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[33, 34, 35, 36] Mechanism: Typically pre-renal, occurring in the setting of volume depletion from GI losses (nausea, vomiting, diarrhea, reduced oral intake) More frequently seen at higher, obesity-level doses Although generally reno-protective long term, post-marketing data describe acute rises in creatinine following days to weeks of significant GI symptoms Risk factors: Underlying chronic kidney disease Concomitant use of ACE inhibitors, ARBs, diuretics, or SGLT2 inhibitors ED Management: IV fluids Hold GLP-1 and contributing medications Usually reversible with supportive care Future Directions GLP-1 receptor agonists are rapidly evolving beyond their original indications in diabetes and obesity

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However, patients should not self-treat severe or persistent constipation without medical advice, especially if they develop pain, bloating, vomiting, inability to pass stool or gas, or rectal bleeding

The inactive form is considered a precursor as it gets converted into an active peptide GLP-1 (7-37) by cleaving a single arginine residue (Fig

Another promising direction involves mucoadhesive nanocarriers that anchor to intestinal epithelium and release GLP-1 analogs in a site-specific manner, minimizing systemic degradation [35]

Regeneron Pharmaceuticals Sector: Muscle-preserving antibody combinations and GLP-1 therapy for obesity HQ: Tarrytown, NY Year Founded: 1988 Origin Story: Founded in 1988 by Leonard Schleifer, MD, PhD, a neurologist and assistant professor at Cornell University Medical College on the premise that drug discovery could be industrialized through proprietary antibody-generation technology