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GLP-1 RA Gastroparesis Worsening — ESENeph MCQ

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ModerateDiabetic Kidney DiseaseGLP-1 RA Gastroparesis WorseningESENeph

A 55-year-old man with CKD G4 and diabetes develops gastroparesis with recurrent vomiting. He is on Metformin, Dapagliflozin, and Semaglutide. Which medication most likely contributes to gastroparesis and what adjustment is needed?

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Correct answer: E — Semaglutide (GLP-1 RA) delays gastric emptying as part of its mechanism – this can worsen pre-existing gastroparesis; dose reduction or switching to a shorter-acting GLP-1 RA or alternative agent should be considered

GLP-1 RAs delay gastric emptying as a key part of their mechanism of action (contributing to appetite suppression and post-prandial glucose control). In patients with pre-existing diabetic gastroparesis, this can significantly worsen symptoms (nausea, vomiting, early satiety, abdominal bloating). ASA 2023 guidelines also raised concerns about aspiration risk under anaesthesia due to delayed gastric emptying. Management includes: dose reduction, switching to a shorter-acting GLP-1 RA (Liraglutide daily vs Semaglutide weekly), or switching to a different drug class (DPP-4i has minimal gastric emptying effect).

Reference: KDIGO 2024 – CKD; ASA 2023 – GLP-1 RA; BNF – Semaglutide