Liraglutide

Liraglutide is a prescription medication used to treat the symptoms of Type 2 Diabetes Mellitus and Obesity. 

• Liraglutide is available under the following different brand names: Saxenda

Dosages of Liraglutide:

Adult and Pediatric dosage

SC solution multidose pen

• 18mg/3mL (Victoza); delivers doses of 0.6mg, 1.2mg, or 1.8 mg
• 18mg/3mL (Saxenda); delivers doses of 0.6mg, 1.2mg, 1.8mg, 2.4mg, or 3mg 

Type 2 Diabetes Mellitus

Victoza only

Adults

• 0.6 mg SC daily for 1 week initially, then increase to 1.2 mg once daily
• If glycemic control is not achieved, can increase to 1.8 mg once daily
• The initial dose of 0.6mg SC daily is only the decreased GI adverse effects and does not provide glycemic control

Pediatric

• Children 10 years of age or older with type 2 diabetes mellitus
• 0.6mg SC once daily for 1 week, may increase the dose to 1.2 mg/day if additional glycemic control is required
• If additional glycemic control is required, may increase to 1.8 mg once daily after at least 1 week after 1.2 mg once daily dose

Obesity

Saxenda only

Adults

• Initiate at 0.6 mg SC once daily for 1 week; increase by 0.6 mg per day in weekly intervals until a dose of 3 mg per day is achieved

Pediatric

• Initiate at 0.6mg SC once daily for 1 week; increase by 0.6 mg/day in weekly intervals until a dose of 3 mg/day achieved
• The recommended maintenance dose is 3 mg/day; if unable to tolerate, may reduce to 2.4 mg/day; discontinue if 2.4 mg is not tolerated

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”.

Common side effects of Liraglutide include:

• low blood sugar, 
• nausea, 
• vomiting, 
• stomach discomfort, 
• loss of appetite, 
• diarrhea, 
• constipation, 
• rash, 
• headache, 
• dizziness, and 
• tiredness

Serious side effects of Liraglutide include:

• hives, 
• fast heartbeats, 
• dizziness, 
• trouble breathing, 
• difficulty swallowing, 
• swelling of the face, lips, tongue, or throat, 
• racing or pounding heartbeats, 
• sudden changes in mood or behavior, 
• thoughts of self-harm, 
• feeling very thirsty or hot, 
• being unable to urinate, 
• heavy sweating, 
• hot and dry skin, 
• headache, 
• hunger, 
• sweating, 
• irritability, 
• dizziness, 
• anxiety, 
• shakiness, 
• sudden and severe pain in the upper stomach that may spread to the back, 
• nausea, 
• vomiting, 
• fever, 
• yellowing of the skin or eyes (jaundice), 
• swelling or a lump in the neck, 
• hoarse voice, and
• shortness of breath

Rare side effects of Liraglutide include:

• none 

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them.  Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first

• Liraglutide has severe interactions with no other drugs.
• Liraglutide has serious interactions with no other drugs.
• Liraglutide has moderate interactions with at least 111 other drugs.
• Liraglutide has minor interactions with the following drugs:
  • acetaminophen
  • acetaminophen IV
  • digoxin
  • lovastatin

This information does not contain all possible interactions or adverse effects.  Visit the RxList Drug Interaction Checker for any drugs interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use.  Keep a list of all your medications with you, and share this information with your doctor and pharmacist.  Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• Hypersensitivity to Liraglutide or its components
• Patients with a personal or family history of medullary thyroid carcinoma (MTC) or patients with multiple endocrine neoplasia syndrome types 2 (MEN 2)
• Saxenda only: Pregnancy

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Liraglutide?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Liraglutide?”

Cautions

• Acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis, has been observed; studied in a limited number of patients with a history of pancreatitis; unknown if patients with a history of pancreatitis are at higher risk for development of pancreatitis
• Acute gallbladder disease reported; if cholelithiasis is suspected, gallbladder studies and follow-up appropriately
• May cause dose-dependent and treatment-duration-dependent thyroid C-cell tumors (adenomas and/or carcinomas) at clinically relevant exposures in both genders of rats and mice; if serum calcitonin is elevated, evaluate further; patients with thyroid nodules noted on physical examination or neck imaging should also be further evaluated
• Renal Impairment reported in association with nausea, vomiting, diarrhea, or dehydration, which may sometimes require hemodialysis; altered renal function has been reversed in many of reported cases with supportive treatment and discontinuation of potentially causative agents; use caution when initiating or escalating doses of in these patients
• There have been posted marketing reports of serious hypersensitivity reactions (eg, anaphylactic reactions, angioedema)
• Never share pen between patients even if the needle is changed

Saxenda only

• Resting heart rate may increase by 2-3 bpm; up to 10-20 bpm increases also reported
• Suicidal ideation; monitor for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior; discontinue in patients who experience suicidal thoughts or behaviors; avoid in patients with a history of suicidal attempts or active suicidal ideation

Drug interactions overview

• May cause a delay of gastric emptying and thereby has the potential to impact the absorption of concomitantly administered oral medications; exercise caution when oral medications are concomitantly administered with liraglutide
• Risk for Hypoglycemia with Concomitant Use of Antidiabetic Therapy
• The risk for hypoglycemia is increased when Saxenda is used in combination with insulin secretagogues (ie, sulfonylureas) or insulin in patients with type 2 Diabetes Mellitus
• In patients with type 2 diabetes, monitor blood glucose before starting therapy and during treatment
• Therefore, patients may require a lower dose of sulfonylurea (or other concomitantly administered insulin secretagogues) or insulin in this setting
• Victoza only: In pediatric patients 10 years of age or older, the risk of hypoglycemia was higher regardless of concomitant antidiabetic therapies

Pregnancy and Lactation

Victoza

• Based on animal reproduction studies, there may be risks to the fetus from exposure during pregnancy
• Use during pregnancy only if the potential benefit justifies the potential risk to the fetus

Saxenda

• Contraindicated during pregnancy because weight loss offers no potential benefit to a pregnant woman and may result in fetal harm
• There are no available data in pregnant women to inform a drug-associated risk for major birth defects and miscarriage
• If a patient wishes to become pregnant, or pregnancy occurs, discontinue treatment
• A minimum weight gain, and no weight loss, recommended for all pregnant women, including those who are already overweight or obese, due to necessary weight gain that occurs in maternal tissues during pregnancy

Clinical Considerations

• Disease-associated maternal and/or embryo/fetal risk
• Poorly controlled diabetes in pregnancy increases the maternal risk for diabetic ketoacidosis, preeclampsia, spontaneous abortions, preterm delivery, and delivery complications
• Poorly controlled diabetes increases the fetal risk for major birth defects, stillbirth, and macrosomia related morbidity
• There are no data on the presence of drugs in human milk, the effects on the breastfed infant, or the effects on milk production
• Present in the milk of lactating rats