FDA Side Effect Updates FDA SIDE EFFECTS UPDATE: Kidney Risks Tied to Dehydration From GLP-1 Drugs

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<p>Welcome to the FDA Side Effects Update. This series is designed to keep you informed about the latest safety advisories and newly documented side effects of your medications. In this installment, we’re highlighting safety updates concerning these drugs: Byetta, Bydureon BCISE, Mounjaro, Saxenda, Soliqua 100/33, Trulicity, Victoza, and Xultophy 100/3.6.</p>
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<div class="wp-block-myplugin-custom-alignment-block alignright"><h2>How to Read This Report</h2><p>This report is prepared using the most recent information posted in the <a href="https://www.accessdata.fda.gov/scripts/cder/safetylabelingchanges/index.cfm" target="_blank" rel="noreferrer noopener">SrLC database</a>. It highlights recent safety labeling changes. It includes only newly reported side effects and safety information; additional side effects and warnings will appear on the drug label. Not all recent changes to the SrLC database or the label may be listed here. For all changes and the complete list of warnings and side effects, please click on the drug label link.<br><br>Each of the items (approval and update dates, drug names, etc.) contained in this report are obtained from the SrLC. The side effects and medication descriptions are simplified and made clearer, if needed. Sometimes, additional sources, like a medical dictionary, may be used to translate technical medical phrases. Other sources (company news, FDA press releases, etc.) may be used to learn about some label changes. </p></div>
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<h1 class="wp-block-heading" id="h-side-effect-update-for-glp-1-receptor-agonists">Side Effect Update for GLP-1 Receptor Agonists</h1>
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<p>The FDA is requiring that Glucagon-like peptide-1 (GLP-1) drug labels include updated warnings about the risk of serious kidney injury associated with the drugs’ gastrointestinal effects. Side effects like diarrhea, nausea, and vomiting may cause severe dehydration or “<a href="https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/fluid-metabolism/volume-depletion" target="_blank" rel="noreferrer noopener">volume depletion</a>,” leading to kidney injury. Some reported cases of kidney injury have required <a href="https://medlineplus.gov/ency/patientinstructions/000707.htm" target="_blank" rel="noreferrer noopener">hemodialysis</a> treatment.</p>
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<p>Healthcare providers are advised to monitor renal (kidney) function in patients reporting adverse reactions that could lead to severe dehydration, especially when the drug is first started and doses are escalated. Signs of potential kidney injury include persistent (or extended) nausea, vomiting, and diarrhea.</p>
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<p>The FDA also required changes to the labels to achieve a more uniform presentation of side effects and risk information for all of the drugs in the GLP-1 category, including adding or changing subsections for “Acute Pancreatitis” and “Severe Gastrointestinal Adverse Reactions” and revising the “Patient Counseling” section and “Medication Guide.” Some of the labels were also updated with post-marketing reports of hair loss (alopecia) and the neurological symptom of “altered sense of touch,” or <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/dysesthesia" target="_blank" rel="noreferrer noopener">dysethesia</a>. Read the revised labels for all changes and additions.</p>
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<p>The following safety label changes were made in response to an FDA letter (like this <a href="https://www.accessdata.fda.gov/drugsatfda_docs/appletter/2025/215866Orig1s031ltr.pdf" target="_blank" rel="noreferrer noopener">notification letter</a> for Mounjaro) informing drug sponsors of the required warning updates. Ozempic, Rybelsus, Wegovy, and Zepbound were not included in the most recent updates because their labels already included the required safety information. Each treatment listed below is administered by subcutaneous injection (a shot directed at fatty tissue just under the skin) and, unless otherwise specified, is administered weekly.</p>
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<h3 class="wp-block-heading" id="h-byetta-active-ingredient-exenatide-synthetic-subcutaneous-injection-bydureon-bcise-extended-release-subcutaneous-injection-active-ingredient-exenatide-synthetic">Byetta (active ingredient: exenatide synthetic) subcutaneous injection; Bydureon BCISE extended-release subcutaneous injection (active ingredient: exenatide synthetic)</h3>
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<p><strong>Initial FDA Approval</strong>: 2005 for Byetta and Bydureon; extended release version approved in 2017</p>
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<p><strong>Side Effect Update Date</strong>: May 28, 2025</p>
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<p><strong>Medication Description</strong>: Treats type 2 diabetes</p>
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<p><strong>Updated Side Effects/Safety Information</strong>: A new warning about the risk of serious kidney injury caused by dehydration due to gastrointestinal adverse effects like diarrhea and vomiting. Signs of potential kidney injury include persistent (or extended) nausea, vomiting, and diarrhea.</p>
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<p>The postmarketing experience section now includes reports of dysesthesia (altered sense of touch).</p>
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<p><strong>Essential Extras</strong>: The original version of Bydureon has been discontinued, but Bydureon BCISE (extended release) remains available and is administered weekly. Byetta is administered twice daily.</p>
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<p><strong>FDA Safety Announcements</strong>: <a href="https://www.accessdata.fda.gov/scripts/cder/safetylabelingchanges/index.cfm?event=searchdetail.page&DrugNameID=1872" target="_blank" rel="noreferrer noopener">Bydureon Extended Release Safety Label Change</a> and<a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/209210s025lbl.pdf" target="_blank" rel="noreferrer noopener"> Revised Label</a></p>
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<p><a href="https://www.accessdata.fda.gov/scripts/cder/safetylabelingchanges/index.cfm?event=searchdetail.page&DrugNameID=1809" target="_blank" rel="noreferrer noopener">Byetta FDA Safety Label Change</a> and <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/021773s050lbl.pdf" target="_blank" rel="noreferrer noopener">Byetta Revised Drug Label<br></a>The revised drug label contains a complete list of FDA-approved indications, side effects, warnings, and more.</p>
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<h3 class="wp-block-heading" id="h-mounjaro-active-ingredient-tirzepatide-subcutaneous-injection">Mounjaro (active ingredient: tirzepatide) subcutaneous injection</h3>
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<p><strong>Initial FDA Approval</strong>: 2022</p>
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<p><strong>Side Effect Update Date</strong>: May 28, 2025</p>
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<p><strong>Medication Description</strong>: Treats type 2 diabetes</p>
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<p><strong>Updated Side Effects/Safety Information</strong>: A new warning about the risk of serious kidney injury caused by dehydration due to gastrointestinal adverse effects like diarrhea and vomiting. Signs of potential kidney injury include persistent (or extended) nausea, vomiting, and diarrhea.</p>
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<p>The postmarketing experience section now includes reports of alopecia (hair loss).</p>
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<p><strong>FDA Safety Announcement</strong>: <a href="https://www.accessdata.fda.gov/scripts/cder/safetylabelingchanges/index.cfm?event=searchdetail.page&DrugNameID=2823" target="_blank" rel="noreferrer noopener">Mounjaro FDA Safety Label Change</a> and <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/215866s010s015s022lbl.pdf" target="_blank" rel="noreferrer noopener">Revised Drug Label<br></a>The revised drug label contains a complete list of FDA-approved indications, side effects, warnings, and more.</p>
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<h3 class="wp-block-heading" id="h-saxenda-active-ingredient-liraglutide-subcutaneous-injection">Saxenda (active ingredient: liraglutide) subcutaneous injection</h3>
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<p><strong>Initial FDA Approval</strong>: 2014 (liraglutide approved in 2010)</p>
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<p><strong>Side Effect Update Date</strong>: May 28, 2025</p>
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<p><strong>Medication Description</strong>: For chronic weight management</p>
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<p><strong>Updated Side Effects/Safety Information</strong>: A new warning section on “Severe Gastrointestinal Adverse Reactions.” An additional warning about the risk of serious kidney injury caused by dehydration due to gastrointestinal adverse effects like diarrhea and vomiting. Signs of potential kidney injury include persistent (or extended) nausea, vomiting, and diarrhea.</p>
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<p>The postmarketing experience section now includes reports of alopecia (hair loss) and dysesthesia (altered sense of touch).</p>
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<p><strong>Essential Extras</strong>: This medication is administered once daily.</p>
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<p><strong>FDA Safety Announcement</strong>: <a href="https://www.accessdata.fda.gov/scripts/cder/safetylabelingchanges/index.cfm?event=searchdetail.page&DrugNameID=438" target="_blank" rel="noreferrer noopener">Saxenda FDA Safety Label Change</a> and <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/206321s020lbl.pdf" target="_blank" rel="noreferrer noopener">Revised Drug Label<br></a>The revised drug label contains a complete list of FDA-approved indications, side effects, warnings, and more.</p>
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<h3 class="wp-block-heading" id="h-soliqua-100-33-active-ingredients-insulin-glargine-and-lixisenatide-subcutaneous-injection">Soliqua 100/33 (active ingredients: insulin glargine and lixisenatide) subcutaneous injection</h3>
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<p><strong>Initial FDA Approval</strong>: 2016</p>
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<p><strong>Side Effect Update Date</strong>: May 28, 2025</p>
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<p><strong>Medication Description</strong>: Treats type 2 diabetes</p>
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<p><strong>Updated Side Effects/Safety Information</strong>: A new warning section on “Severe Gastrointestinal Adverse Reactions.” An additional new warning about the risk of serious kidney injury caused by dehydration due to gastrointestinal adverse effects like diarrhea and vomiting. Signs of potential kidney injury include persistent (or extended) nausea, vomiting, and diarrhea.</p>
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<p>The postmarketing experience section now includes reports of alopecia (hair loss) and dysesthesia (altered sense of touch).</p>
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<p><strong>Essential Extras:</strong> This medication is administered once daily.</p>
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<p><strong>FDA Safety Announcement</strong>: <a href="https://www.accessdata.fda.gov/scripts/cder/safetylabelingchanges/index.cfm?event=searchdetail.page&DrugNameID=1245" target="_blank" rel="noreferrer noopener">Soliqua FDA Safety Label Change</a> and <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/208673s018lbl.pdf" target="_blank" rel="noreferrer noopener">Revised Drug Label</a></p>
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<h3 class="wp-block-heading" id="h-trulicity-active-ingredient-dulaglutide-subcutaneous-injection">Trulicity (active ingredient: dulaglutide) subcutaneous injection</h3>
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<p><strong>Initial FDA Approval</strong>: 2014</p>
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<p><strong>Side Effect Update Date</strong>: May 28, 2025</p>
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<p><strong>Medication Description</strong>: Treats type 2 diabetes</p>
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<p><strong>Updated Side Effects/Safety Information</strong>: A new warning about the risk of serious kidney injury caused by dehydration due to gastrointestinal adverse effects like diarrhea and vomiting. Signs of potential kidney injury include persistent (or extended) nausea, vomiting, and diarrhea.</p>
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<p>Clinical trial results concerning pancreas-related adverse effects have also been added</p>
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<p>The postmarketing experience section now includes reports of alopecia (hair loss) and dysesthesia (altered sense of touch).</p>
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<p><strong>FDA Safety Announcement</strong>: <a href="https://www.accessdata.fda.gov/scripts/cder/safetylabelingchanges/index.cfm?event=searchdetail.page&DrugNameID=816" target="_blank" rel="noreferrer noopener">Trulicity FDA Safety Label Change</a> and <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/125469s061s062lbl.pdf" target="_blank" rel="noreferrer noopener">Revised Drug Label<br></a>The revised drug label contains a complete list of FDA-approved indications, side effects, warnings, and more.</p>
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<h3 class="wp-block-heading" id="h-victoza-active-ingredient-liraglutide-subcutaneous-injection">Victoza (active ingredient:liraglutide) subcutaneous injection</h3>
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<p><strong>Initial FDA Approval</strong>: 2010</p>
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<p><strong>Side Effect Update Date</strong>: May 28, 2025</p>
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<p><strong>Medication Description</strong>: Treats type 2 diabetes</p>
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<p><strong>Updated Side Effects/Safety Information</strong>: A new warning section on “Severe Gastrointestinal Adverse Reactions.” An additional new warning about the risk of serious kidney injury caused by dehydration due to gastrointestinal adverse effects like diarrhea and vomiting. Signs of potential kidney injury include persistent (or extended) nausea, vomiting, and diarrhea.</p>
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<p>Clinical trial results concerning pancreas-related adverse effects have also been added</p>
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<p>The postmarketing experience section now includes reports of alopecia (hair loss) and dysesthesia (altered sense of touch).</p>
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<p><strong>FDA Safety Announcement</strong>: <a href="https://www.accessdata.fda.gov/scripts/cder/safetylabelingchanges/index.cfm?event=searchdetail.page&DrugNameID=171" target="_blank" rel="noreferrer noopener">Victoza FDA Safety Label Change</a> and <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/022341s044lbl.pdf" target="_blank" rel="noreferrer noopener">Revised Drug Label<br></a>The revised drug label contains a complete list of FDA-approved indications, side effects, warnings, and more.</p>
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<h3 class="wp-block-heading" id="h-xultophy-100-3-6-active-ingredients-insulin-degludec-and-liraglutide-subcutaneous-injection">Xultophy 100/3.6 (active ingredients: insulin degludec and liraglutide) subcutaneous injection</h3>
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<p><strong>Initial FDA Approval</strong>: 2016</p>
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<p><strong>Side Effect Update Date:</strong> May 28, 2025</p>
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<p><strong>Medication Description</strong>: Treats type 2 diabetes</p>
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<p><strong>Updated Side Effects/Safety Information</strong>: A new warning section on “Severe Gastrointestinal Adverse Reactions.” An additional new warning about the risk of serious kidney injury caused by dehydration due to gastrointestinal adverse effects like diarrhea and vomiting. Signs of potential kidney injury include persistent (or extended) nausea, vomiting, and diarrhea.</p>
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<p>Clinical trial results concerning pancreas-related adverse effects have also been added.</p>
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<p>The postmarketing experience section now includes reports of alopecia (hair loss) and dysesthesia (altered sense of touch).</p>
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<p><strong>Essential Extras</strong>: This medication is administered once daily.FDA Safety Announcement: <a href="https://www.accessdata.fda.gov/scripts/cder/safetylabelingchanges/index.cfm?event=searchdetail.page&DrugNameID=1863" target="_blank" rel="noreferrer noopener">Xultophy FDA Safety Label Change</a> and <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/208583s025lbl.pdf" target="_blank" rel="noreferrer noopener">Revised Label</a></p>
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