GLP-1 and metabolic peptides, compared
How the incretin drugs and related metabolic compounds differ: what they target, how strong the evidence is, and the doses used on labels and in trials.
| Compound | Evidence | How it works | Doses in labels or trials | US status |
|---|---|---|---|---|
| Dulaglutide Trulicity, LY2189265 | FDA-approved | Established: dulaglutide activates the GLP-1 receptor. This raises insulin release when blood sugar is high, lowers glucagon and slows stomach emptying. Attaching the GLP-1 analog to a large antibody fragment slows its… | Starts at 0.75 mg once weekly, subcutaneous; may be raised to 1.5 mg after 4 weeks, then in 1.5 mg steps every 4+ weeks up to 4.5 mg once weekly 0.75 mg once weekly, may be raised to a maximum of 1.5 mg once weekly after at least 4 weeks | FDA-approved as Trulicity (Eli Lilly): type 2 diabetes in adults (2014), cardiovascular risk reduction (2020), and children 10 and older… |
| Exenatide exendin-4 (synthetic), Byetta, Bydureon | FDA-approved | Established: exenatide activates the GLP-1 receptor. This boosts insulin release only when blood sugar is high, lowers inappropriately high glucagon, and slows stomach emptying. | 5 mcg subcutaneously twice daily within 60 minutes before morning and evening meals; may increase to 10 mcg twice daily after 1 month 2 mg subcutaneously once every 7 days | FDA-approved (Byetta 2005; Bydureon later); US brands Byetta and Bydureon BCise discontinued October 2024 |
| Glucagon Glucagon Emergency Kit, GlucaGen, Baqsimi (nasal) | FDA-approved | Established: glucagon activates glucagon receptors in the liver, breaking down stored glycogen into glucose and raising blood sugar. It only works if the liver has enough glycogen, so it helps little in starvation,… | 1 mg by subcutaneous, intramuscular or IV injection; may repeat if no response in 15 minutes 0.5 mg, or 20–30 mcg/kg | FDA-approved (first US approval 1960); injectable, ready-to-use and nasal (Baqsimi, 2019) forms |
| Insulin (human insulin and analogs) regular human insulin, Humulin R, insulin lispro | FDA-approved | Established: insulin binds the insulin receptor on muscle, fat and liver cells. This increases glucose uptake into muscle and fat, reduces glucose output by the liver, slows fat and protein breakdown, and promotes… | Individualized — labels give no fixed dose; the prescriber sets and adjusts it by glucose monitoring, metabolic needs, route and treatment goals | FDA-approved: human insulin since 1982 (Humulin), lispro 1996, glargine 2000, once-weekly icodec (Awiqli) March 2026 for adult type 2… |
| L-carnitine (levocarnitine) levocarnitine, carnitine, Carnitor | FDA-approved | Established: carnitine acts as a shuttle that moves long-chain fatty acids across the inner membrane of mitochondria, where they are broken down for energy. When carnitine is missing, as in genetic transporter defects,… | 990 mg two or three times daily by mouth 50–100 mg/kg/day in divided doses, maximum 3 g/day | FDA-approved as levocarnitine (Carnitor tablets 1985; oral solution and injection later) for carnitine deficiency and dialysis-related… |
| Liraglutide Saxenda, Victoza, NN2211 | FDA-approved | Established: activates the GLP-1 receptor, increasing glucose-dependent insulin release, lowering glucagon, slowing stomach emptying, and reducing appetite. The fatty-acid chain binds albumin and extends its action to… | 0.6 mg daily week 1, then weekly increases to 1.2, 1.8, 2.4 mg, reaching 3 mg daily from week 5, subcutaneous 3 mg once daily (adults); pediatric 3 mg daily, may reduce to 2.4 mg if not tolerated. Stop in adults if <4% weight loss at 16 weeks. | FDA-approved as Victoza (type 2 diabetes, 2010) and Saxenda (weight management, 2014; adolescents 12+ in 2020). |
| Orforglipron Foundayo, LY3502970 | FDA-approved | Established: activates the GLP-1 receptor like peptide GLP-1 drugs, reducing appetite, slowing stomach emptying, and improving blood sugar control. Because it is a small molecule, it is absorbed as a regular pill… | 0.8 mg once daily, then 2.5 mg, then 5.5 mg, each step at least 30 days; by mouth with or without food May increase to 9, 14.5, or 17.2 mg once daily (max 17.2 mg) at ≥30-day intervals based on response and tolerability | FDA-approved as Foundayo (April 1, 2026) for chronic weight management in adults with obesity, or overweight with a weight-related… |
| Pramlintide Symlin, SymlinPen, pramlintide acetate | FDA-approved | Established: like natural amylin, pramlintide slows stomach emptying, lowers the rise in glucagon after meals (so the liver releases less sugar), and increases fullness, which reduces food intake. | Start 15 mcg subcutaneously before major meals; increase in 15 mcg steps to 30–60 mcg as tolerated Start 60 mcg before major meals; increase to 120 mcg if tolerated | FDA-approved as Symlin (2005) as add-on to mealtime insulin in type 1 and type 2 diabetes |
| Semaglutide Wegovy, Ozempic, Rybelsus | FDA-approved | Established: semaglutide activates the GLP-1 receptor. In the pancreas this boosts insulin release and lowers glucagon when blood sugar is high. In the brain it reduces hunger and food intake, and it slows stomach… | 0.25 mg weekly weeks 1–4, 0.5 mg weeks 5–8, 1 mg weeks 9–12, 1.7 mg weeks 13–16, subcutaneous 2.4 mg (recommended) or 1.7 mg once weekly from week 17; adults may go up to 7.2 mg weekly after at least 4 weeks on 2.4 mg if more weight loss is needed. MASH maintenance 2.4 mg (may reduce to 1.7 mg). | FDA-approved: Ozempic (type 2 diabetes, 2017), Rybelsus (oral, type 2 diabetes, 2019), Wegovy injection (weight management 2021; CV risk… |
| Setmelanotide Imcivree, BIM-22493 | FDA-approved | Established: setmelanotide activates MC4 receptors in the brain, which help control hunger, fullness and energy use. In the approved conditions this signal pathway is broken upstream, and the drug restores it. It is… | 2 mg subcutaneously once daily for 2 weeks, then 3 mg once daily (target) 0.5 mg daily, stepped up every 2 weeks to a 3 mg daily target by week 7 | FDA-approved as Imcivree (2020) for POMC/PCSK1/LEPR deficiency and Bardet-Biedl syndrome (age 2+), and acquired hypothalamic obesity (age… |
| Tirzepatide Zepbound, Mounjaro, LY3298176 | FDA-approved | Established: tirzepatide activates both the GIP and GLP-1 receptors. Together these raise glucose-dependent insulin release, lower glucagon, slow stomach emptying, and reduce appetite and food intake. How much the GIP… | 2.5 mg once weekly for 4 weeks (starter dose only), then 5 mg; increase in 2.5 mg steps after at least 4 weeks on each dose, subcutaneous 5, 10, or 15 mg once weekly for weight management; 10 or 15 mg for sleep apnea; maximum 15 mg weekly | FDA-approved as Mounjaro (type 2 diabetes, 2022) and Zepbound (chronic weight management, 2023; obstructive sleep apnea in adults with… |
| Cagrilintide (and CagriSema) NN9838, CagriSema (cagrilintide + semaglutide), long-acting amylin analog | Late-stage trials | Established in trials: cagrilintide activates amylin and calcitonin receptors, which increases feelings of fullness and slows stomach emptying. Combining it with semaglutide (a GLP-1 agonist) adds two different… | 0.3, 0.6, 1.2, 2.4, or 4.5 mg once weekly, subcutaneous, 26 weeks Cagrilintide 2.4 mg + semaglutide 2.4 mg once weekly, subcutaneous, 68 weeks | Investigational; not FDA-approved. New Drug Application for CagriSema submitted December 2025; FDA review expected in 2026 (no decision… |
| Eloralintide LY3841136 | Late-stage trials | Established for the drug class, proposed for this molecule: natural amylin is released with insulin after meals and acts on amylin receptors (the calcitonin receptor paired with RAMP helper proteins) in the brainstem… | 1, 3, 6 or 9 mg once weekly by subcutaneous injection; also step-up arms of 6→9 mg and 3→6→9 mg | Investigational; not FDA-approved (phase 3 trials ongoing as of Oct 2026). |
| Mazdutide IBI362, LY3305677 | Late-stage trials | Established in trials as a dual GLP-1 and glucagon receptor agonist. GLP-1 action reduces appetite and improves blood sugar; glucagon action is proposed to increase energy use and reduce liver fat. In GLORY-1 people… | 4 mg or 6 mg once weekly, subcutaneous, 48 weeks | Not FDA-approved; investigational in the US. |
| Retatrutide LY3437943, triple agonist, GGG agonist | Late-stage trials | Established in trials as a triple agonist of the GIP, GLP-1, and glucagon receptors. GLP-1 and GIP action reduce appetite and improve insulin release. Glucagon receptor action is proposed to raise energy use and liver… | 1, 4, 8, or 12 mg once weekly, subcutaneous (starting doses 2 or 4 mg for higher arms), 48 weeks Start 2 mg, escalate to 4, 9, or 12 mg once weekly, subcutaneous, 80 weeks | Investigational; not FDA-approved. Lilly plans to submit an application in Q1 2027. |
| Survodutide BI 456906 | Late-stage trials | Established in trials as a dual glucagon and GLP-1 receptor agonist. GLP-1 action lowers appetite; glucagon action is proposed to increase energy use and fat burning in the liver. This liver effect is why it is also… | 0.6, 2.4, 3.6, or 4.8 mg once weekly, subcutaneous; 20-week escalation then 26-week maintenance 3.6 mg or 6.0 mg once weekly, subcutaneous, 76 weeks | Investigational; not FDA-approved. No FDA submission timeline found in sources reviewed. |
| AOD-9604 AOD9604, Tyr-hGH 177-191, anti-obesity drug 9604 | Early human data | Proposed: the fragment was designed to keep growth hormone's fat-breakdown (lipolytic) effect without its effects on growth or blood sugar. In human studies it did not raise IGF-1 or worsen glucose tolerance,… | 25–400 µg/kg (phase 1) and 25–100 µg/kg (phase 2a) intravenous, single doses 9, 27, or 54 mg oral, single doses or daily for 7 days | Not FDA-approved for any use. |
| MOTS-c mitochondrial open reading frame of the 12S rRNA-c, MOTSc, CB4211 (related analog) | Preclinical only | Proposed, mostly from mouse and cell studies: MOTS-c acts mainly on skeletal muscle. It interferes with the folate cycle, which raises the level of a natural molecule (AICAR) that activates AMPK, a cellular energy… | No human dosing data | Not FDA-approved for any use. |
Doses are reported, not recommended. Label doses are started low and increased step by step under a prescriber to limit side effects. See each compound page for the full schedule and sources.