Managing type 2 diabetes can be a difficult task, especially considering that around 80-90% of people living with the condition are overweight or obese. This further complicates their health and highlights the importance of finding effective treatment options.

In response to this issue, healthcare professionals frequently prescribe Liraglutide, a medication recognized for its efficacy in managing diabetes and facilitating weight loss. Although not a magic pill solution, Liraglutide has demonstrated substantial benefits in addressing these health concerns.

However, it’s important to approach its use comprehensively, considering its mechanism of action, potential side effects, and overall safety. The decision to incorporate Liraglutide into a treatment plan can be complex, raising questions about its effectiveness and how it aligns with individual health goals.

In this article, we will provide a comprehensive understanding of liraglutide, including its uses, side effects, dosage, precautions to follow when taking it, and what to do in case of overdose.

Key Takeaways

  • Liraglutide, when used as part of a weight management program, including diet and exercise, has been shown to help adults lose approximately 5-10% of their body weight on average over 12 months.
  • In clinical studies, liraglutide has helped lower blood sugar levels in adults with type 2 diabetes. Some patients experienced a reduction in their HbA1c levels by up to 1.5 percentage points after six months of treatment.
  • Research indicates that liraglutide can reduce the risk of major cardiovascular events, such as heart attack and stroke, by about 13% in people with type 2 diabetes who are at high risk for heart disease.
  • Liraglutide is administered via injection. The starting dose is typically around 0.6 mg per day, however, it can be increased up to 1.8 mg daily for diabetes management and up to 3.0 mg for weight loss, based on individual response and tolerability.
  • The most frequently reported side effects of liraglutide include nausea (affecting approximately 20-30% of users), diarrhea, and headache. These side effects are generally mild to moderate and decrease over time.
  • Liraglutide has been approved for weight management in adolescents aged 12 and older, making it one of the few pharmacologic options available for this age group.

What is Liraglutide?

glucagon-like peptide-1 (GLP-1) molecule

Liraglutide is a medication in the class of glucagon-like peptide-1 (GLP-1) receptor agonists. These medications work by simulating the action of the naturally occurring incretin hormone GLP-1, which regulates glucose metabolism. Liraglutide stimulates the release of insulin from the pancreas in a glucose-dependent manner, meaning insulin is only released when blood glucose levels are high.

The development of liraglutide was based on the naturally occurring hormone GLP-1, which has a short half-life in the bloodstream and is rapidly degraded by the enzyme dipeptidyl peptidase-4 (DPP-4). Researchers developed liraglutide to have a longer half-life than native GLP-1, allowing for once-daily administration. In 2010, liraglutide was approved for medical use in the United States.

How Liraglutide is Used

Liraglutide is a medication that is primarily prescribed for the management of diabetes and weight issues. Here’s a summary of its uses:

Type 2 Diabetes Management: Liraglutide (Victoza) is used alongside a diet and exercise program to control blood sugar levels in adults and children 10 years and older with type 2 diabetes. This is particularly true for cases where other medications have not adequately controlled blood sugar levels. It works by helping the pancreas release the right amount of insulin when blood sugar levels are high, which assists in moving sugar from the blood into other body tissues where it is used for energy. Liraglutide also slows the emptying of the stomach, which may decrease appetite and lead to weight loss, indirectly benefiting diabetes management.

Heart Disease Risk Reduction: In adults with type 2 diabetes and heart and blood vessel disease, Liraglutide (Victoza) is also used to reduce the risk of major cardiovascular events such as heart attack, stroke, or death.

Weight Management: Liraglutide (Saxenda) is used with a reduced-calorie diet and exercise plan to help certain adults and children 12 years of age and older who are obese or overweight with weight-related medical problems lose weight and prevent regaining that weight. This formulation is not used to treat type 2 diabetes.

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Side Effects of Liraglutide

Although liraglutide is a highly effective medication for treating diabetes, it can cause some unintended effects that need to be carefully monitored under medical supervision.  Below are the common and serious side effects associated with liraglutide:

Common Side Effects

Woman experiencing nausea and vomitting

Liraglutide medication may cause common side effects, as mentioned in the prescribing information provided by the FDA. These side effects include:

Nausea: This is one of the most frequently reported side effects of liraglutide and can affect around 20-25% of patients. It usually occurs during the initial stages of treatment and may improve over time.

Diarrhea: About 10-12% of patients may experience diarrhea while taking liraglutide. This side effect may also improve as the body adjusts to the medication.

Vomiting: Around 6-9% of patients may experience vomiting while taking liraglutide. However, this side effect can also decrease in frequency with continued use.

Low Blood Sugar (Hypoglycemia): Liraglutide can cause low blood sugar levels, especially when used with other diabetes medications like sulfonylureas or insulin. Symptoms of low blood sugar include dizziness, shaking, hunger, and sweating. It is important to monitor blood sugar levels regularly and follow the guidance of a healthcare provider on managing low blood sugar.

Serious Side Effects

a person touching his stomach in pain

Serious side effects can occur, although they are rare, with the use of liraglutide. It’s important to be aware of them so that they can seek medical attention promptly. Some possible serious side effects of liraglutide include:

Pancreatitis: In the clinical trials, 13 cases of pancreatitis were reported among Victoza-treated patients and 1 case in a comparator-treated patient. This translates to an incidence rate of pancreatitis of approximately 2.7 cases per 1000 patient-years for Victoza-treated patients.

Renal Impairment: There have been post-marketing reports of acute renal failure and worsening of chronic renal failure, sometimes requiring hemodialysis.

Hypersensitivity Reactions: Hypersensitivity reactions are another possible serious side effect of liraglutide. Serious hypersensitivity reactions, including anaphylactic reactions and angioedema, have been reported.

Gallbladder Disease: In the LEADER trial, 3.1% of Victoza-treated patients reported an acute event of gallbladder disease, such as cholelithiasis or cholecystitis, compared to 1.9% of placebo-treated patients.

Papillary Thyroid Carcinoma: Papillary thyroid carcinoma is another rare but serious side effect of liraglutide. In the glycemic control trials, 7 cases of papillary thyroid carcinoma were reported in patients treated with liraglutide and 1 in a comparator-treated patient. This results in an incidence rate of 1.5 cases per 1000 patient-years for Victoza-treated patients, compared to 0.5 cases per 1000 patient-years for the comparator.

Health Note

Patients should be closely monitored for signs and symptoms of serious side effects. For instance, they should be informed about the symptoms of pancreatitis and thyroid tumors and advised to seek medical attention promptly if such symptoms occur. Managing common side effects involves dose adjustments or temporary discontinuation of liraglutide under medical supervision. For serious side effects, immediate discontinuation of liraglutide and further medical evaluation may be necessary.

Administration and Dosage

a doctor injecting a patient

Liraglutide is a medication that is administered via subcutaneous injection. The injection can be made into the abdomen, thigh, or upper arm, and it is typically given once a day at any time, regardless of meals.

For patients with type 2 diabetes, the recommended starting dose of liraglutide is 0.6 mg daily for one week. This initial dose is intended to minimize gastrointestinal symptoms and is ineffective in controlling blood sugar levels. After one week, the dose is increased to 1.2 mg daily as a maintenance dose. If the 1.2 mg dose is insufficient to control blood sugar levels, the dose may increase to a maximum of 1.8 mg per day.

For the treatment of obesity in adults, the initial recommended dose of liraglutide is 0.6 mg injected under the skin once a day for one week. The doctor will increase the dose weekly up to 3 mg every week until the patient reaches the maximum dose.

Always inspect the liraglutide solution before injecting. It should be clear, colorless, and free of particles. Do not use the medication if it is colored, cloudy, contains particles, or if the expiration date has passed.

You should never reuse needles or share needles or pens. Always remove the needle right after your injection and dispose of it in a puncture-resistant container. Your healthcare provider or pharmacist can instruct you on properly disposing of the container.

If you miss a dose, inject it as soon as you remember. However, if it’s almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose to make up for a missed one. If you forget to use liraglutide injection for 3 or more days, consult your doctor for guidance.

Precautions to Follow When Taking Liraglutide

Doctor speaking with obese patient

When taking liraglutide, there are several special precautions you should follow to ensure safe and effective use of the medication:

Allergy Information: Inform your doctor and pharmacist if you are allergic to liraglutide, other medications, or ingredients in liraglutide injections. Consult the Medication Guide or your pharmacist for a list of ingredients.

Medication Interactions: Tell your doctor and pharmacist about all prescription, over-the-counter medications, vitamins, nutritional supplements, and herbal products you plan to take. It’s crucial because liraglutide may change how your body absorbs oral medications. Inform them about other incretin mimetics you might be taking, such as dulaglutide (Trulicity), exenatide (Bydureon, Byetta), or any insulin or oral diabetes medications. This will help in adjusting doses to avoid side effects.

Medical History: Share your complete medical history with your doctor, especially if you have or have had pancreatitis, gallstones, alcoholism, depression, suicidal thoughts or behavior, stomach problems, gastroparesis, high triglyceride levels, or any kidney or liver disease.

Pregnancy and Breastfeeding: If you are pregnant, planning to become pregnant, or breastfeeding, discuss it with your doctor. Liraglutide (Saxenda) should not be used for weight loss during pregnancy. If you become pregnant while taking liraglutide (Victoza), inform your doctor.

Illness or Stress: If you become ill, experience unusual stress, have an infection or fever, or are injured, contact your doctor. These situations can affect your blood sugar and might require adjustments in your medication.

Thyroid Cancer Warning: Be aware that liraglutide may increase the risk of developing thyroid tumors, including medullary thyroid carcinoma (MTC). Inform your doctor if you or any family member has had MTC or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Watch for symptoms like a lump or swelling in the neck, hoarseness, difficulty swallowing, or shortness of breath, and report them to your doctor immediately.

Regular Check-ups: Keep all appointments with your doctor and the laboratory. Your doctor may order certain tests to check your body’s response to liraglutide.

Instruction on Use: Be sure to read and understand the manufacturer’s instructions for using the injection pen. If you are unsure, ask your doctor or pharmacist to demonstrate the correct way to inject liraglutide.

What Should You Do In Case of An Overdose of Liraglutide?

An obese person having an emergency checkup with his doctor

If someone accidentally takes too much liraglutide, it is crucial to seek immediate medical attention. In one case study, a 49-year-old woman injected 30 times the prescribed amount of liraglutide, a medication used to manage type 2 diabetes. As a result, she experienced severe nausea and vomiting.

However, her treatment at the hospital was primarily supportive, with a focus on hydration and anti-nausea medication (metoclopramide). She did not require anti-hyperglycemic therapy during her hospital stay, and her liver function tests and serum amylase levels remained within the normal range. There were no reports of hypoglycemia or pancreatitis, which are concerns with some diabetes medications.

Based on this case and similar reported cases of liraglutide overdose, the approach to treatment includes:

  • Seek immediate medical help: Call the nearest emergency department or emergency services.
  • Supportive care: Treatment is mainly supportive, focusing on managing symptoms such as nausea and vomiting.
  • Monitoring: Blood glucose levels should be closely monitored following an overdose. Even though hypoglycemia was not reported in this case, monitoring is important due to the drug’s effect on insulin secretion.
  • Hydration: Intravenous fluids may be administered to maintain hydration, especially if vomiting is severe.
  • Anti-nausea medication: Medications like metoclopramide can be used to control nausea and vomiting.

Wrap-Up

Liraglutide is a medication that can be a useful tool for managing type 2 diabetes and obesity-related health problems. However, as with any medication, understanding its benefits and potential side effects is essential. It is crucial to work closely with a healthcare provider to determine if liraglutide is the right medication for you, to monitor any side effects carefully, and to follow the prescribed dosage and usage instructions. With proper guidance and monitoring, liraglutide can be an effective treatment option for those seeking to manage their health conditions and improve their overall well-being.

FAQs On Liraglutide

Is liraglutide an insulin? 

No, liraglutide is not a form of insulin. Instead, it is a GLP-1 receptor agonist that helps regulate blood sugar levels by enhancing the body’s natural insulin release in response to food intake, among other mechanisms.

Can Liraglutide be used with insulin?

Yes, when combined with pre-existing insulin therapy, liraglutide has been found to significantly reduce HbA1c levels and body weight during the initial 6 months of treatment. However, the long-term sustainability of these effects has been questioned. Some studies have suggested that the beneficial effects of liraglutide on HbA1c and weight may diminish over time, particularly after 1 year of treatment.

How should liraglutide be stored?

Keep it away from light and heat. Put unused liraglutide pens in the fridge (between 36°F and 46°F [2°C to 8°C]), but keep them away from the cooling element. Once you start using a liraglutide pen, store it at room temperature (between 59°F and 86°F [15°C to 30°C]) or in the fridge.

Is liraglutide suitable for children?

While it is generally used in adults, studies have shown that liraglutide can also be safely and effectively used in children with type 2 diabetes. However, the use of liraglutide in children should be done under the supervision of a qualified healthcare professional who can adjust the dosage and monitor for any potential side effects.

How does liraglutide affect heart rate?

Liraglutide is known to have an impact on heart rate. Studies have shown that liraglutide can increase heart rate by 2.71 bpm (1.45 to 3.97) compared to placebo and 2.49 bpm (1.77 to 3.21) compared to active control.

Can liraglutide pens be shared?

Liraglutide pens must never be shared between patients, even if the needle is changed, due to the risk of transmitting infectious diseases.

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Nauck, M. A., Ghorbani, M. L. M., Kreiner, E., Saevereid, H. A., Buse, J. B., & LEADER Publication Committee on behalf of the LEADER Trial Investigators. (2019). Effects of Liraglutide Compared With Placebo on Events of Acute Gallbladder or Biliary Disease in Patients With Type 2 Diabetes at High Risk for Cardiovascular Events in the LEADER Randomized Trial. Diabetes Care, 42(10), e118-e120.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364668/

FDA. (2017, August 25). Victoza (liraglutide) injection: Highlights of prescribing information. [PDF]. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/022341s027lbl.pdf

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Elmehdawi, R. R., & Elbarsha, A. M. (2014). An accidental liraglutide overdose: case report. Libyan Journal of Medicine, 9, 10.3402/ljm.v9.23055.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901387/

Lipowsky, C., Sze, L., Krull, I., & Brändle, M. (2015). Liraglutide as Add-On Therapy to Insulin in Type 2 Diabetes Mellitus: A Retrospective, Observational Study From a Daily Clinical Practice Setting in Switzerland. Diabetes Ther, 6(1), 41–47.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374072/

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