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DOAC missed dose — GPhC CRA MCQ

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HardCardiovascular TherapeuticsDOAC missed doseGPhC CRA

A patient using semaglutide has recovered from an admission in which acute pancreatitis was confirmed. They ask to restart at a lower dose because their abdominal pain and lipase have normalised. What is the best response?

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Correct answer: B — Do not restart semaglutide after confirmed pancreatitis; arrange alternative management

MHRA advice is to stop a GLP-1 or dual GLP-1/GIP receptor agonist immediately if pancreatitis is suspected and not restart it when pancreatitis is confirmed. Clinical and biochemical recovery does not create a lower-dose rechallenge pathway. Switching within these classes is not a way around the warning, and neither device choice nor routine lipase monitoring makes rechallenge appropriate. Alternative diabetes or weight-management treatment requires clinical review.

Reference: MHRA GLP-1 pancreatitis warning: https://www.gov.uk/drug-safety-update/glp-1-receptor-agonists-and-dual-glp-1-slash-gip-receptor-agonists-strengthened-warnings-on-acute-pancreatitis-including-necrotising-and-fatal-cases