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As weight drops, your BP, diabetes, and cholesterol meds often need reduction. Project BP/A1C/LDL improvements + flag hypoglycemia and orthostatic risks before they happen.
Why deprescribing matters
The Exit Lane isn\'t just about tapering GLP-1 — your other medications need adjustment too. 15% weight loss typically improves BP by 8 mmHg, A1C by 1.2%, and LDL by 18 mg/dL. Failing to deprescribe causes hypotension, hypoglycemia, and unnecessary side effects.
Your baseline numbers
Blood pressure
Diabetes (if applicable)
Cholesterol
At projected BP of 123 mmHg, expect to reduce 1-2 antihypertensive doses. Most common sequence: stop diuretic first → reduce calcium channel blocker → re-evaluate ACE inhibitor or ARB.
Reduce in conversation with prescriber. Watch for orthostatic dizziness during transition — common but reversible.
This is a framework, not a prescription. Deprescribing is a collaborative process with your prescriber — your cardiac/kidney/diabetes history shapes specific choices. Projections based on STEP, SELECT, and SURMOUNT trial aggregate data.
As weight drops, blood pressure falls, glucose stabilizes, and cholesterol improves. Continuing full-dose comorbid medications can cause hypotension (dizziness, falls), hypoglycemia (especially with insulin/sulfonylureas), or unnecessary side effects. Deprescribing matches medication to actual need.
For most patients with 5-10% weight loss, BP drops 5-10 mmHg systolic. If you're on 2+ BP meds, expect to drop one within 3-6 months. Don't self-reduce — coordinate with your prescriber and watch for orthostatic dizziness.
Endocrine Society 2024 guidance: yes, stop sulfonylureas BEFORE starting GLP-1. The combined hypoglycemia risk is too high to titrate concurrently. Insulin is different — reduce by 20% before starting, don't stop entirely.
Possibly — but consult your prescriber. Statin cardiovascular benefit extends beyond LDL targets. Most clinicians prefer maintaining statin even with low LDL because of plaque-stabilization effects. Some safely reduce after 12+ months of stable maintenance.
GLP-1 INCREASES levothyroxine bioavailability (~33% AUC). Your thyroid dose may need REDUCTION, not increase. Recheck TSH at 6-8 weeks after starting GLP-1, then 3 and 6 months. Drift toward hyperthyroidism is common without dose adjustment.