Switching GLP-1 Medications: What the Labels and Guidelines Say
No dose-conversion chart between different GLP-1 molecules appears in the FDA labels reviewed here. In these labels, switching instructions appear only within the semaglutide family and before starting fixed-ratio insulin combos. Up to one-fourth of patients switch off their first GLP-1 after year one.
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No dose-conversion chart for switching between different GLP-1 medications appears in the FDA prescribing labels reviewed here — Trulicity, Soliqua 100/33, Xultophy 100/3.6, and the oral semaglutide label covering Rybelsus and Ozempic tablets [2] [3] [4] [5]. In these labels, the only switching instructions that appear are within the semaglutide oral/injection family, and for stopping a GLP-1 or basal insulin before starting a fixed-ratio insulin combination pen [2] [3] [4].
That does not mean switching is rare or off-limits. Pharmacy data suggest that up to one-fourth of patients switch from their initial GLP-1 receptor agonist to another glucose-lowering agent after the first year of treatment, and a 2020 review in Clinical Diabetes was written precisely because practical guidance on managing these transitions is scarce [1]. What it means is that the specific starting dose, timing, and stop date for a cross-molecule switch are prescriber decisions, not something any of these labels spells out.
How common is switching between GLP-1 medications?
According to pharmacy data cited in a review by Almandoz, Lingvay, Morales, and Campos (Clin Diabetes 2020;38(4):390–402), up to one-fourth of patients move off their initial GLP-1 receptor agonist to another glucose-lowering agent after the first year of treatment [1]. Some of those patients switch to a different GLP-1 receptor agonist, and the review notes this may occur for several reasons — but the authors’ stated motivation for writing it was that practical guidance on how to safely and effectively manage such a transition is scarce [1].
The same review emphasizes that although GLP-1 receptor agonists belong to a single medication class, the approved agents differ in structure, molecular size, pharmacology, efficacy, and safety [1]. That is the core reason no simple equivalence table exists: the drugs are not interchangeable units of the same thing.
Why is switching GLP-1s not like-for-like?
The GLP-1 receptor agonists sold in the United States fall into two structural groups. Dulaglutide, liraglutide, and semaglutide are analogs of human GLP-1, while exenatide and lixisenatide are exendin-based [1]. Albiglutide was also approved but has since been withdrawn for commercial reasons [1].
They also differ in how often they are taken:
| Agent | Derivation | How it is taken |
|---|---|---|
| Liraglutide | Human GLP-1 analog | Subcutaneous, once daily [1] |
| Lixisenatide | Exendin-based | Subcutaneous, once daily [1] |
| Exenatide | Exendin-based | Subcutaneous, twice daily [1] |
| Dulaglutide | Human GLP-1 analog | Subcutaneous, once weekly [1] |
| Semaglutide (injection) | Human GLP-1 analog | Subcutaneous, once weekly [1] |
| Exenatide extended release | Exendin-based | Subcutaneous, once weekly [1] |
| Semaglutide (tablets) | Human GLP-1 analog | Oral, once daily [1] |
The chemistry explains the differences. Native GLP-1 circulates for only a few minutes, so the molecule has to be altered — amino acid changes or side chain additions — to resist breakdown by the enzyme DPP-4 [1]. Once-weekly dosing was achieved either by attaching heavy chain fragments that slow degradation (dulaglutide and subcutaneous semaglutide) or by formulating an extended-release preparation, as with exenatide [1]. A once-daily oral formulation of semaglutide has been approved in the United States [1].
The approved agents differ in structure, molecular size, and pharmacology [1], and none of the labels reviewed here equates a dose of one molecule with a dose of another [2] [3] [4] [5]. In other words, a milligram of one drug does not map onto a milligram of another — and none of these labels treats it as if it does.
What does the oral semaglutide label say about switching?
The label for Rybelsus and Ozempic tablets is the one place among these labels that explicitly addresses switching, and only within the semaglutide family. It directs readers to the Full Prescribing Information for instructions on switching between Rybelsus and Ozempic tablets (section 2.3) and from semaglutide injection (section 2.4) [2]. The label also states plainly that Rybelsus and Ozempic tablets are not substitutable on a mg-to-mg basis [2].
The label’s own titration schedule for oral semaglutide runs in steps [2]:
| Time period | Dose |
|---|---|
| Days 1–30 | 3 mg orally once daily (starting dose; not effective for glycemic control) [2] |
| Days 31–60 | 7 mg orally once daily [2] |
| Day 61 or later | Maintain 7 mg, or increase to 9 mg once daily if more glycemic control is needed [2] |
Administration rules are strict: once daily, on an empty stomach in the morning, with water only (up to 4 ounces), swallowed whole — not split, crushed, chewed, or dissolved — and then at least 30 minutes before food, other drinks, or other oral medications [2].
The tablets are indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes, and to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes at high risk for those events [2]. The label carries a boxed warning about thyroid C-cell tumors in rodents, and the drug is contraindicated in people with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 [2]. The label’s recent changes are dated: Indications and Usage 10/2025 and Dosage and Administration 12/2025 [2].
What has to happen before starting Soliqua or Xultophy?
The fixed-ratio combination pens — insulin plus a GLP-1 in one injection — are the other place where these labels give explicit switching instructions, and the instruction is to stop, not overlap.
Soliqua 100/33 (insulin glargine plus lixisenatide) requires that basal insulin or a GLP-1 receptor agonist be discontinued prior to initiation, and its limitations of use state that concomitant use with any other product containing a GLP-1 receptor agonist is not recommended [3]. Xultophy 100/3.6 (insulin degludec plus liraglutide) likewise requires discontinuing liraglutide or basal insulin before starting, and is not recommended in combination with any other product containing liraglutide or another GLP-1 receptor agonist [4]. One caveat on the Xultophy figures below: the label reviewed here is the revision dated June 2022, and the source itself carries a notice that it may not be the latest version approved by the FDA, so current labeling should be checked before relying on these numbers [4].
The starting doses differ by prior treatment:
| Product | Starting dose | Maximum daily dose |
|---|---|---|
| Soliqua 100/33 | 15 units once daily if naive to basal insulin or GLP-1 RA, on less than 30 units of basal insulin, or on a GLP-1 RA; 30 units once daily if inadequately controlled on 30–60 units of basal insulin [3] | 60 units (60 units glargine + 20 mcg lixisenatide); pen delivers 15–60 units [3] |
| Xultophy 100/3.6 (June 2022 label revision; source notes it may not be the latest FDA-approved version) | 10 units (10 units degludec + 0.36 mg liraglutide) if naive to basal insulin or GLP-1 RA; 16 units (16 units degludec + 0.58 mg liraglutide) if currently on basal insulin or a GLP-1 RA [4] | 50 units (50 units degludec + 1.8 mg liraglutide); each dose unit = 1 unit degludec + 0.036 mg liraglutide [4] |
Both combination labels carry a medication-error and overdose warning telling patients not to exceed the maximum dose or use the product with other GLP-1 receptor agonists [3] [4].
What does a single-drug label cover — and not cover?
Trulicity (dulaglutide) is a useful example of what a typical single-molecule GLP-1 label contains. Its adult dosing section sets a starting dose of 0.75 mg injected subcutaneously once weekly; after 4 weeks the dose may be increased to 1.5 mg once weekly for additional glycemic control; further increases happen in 1.5 mg increments after at least 4 weeks on the current dose; and the maximum is 4.5 mg once weekly [5]. It comes in 0.75, 1.5, 3, and 4.5 mg per 0.5 mL single-dose pens [5].
The label also covers missed doses: if a dose is missed, it should be administered as soon as possible if there are at least 3 days (72 hours) until the next scheduled dose [5].
What the Trulicity label does not contain is any section on converting from another GLP-1 receptor agonist. Its table of contents covers adult and pediatric dosing, missed doses, and administration — nothing about switching from a different molecule [5]. Trulicity is indicated in adults and pediatric patients 10 years and older with type 2 diabetes, and to reduce the risk of major adverse cardiovascular events in adults with established cardiovascular disease or multiple cardiovascular risk factors [5].
What do professional guidelines say about switching?
The American Diabetes Association released its Standards of Care in Diabetes—2026 on December 8, 2025 [6] [7]. The pharmacologic treatment section — Section 9, Pharmacologic Approaches to Glycemic Treatment, published in Diabetes Care 2026;49(Supplement 1):S183–S215 — is the relevant chapter for glucose-lowering drug choices [7]. The 2026 update adds new guidance on obesity pharmacotherapy dose individualization in people with diabetes, and additional guidance on glucose-lowering therapy beyond glycemia, including heart, kidney, and liver benefits, and use in chronic kidney disease including dialysis [6]. The Standards of Care are updated annually and function as a “living” document, updated online in real time to reflect new evidence and regulatory changes [6] [7].
On choosing agents, the ADA/EASD and AACE/ACE consensus recommendations cited in the 2020 review place GLP-1 receptor agonists among the options for second-line treatment when glucose is not controlled on metformin [1]. In people with type 2 diabetes and atherosclerotic cardiovascular disease or chronic kidney disease, a GLP-1 receptor agonist or SGLT2 inhibitor with proven cardiovascular benefit is recommended as first-line therapy for reducing cardiovascular risk [1]. GLP-1 receptor agonists may also be first-line when metformin cannot be used, including when reduced renal function precludes metformin — with human-based agents only [1]. The recommendations favor GLP-1 receptor agonists partly because of low hypoglycemia risk and weight loss [1].
The guideline updates described in these materials concern which therapies to choose and for whom — dose individualization, and heart, kidney, and liver benefits — not dose conversion between GLP-1 molecules [6].
What side effects should you expect when starting a different GLP-1?
The most common adverse reactions with Trulicity (incidence of 5% or more) are nausea, diarrhea, vomiting, abdominal pain, and decreased appetite [5]. Soliqua’s most common reactions include hypoglycemia, nausea, nasopharyngitis, diarrhea, upper respiratory tract infection, and headache [3].
Class-level warnings appear across the labels: acute pancreatitis, acute kidney injury from volume depletion, acute gallbladder disease, severe gastrointestinal adverse reactions, and pulmonary aspiration during general anesthesia or deep sedation [3] [5]. Trulicity and Soliqua are both not recommended in patients with severe gastroparesis [3] [5].
Hypoglycemia risk rises when a GLP-1 is used together with insulin or an insulin secretagogue, and reducing the dose of the secretagogue or insulin may be necessary [5]. GLP-1s also delay gastric emptying, which can change the absorption of oral medications [5]. The Soliqua label gives specific timing for this: oral contraceptives, some antibiotics, and acetaminophen should be taken at least 1 hour before or 11 hours after the injection [3]. The oral semaglutide label notes that diabetic retinopathy complications were reported in a cardiovascular outcomes trial with semaglutide injection, and that patients with a history of diabetic retinopathy should be monitored [2].
What questions should you ask before switching?
A switch appointment is a good place to get specific. Based on what the labels and the 2020 review actually cover, useful questions include:
- Why switch? The review notes that patients may switch GLP-1 receptor agonists for several reasons; being clear with your clinician about what is prompting the change is the starting point [1].
- What starting dose, and does titration restart? Every label sets dosing through prescriber-directed escalation schedules, so the answer comes from your clinician applying the new drug’s label, not from a conversion table [2] [5].
- When does the old drug stop? These labels specify discontinuation timing only before the fixed-ratio combinations and within the semaglutide family; outside those cases, the stop date is a clinical decision [2] [3] [4].
- What cardiovascular indication might change? Dulaglutide and oral semaglutide both carry indications to reduce major adverse cardiovascular event risk, with differing wording — worth confirming what you would be giving up [2] [5].
- What if control worsens or reactions occur? The Soliqua label advises considering alternative antidiabetic therapy if glycemic control worsens or significant injection-site or allergic reactions occur — a fair question for any switch [3].
Prescribing decisions — dose, timing, washout — belong to the clinician; none of the reviewed labels hands that decision to a chart.
What do the labels rule out?
A few things are explicit in the source documents:
- Taking two GLP-1-containing products together is not recommended, per both fixed-ratio combination labels [3] [4].
- There is no overlap or taper into Soliqua or Xultophy — the prior GLP-1 receptor agonist or basal insulin must be discontinued first [3] [4]. (The Xultophy instruction comes from the June 2022 label revision, which the source notes may not be the latest FDA-approved version [4].)
- Mg-to-mg substitution between the two oral semaglutide brands is explicitly ruled out by the label [2].
- No switching sequence appears in the labels reviewed here other than each product’s own labeled titration schedule [2] [5].
What’s the takeaway on switching GLP-1 medications?
No cross-molecule GLP-1 conversion chart appears in any label reviewed here [2] [3] [4] [5]. Up to one in four patients are off their first GLP-1 receptor agonist after year one [1]. The ADA’s Standards of Care in Diabetes—2026, released December 8, 2025, is a living document updated in real time, and its pharmacologic section guides which drugs to choose — not how to convert between them [6] [7].
Sources
- PubMed Central. Switching Between Glucagon-Like Peptide-1 Receptor Agonists: Rationale and Practical Guidance.
- US Food and Drug Administration. RYBELSUS and OZEMPIC prescribing information. 2026.
- US Food and Drug Administration. SOLIQUA 100/33 (insulin glargine and lixisenatide) injection prescribing information. 2025.
- US Food and Drug Administration. XULTOPHY 100/3.6 (insulin degludec and liraglutide) injection prescribing information. 2022.
- US Food and Drug Administration. TRULICITY (dulaglutide) injection prescribing information. 2025.
- American Diabetes Association. The American Diabetes Association Releases “Standards of Care in Diabetes—2026”. December 8, 2025.
- Diabetes Care. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2026. January 2026.
- US Food and Drug Administration. FDA Approves First Generic of Once-Daily GLP-1 Injection to Lower Blood Sugar in Patients with Type 2 Diabetes.
- Medicaid.gov. NADAC (National Average Drug Acquisition Cost) 2026. Updated September 8, 2026.
- Federal Register. Teva Branded Pharmaceutical Products R&D, Inc., et al.; Withdrawal of Approval of 39 New Drug Applications. August 4, 2025.
- UnitedHealthcare Provider. Discontinuation of Bydureon BCise and Byetta. December 19, 2024.
- Novo Nordisk. Prescription Weight-Loss Medicine | Saxenda (liraglutide) injection 3mg.
- US Food and Drug Administration. 2024 First Generic Drug Approvals.
Frequently asked questions
Is there an FDA-approved chart converting one GLP-1 dose to another?
No. None of the FDA labels reviewed here — Trulicity, Soliqua, Xultophy, and the oral semaglutide label — contains a dose-equivalence table between different GLP-1 molecules. Each label only sets its own starting dose and titration schedule. Any cross-molecule starting dose is a prescriber decision, not a chart lookup.
Can you take two GLP-1 medications at the same time?
No. Both fixed-ratio combination labels state that use with any other GLP-1 receptor agonist product is not recommended, and both warn against exceeding the maximum dose or using other GLP-1 receptor agonists. Before starting Soliqua or Xultophy, the prior GLP-1 or basal insulin must be discontinued — there is no overlap or taper.
Do you restart at the lowest dose when switching to a different GLP-1?
The labels reviewed here do not answer this directly, because no cross-molecule conversion appears in them. Each product's label sets its own prescriber-directed escalation schedule — for example, Trulicity starts at 0.75 mg weekly with increases after at least 4 weeks, and oral semaglutide starts at 3 mg daily for 30 days. Whether a switch restarts titration is a clinician's call.
How long should the gap be between the old drug and the new one?
No reviewed label specifies a washout interval between different GLP-1 molecules. The only labeled discontinuation instructions in these documents are before the fixed-ratio combinations — stop the prior GLP-1 or basal insulin before starting Soliqua or Xultophy — and within the semaglutide family, where the label points to sections 2.3 and 2.4 of the Full Prescribing Information.
Can you switch between the two oral semaglutide brands mg for mg?
No. The label states that Rybelsus and Ozempic tablets are not substitutable on a mg-to-mg basis, and directs readers to the Full Prescribing Information for switching instructions between the tablets (section 2.3) and from semaglutide injection (section 2.4). The specific instructions live in those sections of the full label.
What does the Trulicity label say about missed doses and starting doses?
Trulicity's adult starting dose is 0.75 mg injected subcutaneously once weekly; after 4 weeks it may increase to 1.5 mg, then in 1.5 mg increments after at least 4 weeks each, up to a maximum of 4.5 mg once weekly. A missed dose should be taken as soon as possible if at least 3 days (72 hours) remain before the next scheduled dose.
What has to happen before starting Soliqua or Xultophy?
Soliqua 100/33 requires discontinuing basal insulin or a GLP-1 receptor agonist before initiation, with a maximum of 60 units daily (60 units glargine plus 20 mcg lixisenatide). Xultophy 100/3.6 requires discontinuing liraglutide or basal insulin first, with a maximum of 50 units daily (50 units degludec plus 1.8 mg liraglutide) — figures from the June 2022 label revision, which the source notes may not be the latest FDA-approved version. Neither may be used with another GLP-1 product.
Will nausea come back when changing GLP-1s?
Nausea is among the most common reactions across the class — Trulicity lists nausea, diarrhea, vomiting, abdominal pain, and decreased appetite at 5% or more incidence, and Soliqua lists nausea and diarrhea among its most common reactions. Whether symptoms return after a switch depends on the agent and dose chosen, which is a question for the prescriber.
This article summarizes FDA labeling, published research and company information current as of September 14, 2026. It is not medical advice and does not replace a conversation with your own healthcare provider. How we research and verify.