Ozempic, Mounjaro, and GLP-1 agonists: "weight loss medications"

Recently, the namesOzempicandMounjarohave flooded the media and social networks. The reason is not yet another harmless "trend" that will fade away next season – the story is much deeper and more serious, and for a large number of people, these pharmacological solutions represent a revolution in health status. These are medications from the group ofGLP-1 agonistsand the newerdual GLP-1/GIPapproach, originally developed fortype 2 diabetes, which, with good glucose control, often also bring significantweight loss. For this reason, many perceive them as "weight loss medications", although the foundation of the story is strictly medical: these are therapies for chronic diseases, with clear indications, protocols, and safety measures.

These medications enhance insulin secretion when glucose is elevated, reduce glucagon, slow gastric emptying, and act on the satiety centers in the brain. The result is more stable glycemia, reduced appetite, and gradual weight loss, provided that the therapy is taken correctly and is accompanied by lifestyle changes. They are not a magic wand and do not replace diet, exercise, or professional supervision.

Most importantly – in Croatia and the EU, all the mentioned medications areprescription-onlyand are prescribed following a physician's assessment, with a titration plan (dosage), monitoring of side effects, and realistic expectations. The goal of this guide is to provide acomprehensive picture: how these medications work, what thedifferences between individual preparationsare, who thecandidatesare, what theadvantages and limitationsare, what thescientific basisis, what aboutavailability and regulationsand how we build a safe and effective multidisciplinary care plan at Priska Med Polyclinic. Following the introduction, clear chapters and practical comparisons will help you make an informed decision.

Article contents

1. How GLP-1 and GLP-1/GIP agonists work
2. Who are the candidates and when are these medications prescribed
3. 1. Type 2 diabetes (T2D)
   2. Weight management
   3. Off-label use and ethics
   4. Who is not a candidate?
3. Safety, side effects, and limitations
4. Scientific basis and evidence
5. 1. Sugar regulation (HbA1c)
   2. Weight reduction
   3. Cardiovascular outcomes
   4. What to realistically expect
5. Ozempic (semaglutide)
6. 1. What is it and who is it intended for?
   2. Efficacy of Ozempic and realistic expectations
   3. Cardiovascular benefit
   4. Side effects and safety of Ozempic
   5. Regulatory status of Ozempic
6. Wegovy (semaglutide 2.4 mg)
7. 1. What is Wegovy and who is it intended for?
   2. Efficacy of Wegovy (STEP program)
   3. Why is support in changing lifestyle habits crucial?
   4. Side effects, precautions, and contraindications with Wegovy
   5. Regulatory status of Wegovy
7. Rybelsus (semaglutide – oral form)
8. 1. What is Rybelsus and who is it intended for?
   2. How to take Rybelsus
   3. Efficacy of Rybelsus and comparison with injections
   4. Side effects and safety of Rybelsus
   5. Regulatory notes and status
8. Mounjaro (tirzepatide)
9. 1. What is Mounjaro and who is it intended for?
   2. Efficacy of Mounjaro (SURPASS & SURMOUNT)
   3. Side effects of Mounjaro and safety
   4. Regulatory status of Mounjaro
9. Trulicity (dulaglutide)
10. 1. What is Trulicity and who is it intended for?
    2. Efficacy of Trulicity and cardiovascular outcomes (REWIND)
    3. Tolerance and safety of Trulicity
    4. For whom is Trulicity a good choice?
    5. Regulatory status of Trulicity
10. Saxenda (liraglutide 3.0 mg)
11. 1. What is Saxenda and who is it intended for?
    2. Efficacy of Saxenda (SCALE program)
    3. Comparison of Saxenda with newer agents
    4. Side effects of Saxenda and safety
    5. Regulatory status of Saxenda
11. Victoza (liraglutide)
12. 1. What is Victoza and who is it intended for?
    2. Efficacy of Victoza and cardiovascular outcomes (LEADER)
    3. Tolerance and safety of Victoza
    4. For whom is Victoza a good choice?
    5. Regulatory status of Victoza
12. Byetta / Bydureon (exenatide)
13. 1. What are Byetta / Bydureon and who are they intended for?
    2. Efficacy of Byetta / Bydureon
    3. Side effects of Byetta / Bydureon and safety
    4. Regulatory status of Byetta / Bydureon
13. Lyxumia (lixisenatide) and Soliqua (insulin glargine + lixisenatide)
14. 1. Where do they fit in?
    2. Efficacy and selection
    3. Side effects and safety
    4. Regulatory status
14. Frequently asked questions
15. Patient expectations and general tips for adaptation
16. 1. When are the first effects seen?
    2. Why does weight return after stopping therapy?
    3. Alternative and complementary options
    4. Bariatric surgery – when and for whom?
    5. Regulation and ethics
16. "Weight loss medications" at the Priska Med Polyclinic
17. You might also be interested in

How GLP-1 and GLP-1/GIP agonists work

When we eat, the intestines release hormones calledincretins. The most important among them isGLP-1 (glucagon-like peptide-1): it "tells" the pancreas to increaseinsulin secretion only when blood sugar is elevated, while at the same timereducing glucagon (a hormone that raises blood sugar),slowing gastric emptying and enhancing the feeling offullness. The result islower glycemic "peaks" after meals, fewer hunger pangs, and lower overall calorie intake.

GLP-1 agonists (e.g., semaglutide – Ozempic/Wegovy; liraglutide – Victoza/Saxenda; dulaglutide – Trulicity) are medications thatmimic natural GLP-1. They function as a "booster" of the incretin effect: stabilizing glucose, reducing fluctuations, and easing appetite control at the same time. For this reason, better regulation of blood sugaris seen in type 2 diabetes andgradual weight loss while therapy is ongoing. In general, the dose isintroduced gradually (titrated) to minimize the most common gastrointestinal side effects (nausea, bloating, occasional vomiting or constipation).A newer group are

dual GLP-1/GIP agonists (e.g.,tirzepatide – Mounjaro/Zepbound). They further activate theGIP receptor, the second incretin pathway. In simple terms: while GLP-1 "fine-tunes" insulin, glucagon, gastric emptying, and fullness, theGIP component can enhanceinsulin response and contribute to an evenmore pronounced metabolic effect. In clinical practice, this often meansa stronger reduction in HbA1c andgreater average weight loss compared to the "pure" GLP-1 agonists, although the response is individual.Why does all this work and why is it important?

Glycemia:

• slower gastric emptying and the incretin effect mitigate sugar spikes after meals; the pancreas secretesas much insulin as needed, not "blindly".Appetite and weight:
• the fullness signal in the brain is stronger and comes earlier; meals and snacks are smaller, so thecaloric balance is easier to control.Risks and expectations:
• gastrointestinal discomfort is the most common and usually temporary with proper titration and dietary adjustments (eating slowly, smaller and lighter meals, good fluid intake). Therapyis not a substitute for diet and exercise – it provides the best results as part of a structured plan.In short –

GLP-1 agonists effectively "smooth out" glycemic peaks and help control appetite, whileGLP-1/GIP agonists add another mechanism that often bringsadditional metabolic benefit. Scientific literature consistently confirms these effects in type 2 diabetes and weight regulation; differences among specific medications are discussed below, along with clear indications, advantages, and limitations for each preparation.Who are the candidates and when are these medications prescribed?

Type 2 diabetes (T2D)

GLP-1 agonists (e.g., semaglutide – Ozempic, dulaglutide – Trulicity) and the dual GLP-1/GIP agonist tirzepatide (Mounjaro) are prescribed to adults with

type 2 diabetes when the goal isto lower HbA1c, stabilize glycemia, and reduce glycemic "peaks," along with additional benefits on body weight. They are often introduced asan add-on to metformin or when metformin is contraindicated/intolerable, and can also bethe first choice for patients withelevated cardiovascular risk (history of heart attack/stroke, atherosclerosis, high SCORE2) because some representatives have proven favorableCV outcomes. In practice, they are chosen based on goals (HbA1c, weight reduction), comorbidities (e.g., fatty liver, hypertension), side effect profiles, and tolerability.Food for diabetics – nutritionist tips

Weight regulation

Nutrition for diabetics – nutritionist tips

For

weight regulation there are specific, regulatory-approved indications by brand and dose. In general, candidates are:BMI ≥30

• (obesity) orBMI ≥27
• withat least one comorbidity associated with weight (e.g., hypertension, dyslipidemia, prediabetes/T2D, obstructive sleep apnea, osteoarthritis, "fatty liver," etc.).Semaglutide for weight loss (Wegovy) and liraglutide 3.0 mg (Saxenda) have such indications; 

tirzepatide (Mounjaro/Zepbound) is a newer option with a very pronounced effect on weight, depending on availability and local approvals. In all cases,the medication is prescribed with a structured diet and exercise plan and regular monitoring, as the best and most lasting results are achieved through a combination of pharmacotherapy and lifestyle changes.Off-label use and ethics

The popularity of "

weight loss medications" has led to demand even among people without official indications. It is important to emphasize: all GLP-1/GLP-1/GIP medications are by prescription and may only be used exclusively under medical supervision. Off-label prescribing (outside approved indications) requires individual assessment of benefits and risks, informed consent, and clearly defined goals and a monitoring plan (body weight, HbA1c/glucose in T2D, blood pressure, lipids, potential side effects). The ethical aspect also includes priority of availability for patients with medical need (e.g., T2D with poor control), especially during shortages.Who is not a candidate?

Pregnancy and breastfeeding, active pancreatitis or severe untreated gallbladder disease, and a severe GI-intolerant profile with therapy - these are situations in which these medications

are not introduced or are introduced with special caution. In patients with diabetic retinopathy, close collaboration with an ophthalmologist is recommended in cases of rapid improvements in glucose levels.In summary, the choice between Ozempic, Mounjaro, Wegovy, Saxenda, Trulicity, Rybelsus

and others is not a "brand decision" based on personal preference but a clinical decision made according to indication (T2D vs. weight regulation), goals (HbA1c, kg), comorbidities, tolerability, and availability, always along with a personalized plan and professional supervision.Safety, side effects, and limitationsThe most common side effects

of GLP-1 and GLP-1/GIP agonists (e.g., Ozempic, Wegovy, Mounjaro, Saxenda, Trulicity) originate from

the gastrointestinal system: nausea, feeling of fullness, bloating, belching, occasional vomiting or diarrhea/constipation. In general, they are mild to moderate and weaker over time, especially if the dose is introduced gradually (titration). Practical tips: eat slower, choose smaller and lighter meals, avoid very fatty foods during the titration phase, maintain hydration and if necessary temporarily reduce the dose in consultation with a doctor.Hypoglycemia is rare when on GLP-1 agonist monotherapy as the effect depends on blood glucose levels. However,

the risk increases if the medication is combined with sulfonylureas or insulin - then dosing adjustments of these medications and education about recognizing symptoms should be considered.In a small percentage of patients, cholestatic symptoms

(e.g., gallstones) occur and very rarely pancreatitis. Sudden, severe pain in the upper abdomen that radiates to the back requires immediate evaluation and discontinuation of therapy until clarification.In individuals with T2D and existing retinopathy, rapid decrease in HbA1c

may temporarily worsen symptoms; therefore, coordination with an ophthalmologist and gradual improvement in glucose levels is desirable.Severe gastrointestinal disturbances (frequent vomiting/diarrhea) can lead to dehydration

and subsequent kidney function impairment - it is important to react in a timely manner (fluids, contact a doctor).It is important to note that these medications are not a "magic wand"

. The effect on weight and glucose levels is best while the medication is being taken and with lifestyle changes (diet, activity, sleep, psychological support). After sudden discontinuation, partial reversal of achieved benefits (e.g., regaining some weight) is possible. Therefore, therapy is planned individually, with clear goals, regular check-ups (weight, HbA1c/glucose, blood pressure, lipids, liver enzymes as needed) and assessment of tolerability. Thus, the safety of GLP-1 agonists and tirzepatide is favorable when the medications are used by prescription, under supervision and proper titration. Of course, any unusual discomfort (persistent nausea, severe abdominal pain, signs of dehydration, vision disturbances) should be reported promptly to a doctor.Scientific basis and evidenceFor the purposes of this article, we prepared several sources from scientific studies conducted on these medications. Of course, this is a relatively new category of medications and numerous studies are currently underway that may confirm or refute some existing information.

Sugar regulation (HbA1c)

GLP-1 agonists on average lower

HbA1c by ~0.8-1.5 p.b.

in adults with type 2 diabetes, with a low risk of hypoglycemia when not combined with sulfonylureas/insulin. In a head-to-head study SURPASS-2 in T2D, tirzepatide (GLP-1/GIP) was superiorin reducing HbA1c compared tosemaglutide 1 mg, with a greater decrease in body weight (regardless of tirzepatide dosage). The first effect on glycemia is observed after2-4 weeks, stabilization by12-16 weeks after titration.[1]Reduction in body weightIn the regulation of body weight, the effects largely depend on the drug/dose and lifestyle adjustments:

Liraglutide 3.0 mg (Saxenda)

: average

• ~5-8% weight loss in6-12 months (SCALE).[2]Semaglutide 2.4 mg (Wegovy): in
• STEP-1 average~15% through~68 weeks with lifestyle change.[3]Tirzepatide (Mounjaro/Zepbound): in
• SURMOUNT-1 (people with obesity without T2D) achieved~15-20% and more weight reduction over~72 weeks.[4]In clinical practicethe first changes in appetite

occur within 1-3 weeks,measurable weight loss over 4-8 weeks, andmost of the effect accumulates up to6-12 months; after that, a plateau is common and maintenance of habits is necessary.Cardiovascular outcomesMore large trials have shown

reduction in major cardiovascular events (MACE)

with some members of the class in T2D with elevated cardiovascular risk:LEADER (liraglutide) – reduction in MACE and overall mortality compared to placebo.[5]

• SUSTAIN-6 (semaglutide s.c.) – significant reduction in primary cardiovascular outcome; with a note about a signal for retinopathy with rapid improvement in glycemia.[6]
• REWIND (dulaglutide) – benefit on cardiovascular outcomes even in a population with relatively lower prevalence of established cardiovascular disease.[7]
• Furthermore, in obesitywithout diabetes

,SELECT (semaglutide 2.4 mg) has shownreduction in MACE in individuals with a prior cardiovascular event, which supports the cardiometabolic benefit beyond glycemic control.[8]What to realistically expect2-4 weeks:

decrease in glycemia, initial reduction in appetite.

• 8-12 weeks: clearer decrease in HbA1c; measurable weight loss (depending on dose and adherence).
• 6-12 months: the majority of weight loss; plateau often occurs.
• Long-term: benefits are
• maintained with continuous therapy and lifestyle change; aftersudden interruption partial weight regain may occur (confirmed in long-term arms STEP/SURMOUNT).Ozempic (semaglutide)What is it and who is it intended for?

Ozempic is a weekly subcutaneous injection

of semaglutide

intended for adults withtype 2 diabetes to improve glycemic control. It acts as aGLP-1 agonist: enhances insulin secretion when glucose is high, reduces glucagon, slows gastric emptying, and reduces appetite. In practice, it is often introduced with metformin or as an adjunct to existing therapy, especially in patients who desirelower HbA1c andmoderate weight loss without an increased risk of hypoglycemia.Effectiveness of Ozempic and realistic expectationsIn clinical trials, Ozempic typically

lowers HbA1c by ~1.0-1.5 percentage points

after 12-16 weeks of titration, with additional reduction over the following months. Most patients also reportweight loss (most commonly3-6 kg in the first 6-12 months, depending on dose and changes in lifestyle). The effect on appetite is often noticed within the first few weeks, and glycemia stabilizes as the dose is gradually increased.Cardiovascular benefitFor semaglutide, a

reduction in major cardiovascular events (MACE)

has been shown in patients with T2D and elevated cardiovascular risk. This is an important advantage in choosing therapy for individuals with atherosclerotic disease or high SCORE2 risk, where we target both glycemia andreduction in overall cardiovascular risk.Side effects and safety of OzempicThey are most often

gastrointestinal disturbances

(nausea, feeling of fullness, occasional vomiting or diarrhea/constipation), especially when introducing. Usually reduced with slow titration, smaller and lighter meals, and good fluid intake. Hypoglycemia is rare in monotherapy, but it is possible in combination with sulfonylureas or insulin (dose adjustment required). With a sudden drop in blood sugar in patients with diabetic retinopathy, there may be a transient worsening - ophthalmological monitoring is necessary. Pregnancy and breastfeeding: not recommended.Regulatory status of OzempicOzempic is a

prescription medication (Rx)

. It is prescribed after an individual assessment of benefits and risks, along with a titration plan and regular monitoring.Wegovy (semaglutide 2.4 mg)What is Wegovy and who is it intended for?

Wegovy is a weekly subcutaneous formulation of

semaglutide 2.4 mg

approved for weight management in adults with BMI ≥30 or BMI ≥27 with at least one weight-related comorbidity (e.g., hypertension, dyslipidemia, obstructive sleep apnea). It is not an 'aesthetic' medication, but a therapy for chronic disease - obesity and always accompanies a structured diet and exercise plan.Effectiveness of Wegovy (STEP program)In randomized

STEP

studies, Wegovy, with the support of lifestyle change, led to an average reduction of ~12-15% in body weight over ~68 weeks, and a significant proportion of patients achieved ≥10% and ≥15% loss. Initial changes in appetite are often felt within 2-4 weeks, measurable weight loss through 1-2 months, and the majority of the effect accumulates up to 6-12 months, after which a plateau is common. Maintaining results requires continuous therapy and stable habits (diet, movement, sleep).Why is support in changing lifestyle habits crucial?Semaglutide facilitates appetite control and 'eases' cravings, but

does not replace

proper diet and activity. A professionally guided plan (nutritionist, realistic calorie deficit, progressive movement, psychologist support if needed) increases and stabilizes the effect and reduces the risk of the 'yo-yo effect'.Side effects, caution, and contraindications with WegovyThey are most often

gastrointestinal disturbances

(nausea, fullness, belching, diarrhea/constipation), mainly transient with slow titration, smaller and lighter meals, and good hydration. Less commonly, there are issues with the gallbladder; very rarely pancreatitis (report any severe, persistent pain in the upper abdomen immediately). In pregnancy and breastfeeding, not recommended; a discontinuation plan is necessary before conception. In the presence of diabetic retinopathy and rapid blood sugar improvement, collaboration with an ophthalmologist is mandatory.Regulatory status of WegovyWegovy is a

prescription medication (Rx)

with clearly defined indications and a titration protocol. It is prescribed after a doctor's assessment of benefits and risks along with regular monitoring.Rybelsus (semaglutide - oral form)What is Rybelsus and who is it intended for?

Rybelsus

is

the first oral GLP-1 agonist (semaglutide in pill form) intended for adults with type 2 diabetes to improve glycemic control. The mechanism of action is the same as injectable forms: it enhances insulin when glucose is elevated, reduces glucagon, slows gastric emptying, and helps control appetite. The advantage is avoiding injections, and the challenge is strict adherence to dosing.How to take RybelsusRybelsus must be taken

in the morning on an empty stomach

, with a small amount of water (up to ~120 ml), swallowed whole and wait at least 30 minutes before eating, drinking, or taking other oral medications. These rules significantly improve absorption and effect.Effectiveness of Rybelsus and comparison with injectionsRybelsus significantly lowers HbA1c

and may contribute to

weight loss, especially with lifestyle changes. Comparing with injectable GLP-1 forms, the effect on glycemia and kilograms is usually modest to moderate, while higher doses of weekly injections (e.g., semaglutide 1.0-2.0 mg s.c. or 2.4 mg in the indication for body weight control) achievemore pronounced average results. On the other hand,oral administration may be more acceptable to patients who want to avoid needles, provided thatconsistently adhere to the morning regimen.Side effects and safety of RybelsusThe most common aregastrointestinal disturbances

(nausea, feeling of fullness, belching, diarrhea/constipation), most pronounced during the titration phase. Slower dose introduction, smaller and lighter meals, and good hydration help. Hypoglycemia is rare in monotherapy, but combination with

sulfonylureas or insulin may increase it – then the doctor adjusts the doses. Use during pregnancy and breastfeeding isnot recommended.Regulatory notes and statusRybelsus isa prescription medication (Rx)

approved for

T2D. Regulatory labels for semaglutide as a class (e.g., data on cardiovascular benefits from large studies with injection forms) are evolving.Mounjaro (tirzepatide)What is Mounjaro and who is it intended for?Mounjaro (tirzepatide)

is

a dual agonist of GLP-1/GIP

of the newest generation – it activates two incretin receptors, thus combining effects on glycemia and appetite. In the EU, it isapproved for adults with type 2 diabetes to improve glycemic control and, according to the current approval, forregulation of body weight in individuals meeting criteria (BMI thresholds/comorbidities). In practice, it is chosen when we wanta strong drop in HbA1c anda pronounced reduction in body weight, with weekly dosing.Effectiveness of Mounjaro (SURPASS & SURMOUNT)In studiesSURPASS

(T2D) tirzepatide showed

a very large drop in HbA1c (often-1.8 to -2.5 percentage points.) with a significant loss of body weight compared to the comparator(s), including 1 mg of semaglutide. In obesity without diabetes,SURMOUNT-1 showedan average ~15-20% reduction in body weight over ~72 weeks with lifestyle change support, with a higher proportion of participants achieving ≥10%, ≥15%, and ≥20% weight loss. The first effects on appetite are often seen in2-4 weeks, and glycemia and weight stabilize more steadily after8-12 weeks and during further titration.Side effects of Mounjaro and safetyThe most common aregastrointestinal complaints

(nausea, feeling of fullness, belching, diarrhea/constipation), most pronounced in the early steps of titration. Smaller and lighter meals, slower eating, good fluid intake, and, if necessary,

slower titration help. Hypoglycemia is rare in monotherapy, but it ispossible in combination with sulfonylurea/insulin (consider dose adjustment). As with other members of the class, caution is required in the history of pancreatitis or active gallbladder diseases;pregnancy/breastfeeding –is not recommended.Regulatory status of MounjaroMounjaro isa prescription medication (Rx). It is prescribed after a physician's assessment of indications (T2D and/or body weight regulation according to criteria), goals (HbA1c, weight), and safety profile, along withregular monitoring

and

lifestyle change program for a long-term sustainable outcome.Trulicity (dulaglutide)What is Trulicity and who is it intended for?Trulicity (dulaglutide) isa GLP-1 agonist

for adults with

type 2 diabetes

for whom we aim to improve glycemic control with simpledosing once a week. It is often introduced alongside metformin or as an addition to existing therapy when we want to stabilize HbA1c with a low risk of hypoglycemia and without a complicated dosing regimen.Effectiveness of Trulicity and cardiovascular outcomes (REWIND)Trulicity consistentlylowers HbA1c by about~1.0 percentage points

(depending on baseline values and dose). In the study

REWIND cardiovascular benefit was demonstrated (reduction of major cardiovascular events – MACE) even in a population with a relatively high proportion of patientswithout established cardiovascular disease, which is an important message for broader application in T2D with increased cardiovascular risk. The effect onbody weight is most oftenmodest to moderate (lower on average than with semaglutide or tirzepatide), but can be clinically beneficial when simplicity and tolerability are prioritized.Tolerance and safety of TrulicityThe profile of side effects is similar to the GLP-1 class: nausea, feeling of fullness, diarrhea/constipation - usually mild to moderate and transient with gradual titration and dietary adjustments (smaller, lighter meals, slower eating, hydration).

Hypoglycemia

is rare in monotherapy; the risk increases in combination with sulfonylureas or insulin (adjustment required). Caution is needed in patients with a history of pancreatitis or gallbladder disease; in pregnancy/breastfeeding the usage is not recommended.Who is Trulicity a good choice for?For patients seeking stable glycemic control, simple weekly dosing and proven

CV safety/benefit

, for whom maximal weight loss is not the primary goal – Trulicity is a pragmatic choice.Regulatory status of TrulicityTrulicity is a prescription medication (Rx). It is prescribed after a medical evaluation of indications, goals (HbA1c, body weight), and safety profile, along with regular monitoring.Saxenda (liraglutide 3.0 mg)What is Saxenda and whom is it intended for?

Saxenda

is a daily subcutaneous injection of liraglutide 3.0 mg approved for

weight management

in adults with

BMI ≥30 or BMI ≥27 with at least one comorbidity associated with overweight (e.g., hypertension, dyslipidemia, prediabetes). It is not a "quick fix," but a therapy for chronic obesity disease and is always conducted with a dietary and exercise plan.Effectiveness of Saxenda (SCALE program)In the SCALE studies, Saxenda – in combination with lifestyle changes – led to average ~5-8% weight loss over

6-12 months

. A significant proportion of participants achieve ≥5% and ≥10% weight loss, which already brings metabolic benefits (lower pressure, better lipids, glycemia). Initial changes in appetite often occur within 2-4 weeks, and weight loss is observable over 1-2 months, with the greatest effect up to 6-12 months.Comparison of Saxenda with newer agentsCompared to semaglutide 2.4 mg (Wegovy) or tirzepatide (Mounjaro), the average weight loss with Saxenda is

more modest

. However, Saxenda remains a relevant option for patients who fit into a daily routine with fine titration and proven safety, especially when the availability of newer medications is limited or they are not tolerable.Side effects of Saxenda and safetyThe most common are gastrointestinal issues (nausea, fullness, belching, diarrhea/constipation), most pronounced during early titration. It helps to eat slowly,

smaller and lighter meals

, adequate fluid intake; if necessary, temporarily hold the dose or slow down the increase. Hypoglycemia is rare in monotherapy, but possible in combination with sulfonylureas/insulin. Caution in history of pancreatitis and gallbladder disease; in pregnancy/breastfeeding it is not indicated.Regulatory status of SaxendaSaxenda is a prescription medication (Rx) with clear indications and a solid evidence base. When the goals moderate weight loss,

professional support

and gradual titration, Saxenda is a meaningful, proven choice - especially as part of a structured plan with a nutritionist and physician supervision.Victoza (liraglutide)What is Victoza and who is it intended for?Victoza is liraglutide for adults with

type 2 diabetes

with the aim of improving glycemic control. It belongs to the group of

GLP-1 agonists: it enhances insulin secretion when glucose is elevated, reduces glucagon, slows gastric emptying, and helps control appetite. It is often introduced alongside metformin or as an add-on to existing therapy when we aim for lowering HbA1c with a low risk of hypoglycemia (if not combined with sulfonylureas/insulin).The effectiveness of Victoza and cardiovascular outcomes (LEADER)Victoza typically lowers HbA1c by ~1.0 percentage points (depending on baseline values and dose), with a modest to moderate decrease in body weight. A particularly important finding comes from the study

LEADER

, in which liraglutide in patients with T2D and elevated cardiovascular risk reduced the risk of major cardiovascular events (MACE) and overall mortality compared to placebo. Therefore, Victoza is a pragmatic choice when, alongside glycemic control, we also target reduction of cardiovascular risk.Tolerance and safety of VictozaThe most common side effects are gastrointestinal (nausea, feeling of fullness, belching, diarrhea/constipation), usually mild and transient, most pronounced during the titration phase. Smaller and lighter meals, slower eating, good fluid intake, and gradual dose increase help.

Hypoglycemia

is rare in monotherapy, but the risk increases in combination with sulfonylureas or insulin, so often it is necessary to adjust the dose of those medications. Caution is needed in case of a history of pancreatitis or gallbladder disease; during pregnancy and breastfeeding use is not recommended.For whom is Victoza a good choice?For patients with T2D who want a daily, predictable routine, stable reduction of HbA1c,

moderate impact on weight

and proven cardiovascular benefit - especially if they are already at risk or have established cardiovascular disease.Regulatory status of VictozaVictoza is a prescription medication (Rx). It is prescribed after medical assessment of indications, goals (HbA1c, weight, cardiovascular risk) and safety profile, with regular monitoring and education on how to use it.Byetta / Bydureon (exenatide)What are Byetta / Bydureon and who are they intended for?

Exenatide

is one of the oldest representatives of GLP-1 agonists. It comes in two clinically different versions:

Byetta

(short-acting exenatide, used

twice daily) and Bydureon (long-acting, once weekly). Both are intended for adults with type 2 diabetes to improve glycemic control, most often in combination with metformin or as an add-on to existing therapy. Today, they are prescribed less frequently than newer preparations (semaglutide, dulaglutide, tirzepatide) due to easier dosing and stronger effects of the latter on body weight and HbA1c, but exenatide can still be a reasonable choice in specific situations.Effectiveness of Byetta / BydureonOn average, a decrease in HbA1c of around 0.7-1.0 percentage points, with a modest to moderate decrease in body weight. Byetta, due to its shorter action, has a stronger effect on

jumps

glucose after a meal, while Bydureon provides a more stable weekly profile. Compared to newer agents (e.g. semaglutide, tirzepatide), the average weight loss and ease of dosing are usually smaller, which is also the reason for the shift in clinical practice towards newer medications.Side effects of Byetta / Bydureon and safetyThe most common are gastrointestinal disturbances (nausea, fullness, occasional vomiting, diarrhea/constipation), especially during the initiation or dose increase – it facilitates slower titration and lighter meals. Frequent are

local reactions

(sensitivity, lumps) due to the microspheres of prolonged release.Hypoglycemia is rare in monotherapy, but possible in combination with sulfonylureas/insulin (consider lowering their doses). Caution is required with a history of pancreatitis and with severe renal impairment (exenatide is predominantly eliminated by the kidneys).It is not used in type 1 diabetes or in pregnancy/breastfeeding.Regulatory status of Byetta / BydureonByetta and Bydureon are prescription medications (Rx). The choice of exenatide is most often considered when targeting postprandial glucose (Byetta), when the patient prefers weekly dosing (Bydureon) or when newer GLP-1/dual agonists are not available or are intolerable. For individual assessment and combining with other therapies, we recommend a consultation at

an endocrinology clinic

.Lyxumia (lixisenatide) and Soliqua (insulin glargine + lixisenatide)Where do they fit?Lixisenatide (brand name Lyxumia) is a short-acting GLP-1 agonist

for adults with

type 2 diabetes

. It acts more strongly on postprandial glucose (PPG) than long-acting GLP-1 analogs, making it useful when “jumps after meals are a major problem.Soliqua is a fixed combination of insulin glargine (basal insulin) and lixisenatide in one pen, intended for T2D when basal insulin alone does not achieve target values; the advantage is one injection per day instead of separate titration of two medications. Note: in the EU, the combination is often available under the name Suliqua – functionally it is the same concept.Efficacy and selectionLixisenatide on average lowers HbA1c by ~0.7-1.0 percentage points and strongly reduces PPG, with a modest to moderate

impact on body weight (less than with more potent, long-acting GLP-1 or tirzepatide). Soliqua combines

basal control (glargine) and PPG effect (lixisenatide), so it often achieves better overall glycemia than merely increasing insulin, with a lower risk of weight gain and lower insulin dose compared to basal-bolus escalation.Side effects and safetyThe most common are GI symptoms (nausea, fullness, belching, diarrhea/constipation), more pronounced during initiation; it helps slow titration and lighter meals. With Soliqua

one should consider

a higher risk of hypoglycemia than with GLP-1 monotherapy (due to the presence of insulin) – education and careful titration are necessary. Caution with a history of pancreatitis and gallbladder disease I severe kidney damage (lixisenatide is mainly eliminated by the kidneys). Pregnancy/breastfeeding: application is not recommended.Regulatory statusLyxumia and Soliqua are prescription medications (Rx). Lixisenatide is a rational choice when it is necessary to accurately target PPG with simple once daily

 administration, while 

Soliqua is a practical solution when basal insulin is no longer sufficient, and we want to avoid a complex basal-bolus regimen and additional pounds.Frequently Asked QuestionsWhat is the main difference between Ozempic and Mounjaro?Do I have to inject with a needle or are there pills?Will I regain weight if I stop taking the medication?Can I get a prescription for Ozempic if I want to lose just 5-10 pounds?What are the most common side effects and how can I mitigate them?What is the cost of therapy at the Priska Med Polyclinic?

When can I expect the first results after starting therapy?

Are there other health benefits of these medications aside from their effects on sugar and weight?

Who should not take these medications? Are there any contraindications?

Patient expectations and general adaptation tips

When are the first effects seen?

Already in the first 

2-4 weeks

 many patients notice 

reduced appetite

 and more stable glucose levels after meals. 

Measurable weight loss

 usually occurs within 

4-8 weeks, while the main effect accumulates over 3-6 months (with dose titration and changes in habits). After that, a common plateau and stagnation is a normal physiological response. At that point, more accurate nutrition, targeted exercise, and, if necessary, dose adjustment help.The role of diet and physical activity (without this, the effects fade):Eat more slowly and reduce portions; choose proteins and fibers in every meal (satiety, muscle preservation).Prefer 

whole carbohydrates

•  and healthy fats; avoid "heavy" fatty meals during the titration phase.Drink at least 1.5 liters of water daily (prevents nausea, constipation, and energy drop).2-3 strength training sessions + 150 minutes of cardio training per week (protects metabolism and muscle mass).
• 7 or more hours of sleep and stress management reduce "emotional hunger".Limit alcohol (it increases nausea, disrupts sleep, and appetite).
• Why does weight return after stopping therapy?GLP-1/GLP-1+GIP therapy 
• suppresses appetite and reduces cravings. After 
• abruptly stopping, hormonal appetite signals return to baseline values making it 
• easier to eat more

. If habits haven't been adopted, 

partial weight regainoccurs. Therefore, do not stop therapy on your own initiative; plan a gradual exit with a clear nutrition and activity strategy.How to alleviate side effects:During titration: smaller, more frequent, and lighter meals, without "heavy" and fatty dishes.If nausea is present: ginger/mint tea, cooler meals, avoid large portions in the evening.For constipation: more water

, vegetables, and whole grains, fiber supplement if necessary; light walking after meals.

• If symptoms worsen, contact your doctor – sometimes slower titration or temporary dose reduction helps.
• Controls and dose adjustment (what to expect):
• Start and titration: contacts every 2-4 weeks
•  to stable dose.After stabilization: control every 

2-3 months

•  (weight, waist circumference, blood pressure), lab as planned (HbA1c, glucose, lipids; liver and kidney parameters if necessary).If you are on 
• insulin or sulfonylurea, the doctor may reduce the doseto reduce the risk of hypoglycemia.Are you planning for pregnancy or a procedure under anesthesia?Mandatory
• timely arrange a plan with your doctor.Missed dose and life organization:In case of a missed dose: take the dose as soon as you rememberif it is not near the end of the interval; otherwise skip it and continue regularly (do not double dose).
• Travel: bringan adequate number of doses, a reminder on your phone, and a dosing summary.

Diary: record your weekly weight, appetite, any side effects – this helps with adjustments.

• When to urgently contact a doctor:Persistent, severe pain in the upper abdomen(especially with nausea/vomiting), signs of dehydration,
• sudden vision disturbances, recurrent hypoglycemia, newly developed jaundice or dark urine.Alternative and complementary options
• Metformin – the cornerstone of T2D therapy

In type 2 diabetes,

• metforminremains the starting point: it reduces hepatic gluconeogenesis, has a favorable effect on weight (neutral or slight minus), and has a good safety profile. It is oftencombinedwith GLP-1 agonists; if metformin is

contraindicated

or poorly tolerated (e.g., GI issues despite gradual introduction and XR form), the doctor chooses an alternative.

SGLT2 inhibitorsMedications such asempagliflozinordapagliflozinreduce glucose reabsorption in the kidney and thereby lower glycemia and blood pressure withslight weight loss

. They are particularly useful due to

cardio-renal benefits(HF, CKD) in appropriate indications. They are oftencomplementaryto GLP-1 therapy.Lifestyle change – an essential foundationRegardless of medication,nutrition and movementmake the difference between temporary and lasting success. Focus onproteins and fibers in every meal, whole carbohydrates, healthy fats, andan energy deficit

tailored to individual consumption. The physical activity we can generally recommend includes

150+ min weeklyof aerobic training and2–3 strength training(to preserve muscle, increase glucose consumption). Sleep (at least 7–8 h) and stress reduction decrease hormonal triggers of hunger.Psychological support – addressing "hidden" triggersEmotional overeating, perfectionism, binge eating episodes, and stress triggers often sabotage the result.A brief cognitive-behavioral intervention, education, and self-regulation techniques increase adherence and help maintain effects after dose stabilization or potential discontinuation of medication.Bariatric surgery – when and for whom?In the case ofsevere obesity

(e.g.,

BMI ≥40or≥35

with comorbidities) and/or in cases of

failure of conservative treatment, bariatric procedures (e.g., "sleeve", bypass) providethe greatest and most lasting average weight lossand strongly impact T2D remission and risks. The choice depends on age, comorbidities, expectations, and willingness for lifelong monitoring and supplementation. Nevertheless, post-surgery, keynutritional and psychologicalcare remains essential.General overview:T2D without contraindications:metformin ± SGLT2; if necessary addGLP-1(or reverse order in case of high CV risk/weight).Primary targeting of weight reduction:GLP-1/GLP-1+GIP + lifestyle change; consider SGLT2 in metabolic risk.

Severe obesity or relapse after multiple attempts:

• evaluation forbariatrics.In every scenario:psychological support + maintenance plan after initial success.
• At Priska Med Polyclinic we workmultidisciplinary
• (over 25 specialties under one roof): endocrinology, nutrition, psychology, internal medicine, cardiology, and (if necessary) surgeons – to create arealistic, sustainableplan that does not stop at medication but changes habits and reduces long-term risk.Regulation and ethics
• All GLP-1 and GLP-1/GIP medications are available strictly by prescription (Rx)in Croatia and the EU. This means that they are prescribed

exclusively for approved indications– primarilytype 2 diabetes, and in some cases forweight managementwith clearly defined

BMI criteria and comorbidities.

Off-label use is possible only afterindividual medical assessment of benefits and risks, withinformed consent and monitoring plan; should never be initiated for marketing or "cosmetic" reasons without a medical basis.Due to global demand, there are occasionalsupply difficulties. Ethical priority in such circumstances is given topatients with clear medical needs (e.g., T2D with poor control or high-risk metabolic profiles). This includes rational prescribing, avoiding "stacking" therapies, and planned monitoring to prevent treatment interruptions.Medical supervision is not a formality. Therapy requiresdose titration, monitoring

HbA1c/glucose levels, body weight, blood pressure, lipids, as well asside effects (GI issues, rarely bile/pancreatitis). Inpregnancy and breastfeeding

, these medications arenot recommended; conception planning should be discussed with a doctor and treatment adjusted in a timely manner. For patients withdiabetic retinopathy, it is necessary to coordinate the pace of glycemic improvement with an ophthalmologist. Combinations withsulfonylureas or insulin require dose adjustments due to the risk ofhypoglycemia.Safety and legally risky practices should beavoided without exception: procurement throughunofficial online channels, use ofcounterfeit or unregistered products, sharing pens between individuals, "microdosing" without supervision, as well as "circles" of advice on social media that substitute for professional oversight. Such practices increase the risk ofserious complications and legal consequences.

Finally, even when the goal is primarilyweight reduction, the ethical framework requiresa holistic approach: realistic expectations, work on nutrition and behavior, psychological support if needed, and clear criteriawhen to start, continue, or discontinue therapy. The drug is not a "quick fix", but a tool withinmedically indicated and monitored plans that protects the patient, ensures sustainable results, and maintains availability for those who need it most.

"Weight loss medications" at Priska Med PolyclinicAt Priska Med Polyclinic, we manage GLP-1 (and GLP-1/GIP) therapymultidisciplinary: an endocrinologist sets the indication and titration plan,a nutritionist creates a sustainable meal plan tailored to needs and lifestyle,a psychologist helps manage habits, stress, and "emotional hunger", whilean internist

coordinates the cardiometabolic assessment (blood pressure, lipids, liver, kidneys). At the beginning, we define

clear goals (HbA1c, weight, waist circumference, fitness), agree onmonthly check-ups during the introduction phase and less frequently after stabilization, with education on nutrition, activities, and practical advice for therapy tolerance. Each plan ispersonalized – we adjust the dose, pace, and support to your life rhythm, comorbidities, and motivation. We do everythingdiscreetly, without waiting lists, in a comfortable environment and with an emphasis onsafety and sustainable results.Do you want an assessment of therapy and a personalized treatment plan? Book your appointment at Priska Med Polyclinic – without waiting lists:📍 Through Smrdečac 45, Split📞 021 44 33 44📧 poliklinika@priska-med.com💻 Directly via our contact formReferences

ozempic-mounjaro-and-glp-1-agonists-weight-loss-medications Rezervirajte svoj termin u Poliklinici Priska Med – bez listi čekanja:

📍 Kroz Smrdečac 45, Split
📞 021 44 33 44
📧 poliklinika@priska-med.com
💻 Izravno putem naše kontakt forme

Reference