A 56-year-old man with type 2 diabetes and established cardiovascular disease is being considered for a glucagon-like peptide-1 receptor agonist. Which condition in his history is an absolute contraindication to this drug class?
- A Previous non-ST elevation myocardial infarction
- B Background diabetic retinopathy
- C Medullary thyroid carcinoma ✓
- D Mild gastroparesis
Correct answer: C. Medullary thyroid carcinoma
Explanation
All GLP-1 receptor agonists carry a boxed warning against use in personal or family history of medullary thyroid carcinoma or MEN2, based on rodent B-cell tumours mediated by GLP-1 receptors on B cells. Prior myocardial infarction is actually an indication given the cardiovascular benefit shown in trials such as LEADER. Retinopathy warrants caution with semaglutide but is not absolute, and gastroparesis is a relative concern only.
Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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