Insulin Degludec Liraglutide

Insulin Degludec Liraglutide Brand Name– Xultophy

What is Insulin Degludec Liraglutide

Insulin degludec liraglutide is a once-daily subcutaneous injection containing a combination of basal insulin (insulin degludec) and a glucagon-like peptide-1 receptor agonist (GLP-1 RA) (liraglutide).

The combination is used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus (DM). Insulin degludec acts in a manner that gives a flat and stable effect on blood glucose throughout the day; liraglutide stimulates insulin secretion and lowers inappropriately high glucagon secretion in a glucose-dependent manner.

The combination improves blood glucose control via a sustained lowering of fasting plasma glucose concentrations and postprandial glucose levels after all meals. During clinical trials, the mean A1C reduction was 1.84% and was a greater reduction than the use of either drug alone.

Liraglutide is not a first-line therapy due to the boxed warning regarding rodent C-cell tumors and the uncertain risk to humans.

However, liraglutide is associated with cardiovascular (CV) risk reduction.

Liraglutide monotherapy is indicated to reduce the risk of major adverse cardiovascular events (MACE, e.g., non-fatal myocardial infarction, non-fatal stroke, and CV mortality) in patients with type 2 DM who also have CV disease; however, the insulin degludec; liraglutide products are not approved for this indication.

Metformin is first-line in the treatment of type 2 DM.

Additional therapy with a GLP-1 RA that has proven CV benefit should be considered in patients with indicators of high-risk or established CV disease, independent of baseline A1C or individualized A1C target. GLP-1 RAs improve CV outcomes, as well as secondary outcomes such as heart failure (HF) and progression of renal disease, in patients with established CV disease or chronic kidney disease (CKD); this makes them an alternative treatment option in patients with indicators of high-risk or established heart failure HF or CKD who cannot tolerate a sodium-glucose cotransporter 2 inhibitor (SGLT2i).

Patients who need to minimize weight gain or lose weight should be started on a GLP-1 RA with proven efficacy for weight loss, such as liraglutide or an SGLT2i. Insulin is generally reserved for patients who continue to have an A1C above target despite dual/triple therapy with metformin and other antidiabetic agents.

Consider switching to a fixed-ratio combination, like insulin degludec; liraglutide in patients already receiving a GLP-1 RA who are starting on insulin. In patients who are starting on insulin therapy and are taking a thiazolidinedione or insulin secretagogue, discontinue or reduce the dose of the oral medication.

Indications

  • type 2 diabetes mellitus

For the treatment of type 2 diabetes mellitus in combination with diet and exercise

Side Effects

  1. abdominal pain
  2. anaphylactic shock
  3. anaphylactoid reactions
  4. angioedema
  5. antibody formation
  6. back pain
  7. bronchospasm
  8. cholecystitis
  9. cholelithiasis
  10. cholestasis
  11. constipation
  12. cutaneous amyloidosis
  13. diarrhea
  14. dyspepsia
  15. elevated hepatic enzymes
  16. eructation
  17. flatulence
  18. gastritis
  19. gastroesophageal reflux
  20. headache
  21. hepatitis
  22. hyperamylasemia
  23. hyperbilirubinemia
  24. hyperinsulinemia
  25. hypertension
  26. hypoglycemia
  27. hypokalemia
  28. hypotension
  29. infection
  30. injection site reaction
  31. insulin resistance
  32. insulin shock
  33. lipodystrophy
  34. nausea
  35. new primary malignancy
  36. pancreatitis
  37. peripheral edema
  38. pharyngitis
  39. pruritus
  40. rash
  41. renal failure (unspecified)
  42. Somogyi effect
  43. urticaria
  44. vomiting
  45. weight gain

Monitoring Parameters

  • blood glucose
  • glycosylated hemoglobin A1c (HbA1c)

Contraindications

  • alcoholism
  • breast-feeding
  • burns
  • children
  • cholelithiasis
  • coma
  • continuous subcutaneous insulin infusion (CSII) administration
  • diabetic ketoacidosis
  • diarrhea
  • fever
  • gallbladder disease
  • gastroparesis
  • geriatric
  • hepatic disease
  • history of angioedema
  • hyperosmolar hyperglycemic state (HHS)
  • hypoglycemia
  • hypokalemia
  • infants
  • infection
  • intramuscular administration
  • intravenous administration
  • medullary thyroid carcinoma (MTC)
  • multiple endocrine neoplasia syndrome type 2 (MEN 2)
  • pancreatitis
  • pregnancy
  • renal failure
  • renal impairment
  • serious hypersensitivity reactions or anaphylaxis
  • surgery
  • thyroid C-cell tumors
  • thyroid cancer
  • thyroid disease
  • tobacco smoking
  • trauma
  • type 1 diabetes mellitus
  • visual impairment
  • vomiting

Interactions

  • Acebutolol
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Guaifenesin; Phenylephrine
  • Acetaminophen; Propoxyphene
  • Acetaminophen; Pseudoephedrine
  • Acetazolamide
  • Acrivastine; Pseudoephedrine
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Aliskiren; Hydrochlorothiazide, HCTZ
  • Aliskiren; Valsartan
  • Alogliptin; Metformin
  • Alogliptin; Pioglitazone
  • Amiloride; Hydrochlorothiazide, HCTZ
  • Aminosalicylate sodium, Aminosalicylic acid
  • Amlodipine; Benazepril
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amlodipine; Olmesartan
  • Amlodipine; Telmisartan
  • Amlodipine; Valsartan
  • Amoxicillin; Clarithromycin; Lansoprazole
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  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
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  • Aspirin, ASA; Dipyridamole
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  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone; Phenylephrine
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  • Chlorpheniramine; Phenylephrine
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  • Enalapril; Hydrochlorothiazide, HCTZ
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  • Ethinyl Estradiol; Norethindrone
  • Ethinyl Estradiol; Norethindrone Acetate
  • Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
  • Ethinyl Estradiol; Norethindrone; Ferrous fumarate
  • Ethinyl Estradiol; Norgestimate
  • Ethinyl Estradiol; Norgestrel
  • Ethotoin
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  • Exenatide
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  • Green Tea
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Guaifenesin; Phenylephrine
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  • Hydralazine; Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ
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  • Hydrochlorothiazide, HCTZ; Losartan
  • Hydrochlorothiazide, HCTZ; Methyldopa
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Moexipril
  • Hydrochlorothiazide, HCTZ; Olmesartan
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrochlorothiazide, HCTZ; Quinapril
  • Hydrochlorothiazide, HCTZ; Spironolactone
  • Hydrochlorothiazide, HCTZ; Telmisartan
  • Hydrochlorothiazide, HCTZ; Triamterene
  • Hydrochlorothiazide, HCTZ; Valsartan
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydrocortisone
  • Hydroxychloroquine
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  • Ibuprofen; Pseudoephedrine
  • Iloperidone
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  • Methamphetamine
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  • Nicotine
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  • Orlistat
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  • Pegvisomant
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  • Penbutolol
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  • Perindopril
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  • Perphenazine
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  • Phendimetrazine
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  • Ziprasidone
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