal contraception during those windows per the current product information.

Breastfeeding. Limited data; alternatives are usually preferred. Discuss case-by-case.

The eating-disorder and mental-health surface

These medicines work, in part, by quieting appetite. For many people that feels like relief — for some it can also reawaken or destabilise a relationship with food that has been hard-won. This is not a minor consideration and it’s worth naming directly.

If you have any history of disordered eating (anorexia, bulimia, binge eating disorder, orthorexia, body dysmorphia), or significant anxiety, depression, or trauma history that involves the body — book proactive mental health support before or alongside starting this medicine, not after a problem develops. A psychologist familiar with eating disorders or with the GLP-1 era specifically is the right level of support.

Watch for:

• Restricting beyond what the medicine is doing on its own.
• Compulsive weighing or measuring.
• Increased anxiety about food, eating in front of others, or eating “off plan”.
• Persistent low mood, hopelessness, or new or worsening suicidal thoughts.
• A sense that the body is becoming a project rather than a place you live.

Any of these is worth raising — with us, with a mental health professional, or with both. The medicine is not a moral test. It is a tool that does something specific in the body, and the person using it deserves to be supported as a whole person, not just a number on a scale.

If you’re in crisis or having thoughts of harming yourself, contact Lifeline on 13 11 14, Beyond Blue on 1300 22 4636, or call 000 in an emergency.

Cost — PBS, private, and the practical reality

Type 2 diabetes brands (PBS-listed with Streamlined Authority when criteria met):

• Ozempic (semaglutide injection) — PBS Streamlined Authority for type 2 diabetes when prescribing criteria are met (typically HbA1c above target on metformin plus at least one other oral agent — confirm current criteria with your prescriber).
• Mounjaro (tirzepatide) — NOT PBS-listed at last review (11 June 2026), despite the diabetes indication: the PBAC recommended a type 2 diabetes listing at its March 2026 meeting (after three earlier rejections), but the sponsor declined the listing terms, so it remains a private prescription — typically AUD $350–500 per month. Check the PBS schedule for current status.
• Victoza (liraglutide for T2DM) — PBS-listed for type 2 diabetes.
• Trulicity (dulaglutide), Byetta, Bydureon BCise — verify current PBS listing with your pharmacist; status has shifted over time.

When PBS-subsidised, from 1 January 2026 the PBS co-payment is up to $25.00 per script (general patient) or $7.70 per script (concession card holder).

Weight-management brands (private cost, with one PBS change in motion):

• Wegovy (semaglutide for obesity) — full private cost at last review. Typical retail is in the order of AUD $400–650 per month depending on dose, pharmacy, and supply. Confirm with your pharmacist as pricing moves. PBS change in motion: the PBAC recommended a first PBS listing (December 2025) for adults with a prior heart attack, stroke, or symptomatic peripheral arterial disease plus BMI ≥35 (≥32.5 for people of Asian, Aboriginal or Torres Strait Islander background). The Government has committed to the listing, expected to take effect around mid-2026 — not yet active at last review (11 June 2026). When live, eligible scripts fall to the standard co-payment ($25.00 / $7.70). Check the PBS schedule for current status.
• Saxenda (liraglutide for obesity) — full private cost, similar order of magnitude. No PBS listing recommended.

This split is the source of much of the public conversation around this class. Ozempic for diabetes is heavily subsidised. Wegovy for obesity is fully private. The medicines are pharmacologically related (Ozempic and Wegovy are the same molecule at different dose ranges and TGA indications) — but the subsidy structure treats them very differently, and the affordability question is real.

A few practical things:

• Confirm the exact price for your script with your pharmacist — under-co-payment pricing can apply, and pharmacy-to-pharmacy pricing varies for private scripts.
• Brand swaps at the pharmacy for a generic version are not currently relevant here — these are originator-brand medicines without generics on the Australian market at time of drafting.
• Compounded versions (any compounding-pharmacy preparation marketed as “compounded semaglutide” or similar) are a separate question and are subject to changing TGA rules — discuss with your prescriber and your pharmacist rather than relying on an online supplier.

If you’re on a combination tablet or pen

A few combination products contain a GLP-1 alongside another medicine. Verify current Australian ARTG and PBS listing with your pharmacist — listings have shifted over recent years.

• Xultophy — insulin degludec (a long-acting basal insulin) + liraglutide. A fixed-dose combination injection used in type 2 diabetes when basal insulin alone hasn’t been enough.
• Soliqua — insulin glargine (a long-acting basal insulin) + lixisenatide (a short-acting GLP-1). Lixisenatide is not separately marketed as a stand-alone GLP-1 in Australia.

If you’re on one of these, you’re on more than just a GLP-1 — everything on this page about the GLP-1 component applies, but the insulin component has its own considerations (hypoglycaemia risk, injection technique, storage rules). Ask us, and we’ll work through the insulin side with you separately.

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The integrative view

Most of the patients I see on a GLP-1 want to do everything they reasonably can in addition to taking the medicine. This section is the longer version of that conversation. Two principles to hold first.

One. These medicines do something specific in the body — they amplify a real hormone signal. They are not a substitute for the lifestyle scaffolding underneath, and the foundational work matters more once the medicine is on board, not less. The reason is straightforward — what is built underneath the medicine is what remains if it ever comes off.

Two. The integrative angle here is not about replacing the medicine with supplements. It is about making sure the body that’s losing weight (or recovering glycaemic control) keeps its muscle, its bones, its nutrient adequacy, and its mental health intact. This is sometimes called “the scaffolding around the medicine” — and it is the lever that determines whether the change you make on the medicine becomes a permanent one or a temporary one.

Strong evidence — these reliably matter

These are interventions where the data is solid enough to recommend to any patient on a GLP-1, regardless of indication.

• Resistance training, 2-3 sessions per week. This is the single most important lever for preserving muscle during weight loss. Bodyweight, resistance bands, or weights — the format matters less than the consistency. Sarcopenia (losing muscle alongside fat) is a real risk, particularly for older adults and anyone whose appetite has dropped sharply.
• Protein adequacy — around 1.6 g/kg of reference body weight per day. Spread across meals (roughly 30-40 g per meal for most adults). Appetite is quieter on the medicine, so protein density per meal climbs in importance. Animal protein, fish, eggs, dairy, legumes, tofu, tempeh — all count.
• Mediterranean-style eating pattern (NEJM 2018 PREDIMED). Vegetables, fruit, whole grains, fish, olive oil, nuts, legumes, modest dairy, low ultra-processed. Demonstrated cardiovascular benefit in its own right and complements both the glycaemic and the weight goals.
• Sleep — 7-9 hours, regular timing. Sleep restriction worsens insulin resistance and increases appetite-regulating hormone disruption. If you suspect obstructive sleep apnoea (snoring, daytime sleepiness, observed pauses), pursue a sleep study — treating it improves glycaemia and weight outcomes independently.
• Aerobic exercise — 150 minutes/week of moderate intensity. Brisk walking, cycling, swimming, or equivalent. Independent cardiovascular and glycaemic benefit. Add to resistance training, don’t replace it.
• Adequate hydration. Steady, regular fluid intake — particularly important on a class that can dehydrate quickly via GI side effects.

Moderate evidence — likely helpful

• Vitamin D adequacy. Measure if symptomatic or high-risk; target 75-100 nmol/L. Independent associations with both glycaemic control and bone density. Food and sunlight first; supplement if low.
• Magnesium adequacy through food (leafy greens, nuts, seeds, legumes, dark chocolate). Supports insulin signalling. Routine supplementation not required unless there’s a specific reason.
• Stress management practices — meditation, slow breathing (~6 breaths/minute), yoga. Helps with eating regulation, sleep, and the vagal-tone side of metabolic health. Modest direct effect on glycaemia.
• Mindful-eating skill development — particularly for people coming from a long history of dieting cycles. Re-learning hunger and fullness cues while the medicine is shifting them is its own work and benefits from structured support.

Limited or emerging evidence

• Specific supplements marketed for weight loss alongside GLP-1s (berberine, green tea extract, chromium, etc.) — none have meaningful evidence on top of a GLP-1, and several have their own interaction or side effect profiles. Generally not worth adding without a specific reason.
• Probiotic supplementation — interesting research domain, weak clinical signal for weight or glycaemia specifically. Fermented foods (yoghurt, kefir, sauerkraut, kimchi, miso) are a reasonable food-first approach.
• Inositol for PCOS in women on a GLP-1 — small studies, plausible mechanism, generally well-tolerated. Discuss with your prescriber if PCOS is part of your picture.

Specific to being on a GLP-1

• Multivitamin during active weight loss. Suppressed appetite means total intake can fall below the level that comfortably covers vitamin and mineral needs. A general one-a-day multivitamin during the active phase is reasonable. Pay particular attention to B12, iron, vitamin D, calcium, zinc, and magnesium — check levels if symptoms develop (fatigue, hair changes, brittle nails, frequent infections, low mood, cramps).
• Calcium adequacy. Around 1000-1300 mg/day from food where possible (dairy, fortified plant milks, leafy greens, tinned fish with bones, tofu set with calcium). Important for bone density during weight loss.
• Electrolyte adequacy during GI side effects. If you’re losing fluid through nausea or diarrhoea in the first weeks, replace electrolytes deliberately — oral rehydration salts are the cleanest way; sports drinks are usually too sugary; coconut water and broths are reasonable food sources.
• Bone density consideration if rapid weight loss has happened. Baseline DXA worth considering for older adults or postmenopausal women, particularly with other risk factors. Weight-bearing and resistance exercise are the strongest protective levers.

The foundational lifestyle picture (DPP-style)

The Diabetes Prevention Program (NEJM 2002) showed lifestyle change reduced progression from prediabetes to type 2 diabetes by 58% over 2.8 years — bigger than metformin in the same trial. The headline applies to GLP-1 use too. The medicine is a real lever. The foundational lifestyle work is a bigger one. They work best together, and what remains if the medicine ever comes off is what you’ve built underneath it.

Earning a dose reduction (where it applies)

• For type 2 diabetes — if foundational lifestyle work has shifted HbA1c, weight, and cardiometabolic risk meaningfully, dose reductions or de-escalation can be discussed. Done together with monitoring, not on your own. The exception is established type 2 diabetes with significant duration, complications, or cardiovascular indication — there the medicine is doing structural protection beyond a number, and we usually keep it going.
• For chronic weight management — current evidence is that the medicine is a long-term tool. Stopping unwinds the appetite effect for most people. Discussing dose holidays, lower maintenance doses, or alternative strategies is a conversation worth having ahead of time with your prescriber.

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Track these between now and your next visit

• Injection days (or daily dose times for Rybelsus, Victoza, Saxenda, Byetta) — keep a simple log so dose-step timing is clear.
• GI symptoms — when they started, how often, how severe. Particularly any persistent abdominal pain.
• Weight and waist — weekly is enough; daily creates noise. Same conditions each time.
• Home blood glucose (for type 2 diabetes use, if you’re testing) — fasting and post-meal readings.
• Any new symptom worth flagging — new thyroid lump, persistent neck discomfort, right-upper-quadrant pain, mood changes, new medicine or supplement started.
• Anything you’ve bought over the counter that might interact — particularly anti-inflammatories, supplements, weight-loss products.

Bring the list to your review appointment.

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This is general information, not personal medical advice. Every patient is different. Decisions about your medicines — which one, what dose, when to stop, what to combine with — are made with the doctor who prescribed them. If anything on this page appears to contradict advice from your treating doctor, follow your doctor; they have context about your situation that this page cannot.

Reading this page does not establish a doctor-patient relationship with Dr Hoebing Lo. If you are not a current patient, please discuss your medicines with your own GP, specialist, or pharmacist.

About the integrative content. The lifestyle, dietary, and complementary recommendations on this page summarise current published research. Effect sizes are approximations from clinical studies — your individual response will vary, and real-world results are commonly smaller than trial results because day-to-day life differs from study conditions. Supplements and herbal products are not interchangeable with prescribed medication and can interact with it. Talk to your doctor and pharmacist before starting any new supplement, herbal product, or significant change in diet.

About the off-label conversation. Several uses of medicines in this class are discussed by patients and prescribers across Australia, including uses that are not the TGA-approved indication for a particular brand. Discussion of those uses on this page is factual, not promotional. The TGA-approved indication for each brand is what determines what your prescriber writes against — that conversation belongs in the consult with full knowledge of your history.

Currency. This page reflects clinical practice as of the last-reviewed date. Medicine evolves; specific details (TGA indications, PBS listings, ASA/ANZCA perioperative guidance, supply status) may date between reviews. Pricing shown is indicative; confirm with your pharmacist.

No commercial relationships. Dr Hoebing Lo has no financial or commercial relationship with the manufacturer of any medicine, brand, or supplement mentioned on this page.

Emergencies. If you have sudden swelling of face, lips, tongue, or throat; difficulty breathing; severe persistent abdominal pain; chest pain; severe dizziness or fainting; or new or worsening suicidal thoughts, call 000 or go to your nearest emergency department. For mental-health crisis support call Lifeline on 13 11 14 or Beyond Blue on 1300 22 4636. Do not wait, and do not message us first.