Switching GLP-1 Medications: What the Guidelines and Labels Actually Say

If you type “GLP-1 conversion chart” into a search bar, you will get results. Most of them are made up.

Here is the situation as it actually stands in September 2026: the FDA has not approved a single dose-equivalence table between different GLP-1 molecules. There is no official answer to “what dose of Ozempic equals my dose of Trulicity.” The charts circulating online are someone’s estimate, and some of them are wrong in ways that matter.

What does exist is a small body of published guidance, some very specific label instructions that apply within a single molecule, and a lot of accumulated clinical practice. This article walks through all of it.

This is not medical advice, and it is not a set of instructions to follow. It describes what the labels, the guidelines and the published literature say. Any change to your medicine is a decision for you and a healthcare provider.

Why do people switch GLP-1s in the first place?

The published guidance most often cited in the US is a 2020 review in Clinical Diabetes by Almandoz and colleagues, written specifically to fill this gap. It notes that pharmacy data suggest up to a quarter of patients move off their first GLP-1 receptor agonist within a year [1].

The reasons fall into four buckets:

Results. The drug is not lowering A1C or weight enough, even at the maximum dose.

Side effects. Nausea, vomiting, diarrhea or injection-site reactions that do not settle. Some people tolerate one GLP-1 and not another, which is one of the documented reasons clinicians switch [1].

Convenience. Moving from a daily injection to a weekly one, or from an injection to a tablet.

Money and coverage. By far the most common reason in practice. A plan drops a drug from its preferred list, a copay changes, a savings card expires, or the product is discontinued outright.

That last category is worth sitting with. Many GLP-1 switches in the US are not clinical decisions at all. They are administrative ones, and the patient and prescriber are reacting to them.

What do the labels actually say about switching?

Very little, and only within a single molecule. Here is the complete set of labeled switching instructions in the US GLP-1 class.

Between the two semaglutide tablets. The semaglutide tablet label includes a dedicated switching section. It says not to switch between Rybelsus and Ozempic tablets during the initiation phase, days 1 to 30. After those 30 days, patients may switch, and the label gives a table: Rybelsus 7 mg corresponds to Ozempic tablets 4 mg, and Rybelsus 14 mg corresponds to Ozempic tablets 9 mg. When switching, the label says to start the new tablet the day after stopping the old one [2].

From semaglutide injection to a semaglutide tablet. The same label says patients taking the 0.5 mg dose of Ozempic injection may switch to tablets, and that one week after the last injection they start either Rybelsus 7 mg or 14 mg, or Ozempic tablets 4 mg or 9 mg [2]. Note what is not there: no instruction for switching from the 1 mg or 2 mg injection doses, and no instruction for going the other direction.

Into a fixed-ratio insulin combination. Both Soliqua 100/33 and Xultophy 100/3.6 labels require that basal insulin or a GLP-1 receptor agonist be discontinued before starting [3][4]. You do not taper one into the other. You stop, then you start.

That is the entire list. The Trulicity label, for example, gives detailed instructions for missed doses and for changing the weekly injection day, but says nothing about converting from another GLP-1 [5].

So when a prescriber moves you from Trulicity to Ozempic, or from liraglutide to tirzepatide, they are not following a labeled conversion. They are making a clinical judgment.

What do professional guidelines recommend?

The American Diabetes Association’s Standards of Care, updated annually and maintained as a living document, is the main US reference for diabetes treatment. The 2026 edition, released December 8, 2025, added guidance on individualizing obesity pharmacotherapy doses in people with diabetes and updated its position to specify that a GLP-1 receptor agonist with demonstrated benefit is preferred for glycemic management in the appropriate patients [6][7].

What the Standards do not provide is a switching algorithm between specific agents. Neither does any other major US society guideline. That gap is why the Almandoz review is cited as often as it is.

Its practical points, in plain English [1]:

• Long-acting beats short-acting. Long-acting GLP-1 receptor agonists generally produce larger reductions in A1C, fasting glucose and body weight than short-acting ones. That is part of why exenatide twice daily and lixisenatide once daily lost ground.
• Two are not combined. The review states that taking two GLP-1 receptor agonists together is not recommended, and no US label describes a combination of two.
• Restarting low is common. When moving to a more potent agent, restarting titration from a low dose is common practice, because gastrointestinal side effects track dose escalation rather than the drug itself.
• Set expectations before the switch. People who have already adapted to one GLP-1 often assume the new one will feel the same. It frequently does not, at least at first.

Does switching from a brand to its generic count as switching?

No, and this is worth being clear about because liraglutide is now the most genericized GLP-1 in the US.

Teva launched an authorized generic of Victoza on June 24, 2024 — the first generic GLP-1 in the country — and on December 23, 2024 the FDA announced approval of the first true ANDA generic of Victoza, to Hikma [8]. By September 2026 the FDA’s directory lists liraglutide products from Teva, Hikma, Meitheal, Lupin, NorthStar Rx, Cipla, Biocon, Orbicular and Hybio.

Moving from Victoza to generic liraglutide is a substitution of the same molecule at the same dose. There is no titration decision and no new drug to adapt to.

One caveat: some liraglutide generics reference Victoza, the type 2 diabetes product, and some reference Saxenda, the weight-management product. The approved indications and the maximum dose differ. If you are handed a generic liraglutide, it is reasonable to ask the pharmacist which product it references.

The money involved is real. Generic liraglutide for diabetes runs about $32.00 per milliliter at pharmacy acquisition cost for the three-pack, effective August 19, 2026, roughly 64 percent below brand Victoza at $87.81 on the same date [9]. Those are acquisition costs, not patient prices, but the gap is why plans push the substitution.

What happens when your GLP-1 is discontinued?

This has now happened twice in the class, and it is the cleanest example of a switch nobody chose.

Byetta and Bydureon. AstraZeneca stopped marketing Byetta on October 25, 2024 and Bydureon BCise on October 28, 2024. The FDA formally withdrew approval of all three exenatide applications effective September 3, 2025, at the company’s own request — an administrative action, explicitly not a safety withdrawal [10]. Product already in inventory could be dispensed until it ran out or expired.

UnitedHealthcare’s provider notice of December 19, 2024 shows how a large payer handled the fallout. It told prescribers the products were being discontinued and listed the GLP-1s that remained preferred on its commercial plans — Mounjaro, Ozempic, Rybelsus, Trulicity and liraglutide — with a shorter list on its ACA marketplace plans [11].

Patients on twice-daily Byetta at least had a same-molecule option: the FDA approved Amneal’s generic exenatide under ANDA 206697 on November 19, 2024, and its FDA product listing shows marketing beginning November 22, 2024 [8][13]. Patients on weekly Bydureon BCise had nothing equivalent, because no generic weekly exenatide exists. They had to change molecules.

Saxenda. Novo Nordisk has given advance notice that it is discontinuing Saxenda, with last shipments to wholesalers in late January 2027 [12]. Generic liraglutide 3 mg for weight management, approved and launched by Teva on August 28, 2025, remains available, so there is a same-molecule path here — but as with any generic, availability by manufacturer moves around.

If your medicine is on one of these lists, the practical advice is mundane and important: raise it at a routine appointment rather than when you have three days of medicine left, because prior authorizations take time.

How should you think about a switch you are considering?

Some questions that are worth bringing to the appointment:

Why are we switching? If the answer is “your A1C is not at goal,” the next drug should plausibly be stronger. If the answer is “you cannot tolerate it,” a stronger drug may not help. If the answer is “your plan changed,” that is worth naming out loud, because a formulary exception is sometimes possible.

What are we starting at? Ask specifically, and ask whether you are restarting the escalation ladder. There is no conversion chart, so the answer is a judgment and you are entitled to hear the reasoning.

When do I stop the old one? The labels only answer this inside the semaglutide family — for example, the tablet label’s one-week interval after a 0.5 mg Ozempic injection. Everywhere else the labels are silent, which means the date is a clinical judgment rather than a labeled instruction.

What should I expect for the first month? Gastrointestinal side effects on a new escalation are common and usually settle. Knowing that in advance is the difference between riding it out and abandoning the drug.

What am I giving up? Some GLP-1s carry cardiovascular indications and some do not, and the wording differs. Liraglutide’s LEADER trial showed a reduction in cardiovascular death; dulaglutide’s REWIND trial showed a reduction in major cardiovascular events driven mainly by fewer strokes, in a population largely without established heart disease. If one of those is part of why you are on your current drug, the switch is not only about weight and A1C.

What do the source documents rule out?

Four things that come up constantly are addressed, directly or by omission, in the labels and the published guidance.

Overlapping two GLP-1s. No US label describes taking two GLP-1 receptor agonists at once. The Almandoz review states plainly that the combination is not recommended, and the Soliqua and Xultophy labels require any prior GLP-1 receptor agonist to be discontinued before the combination pen is started — not tapered, not overlapped [1][3][4].

Setting a starting dose from a chart. There is no FDA-approved dose-equivalence table between GLP-1 molecules, so no chart found online carries regulatory weight. Every label directs that dosing be set by the prescriber, and the escalation schedules in the Instructions for Use are the only sequences the FDA has reviewed.

Substituting a compounded or gray-market product. Compounded GLP-1 products are not FDA-approved, are not covered by any of these labels, and the FDA has warned about dosing errors with them. Nothing in the guidance discussed here applies to them.

Leaving an unplanned gap. The guidance frames the interval between agents as part of the switch to be decided in advance, not an outcome to be discovered. For type 2 diabetes in particular, the labels describe glycemic control as the purpose of continuous therapy [1].

None of the above is a direction to you. It is a summary of what the FDA-approved labels, the FDA-approved Instructions for Use and the published guidance contain — your own prescription and your own prescriber govern what you actually do.

What is the short version?

There is no official conversion chart between GLP-1 molecules, and anyone presenting one as authoritative is guessing. The labels only describe switching within the semaglutide family and into the insulin combinations. The published guidance says long-acting agents outperform short-acting ones, that two GLP-1s should not be combined, and that restarting low on a more potent agent is common practice.

Most real-world switches are driven by cost, coverage or a product leaving the market rather than by trial data. That does not make them wrong, but it does mean the reasoning deserves to be said out loud at your appointment rather than assumed.

Sources

1. Switching Between Glucagon-Like Peptide-1 Receptor Agonists: Rationale and Practical Guidance, Clinical Diabetes, 2020
2. RYBELSUS and OZEMPIC (semaglutide) tablets — US prescribing information, US Food and Drug Administration, 2026
3. SOLIQUA 100/33 (insulin glargine and lixisenatide injection) — US prescribing information, US Food and Drug Administration
4. XULTOPHY 100/3.6 (insulin degludec and liraglutide injection) — US prescribing information, US Food and Drug Administration
5. TRULICITY (dulaglutide) injection — US prescribing information, US Food and Drug Administration
6. American Diabetes Association Releases Standards of Care in Diabetes 2026, American Diabetes Association, December 8, 2025
7. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes 2026, Diabetes Care, 2026
8. FDA Approves First Generic of a Once-Daily GLP-1 Injection to Lower Blood Sugar in Patients with Type 2 Diabetes, US Food and Drug Administration
9. NADAC (National Average Drug Acquisition Cost), Centers for Medicare & Medicaid Services
10. Withdrawal of Approval of 39 New Drug Applications, Federal Register, August 4, 2025
11. Discontinuation of Bydureon BCise and Byetta, UnitedHealthcare, December 19, 2024
12. Saxenda (liraglutide) injection 3 mg — official site, discontinuation notice, Novo Nordisk
13. 2024 First Generic Drug Approvals (ANDA 206697, exenatide injection, approved November 19, 2024), US Food and Drug Administration