<i>In Silico</i> Exploration of Therapeutics for GLP-1 Receptor Agonist-Induced Nausea and Their <i>in Vivo</i> Validation in Mice

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are clinically used to control hyperglycemia and body weight in patients with type 2 diabetes mellitus and obesity. Despite their efficacy, GLP-1 RAs frequently induce nausea and vomiting as adverse effects, which are prominent factors for non-adherence to GLP-1 RAs. Therefore, new prophylaxes and treatments for GLP-1 RA-induced nausea are urgently needed. Here, we explored the U. S. Food and Drug Administration (FDA) Adverse Event Reporting System database to determine the effective drug combinations mitigating GLP-1 RA-induced nausea and vomiting in real-world settings. We further investigated the effects of the identified drugs on GLP-1 RA-induced pica behavior, a behavioral index of nausea in mice. Analysis of the FDA Adverse Event Reporting System revealed that therapeutics, including gabapentin and acetaminophen, significantly lowered the occurrence of nausea-related events in GLP-1 RA-treated patients. In mice, we confirmed that exenatide, a GLP-1 RA, significantly increased the pica behavior in a dose-dependent manner, without affecting the food intake. Finally, we found that co-treatment with gabapentin significantly decreased the pica behavior induced by exenatide. These results demonstrate the therapeutic efficacy of gabapentin against nausea and vomiting in patients administered GLP-1 RAs.