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
- abdominal pain
- anaphylactic shock
- anaphylactoid reactions
- angioedema
- antibody formation
- back pain
- bronchospasm
- cholecystitis
- cholelithiasis
- cholestasis
- constipation
- cutaneous amyloidosis
- diarrhea
- dyspepsia
- elevated hepatic enzymes
- eructation
- flatulence
- gastritis
- gastroesophageal reflux
- headache
- hepatitis
- hyperamylasemia
- hyperbilirubinemia
- hyperinsulinemia
- hypertension
- hypoglycemia
- hypokalemia
- hypotension
- infection
- injection site reaction
- insulin resistance
- insulin shock
- lipodystrophy
- nausea
- new primary malignancy
- pancreatitis
- peripheral edema
- pharyngitis
- pruritus
- rash
- renal failure (unspecified)
- Somogyi effect
- urticaria
- vomiting
- 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
- Amoxicillin; Clarithromycin; Omeprazole
- Amphetamine
- Amphetamine; Dextroamphetamine
- Amprenavir
- Androgens
- Angiotensin II receptor antagonists
- Angiotensin-converting enzyme inhibitors
- Aripiprazole
- Articaine; Epinephrine
- Asenapine
- Aspirin, ASA
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Dipyridamole
- Aspirin, ASA; Omeprazole
- Aspirin, ASA; Oxycodone
- Aspirin, ASA; Pravastatin
- Atazanavir
- Atazanavir; Cobicistat
- Atenolol
- Atenolol; Chlorthalidone
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- atypical antipsychotic
- Azelastine; Fluticasone
- Azilsartan
- Azilsartan; Chlorthalidone
- Beclomethasone
- Benazepril
- Benazepril; Hydrochlorothiazide, HCTZ
- Bendroflumethiazide; Nadolol
- Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Benzphetamine
- Beta-blockers
- Betamethasone
- Betaxolol
- Bexarotene
- Bismuth Subsalicylate
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Bisoprolol
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Bortezomib
- Brexpiprazole
- Brimonidine; Timolol
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Phenylephrine
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Budesonide
- Budesonide; Formoterol
- Bumetanide
- Canagliflozin; Metformin
- Candesartan
- Candesartan; Hydrochlorothiazide, HCTZ
- Captopril
- Captopril; Hydrochlorothiazide, HCTZ
- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Guaifenesin; Phenylephrine
- Carbetapentane; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbetapentane; Pseudoephedrine
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbinoxamine; Phenylephrine
- Carbinoxamine; Pseudoephedrine
- Carbonic anhydrase inhibitors
- Cariprazine
- Carteolol
- Carvedilol
- Cetirizine; Pseudoephedrine
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chlophedianol; Guaifenesin; Phenylephrine
- Chloroquine
- Chlorothiazide
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Chlorpromazine
- Chlorthalidone
- Chlorthalidone; Clonidine
- Choline Salicylate; Magnesium Salicylate
- Chromium
- Ciclesonide
- Cisapride
- Clarithromycin
- Clonidine
- Clozapine
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Colesevelam
- Conjugated Estrogens
- Conjugated Estrogens; Bazedoxifene
- Conjugated Estrogens; Medroxyprogesterone
- Corticosteroids
- Cortisone
- Cyclosporine
- Daclatasvir
- Danazol
- Dapagliflozin; Metformin
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Deflazacort
- Desloratadine; Pseudoephedrine
- Dexamethasone
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dexmethylphenidate
- Dextroamphetamine
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Guaifenesin; Phenylephrine
- Dextromethorphan; Guaifenesin; Pseudoephedrine
- Dextromethorphan; Promethazine
- Diazoxide
- Dienogest; Estradiol valerate
- Diethylpropion
- Diethylstilbestrol, DES
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Phenylephrine
- Disopyramide
- Dobutamine
- Dopamine
- Dorzolamide; Timolol
- Drospirenone
- Drospirenone; Estradiol
- Drospirenone; Ethinyl Estradiol
- Drospirenone; Ethinyl Estradiol; Levomefolate
- Edetate Calcium Disodium, Calcium EDTA
- Edetate Disodium, Disodium EDTA
- Elagolix; Estradiol; Norethindrone acetate
- Elbasvir; Grazoprevir
- Empagliflozin; Linagliptin; Metformin
- Empagliflozin; Metformin
- Enalapril, Enalaprilat
- Enalapril; Felodipine
- Enalapril; Hydrochlorothiazide, HCTZ
- Ephedrine
- Epinephrine
- Eprosartan
- Eprosartan; Hydrochlorothiazide, HCTZ
- Ertugliflozin; Metformin
- Erythromycin; Sulfisoxazole
- Esmolol
- Esterified Estrogens
- Esterified Estrogens; Methyltestosterone
- Estradiol
- Estradiol Cypionate; Medroxyprogesterone
- Estradiol; Levonorgestrel
- Estradiol; Norethindrone
- Estradiol; Norgestimate
- Estradiol; Progesterone
- Estramustine
- Estrogens
- Estropipate
- Ethanol
- Ethinyl Estradiol
- Ethinyl Estradiol; Desogestrel
- Ethinyl Estradiol; Ethynodiol Diacetate
- Ethinyl Estradiol; Etonogestrel
- Ethinyl Estradiol; Levonorgestrel
- Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
- Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
- Ethinyl Estradiol; Norelgestromin
- 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
- Etonogestrel
- Exenatide
- Fenofibrate
- Fenofibric Acid
- Fexofenadine; Pseudoephedrine
- Fibric acid derivatives
- Fludrocortisone
- Flunisolide
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluoxymesterone
- Fluphenazine
- Fluticasone
- Fluticasone; Salmeterol
- Fluticasone; Umeclidinium; Vilanterol
- Fluticasone; Vilanterol
- Formoterol; Mometasone
- Fosamprenavir
- Fosinopril
- Fosinopril; Hydrochlorothiazide, HCTZ
- Fosphenytoin
- Furosemide
- Garlic, Allium sativum
- Gemfibrozil
- Glecaprevir; Pibrentasvir
- Glimepiride; Pioglitazone
- Glimepiride; Rosiglitazone
- Glipizide; Metformin
- Glucagon
- Glyburide; Metformin
- Green Tea
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Guaifenesin; Phenylephrine
- Guaifenesin; Pseudoephedrine
- Hydralazine; Hydrochlorothiazide, HCTZ
- Hydrochlorothiazide, HCTZ
- Hydrochlorothiazide, HCTZ; Irbesartan
- Hydrochlorothiazide, HCTZ; Lisinopril
- 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
- Hydroxyprogesterone
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Ibuprofen; Pseudoephedrine
- Iloperidone
- Indapamide
- Indinavir
- Insulin Aspart
- Insulin Degludec
- Insulin Detemir
- Insulin Glargine
- Insulin Glargine; Lixisenatide
- Insulin Glulisine
- Insulin Lispro
- Insulin Lispro
- Insulin Lispro; Insulin Lispro Protamine
- Insulin Regular
- Insulin, Inhaled
- Irbesartan
- Isocarboxazid
- Isoproterenol
- Labetalol
- Lanreotide
- Ledipasvir; Sofosbuvir
- Leuprolide; Norethindrone
- Levobetaxolol
- Levobunolol
- Levonorgestrel
- Levothyroxine
- Levothyroxine; Liothyronine (Porcine)
- Levothyroxine; Liothyronine (Synthetic)
- Linagliptin; Metformin
- Linezolid
- Liothyronine
- Lisdexamfetamine
- Lisinopril
- Lithium
- Lixisenatide
- Lomefloxacin
- Loop diuretics
- Lopinavir; Ritonavir
- Loratadine; Pseudoephedrine
- Lorcaserin
- Losartan
- Lovastatin; Niacin
- Lumateperone
- Lurasidone
- Macimorelin
- Magnesium Salicylate
- Mecasermin rinfabate
- Mecasermin, Recombinant, rh-IGF-1
- Medroxyprogesterone
- Meperidine; Promethazine
- Mepivacaine; Levonordefrin
- Mesoridazine
- Mestranol; Norethindrone
- Metformin
- Metformin; Pioglitazone
- Metformin; Repaglinide
- Metformin; Rosiglitazone
- Metformin; Saxagliptin
- Metformin; Sitagliptin
- Methamphetamine
- Methazolamide
- Methohexital
- Methyclothiazide
- Methylphenidate
- Methylprednisolone
- Methyltestosterone
- Metoclopramide
- Metolazone
- Metoprolol
- Metreleptin
- Metyrapone
- Midodrine
- Moexipril
- Mometasone
- Monoamine oxidase inhibitors
- Nadolol
- Nandrolone Decanoate
- Naproxen; Pseudoephedrine
- Nebivolol
- Nebivolol; Valsartan
- Nelfinavir
- Niacin, Niacinamide
- Niacin; Simvastatin
- Nicotine
- Norepinephrine
- Norethindrone
- Norgestrel
- Octreotide
- Olanzapine
- Olmesartan
- Ombitasvir; Paritaprevir; Ritonavir
- Orlistat
- Oxandrolone
- Oxymetholone
- Paliperidone
- Pasireotide
- Pegvisomant
- Pemoline
- Penbutolol
- Pentamidine
- Pentoxifylline
- Perindopril
- Perindopril; Amlodipine
- Perphenazine
- Perphenazine; Amitriptyline
- Phendimetrazine
- Phenelzine
- Phenothiazines
- Phentermine
- Phentermine; Topiramate
- Phenylephrine
- Phenylephrine; Promethazine
- Phenytoin
- Pindolol
- Pioglitazone
- Pramlintide
- Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
- Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
- Prednisolone
- Prednisone
- Prilocaine; Epinephrine
- Prochlorperazine
- Progesterone
- Progestins
- Promethazine
- Propoxyphene
- Propranolol
- Protease inhibitors
- Pseudoephedrine
- Pyrimethamine; Sulfadoxine
- Quetiapine
- Quinapril
- Quinolones
- Racepinephrine
- Ramipril
- Regular Insulin
- Regular Insulin; Isophane Insulin (NPH)
- Reserpine
- Risperidone
- Ritodrine
- Ritonavir
- Rosiglitazone
- Sacubitril; Valsartan
- Salicylates
- Salsalate
- Saquinavir
- Segesterone Acetate; Ethinyl Estradiol
- Sodium Polystyrene Sulfonate
- Sofosbuvir
- Sofosbuvir; Velpatasvir
- Sofosbuvir; Velpatasvir; Voxilaprevir
- Somatropin, rh-GH
- Sotalol
- Sparfloxacin
- Sulfadiazine
- Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
- Sulfasalazine
- Sulfinpyrazone
- Sulfisoxazole
- Sulfonamides
- Sympathomimetics
- Tacrolimus
- Tegaserod
- Telmisartan
- Testolactone
- Testosterone
- Thiazide diuretics
- Thiethylperazine
- Thioridazine
- Thyroid hormones
- Timolol
- Tipranavir
- tobacco
- Torsemide
- Trandolapril
- Trandolapril; Verapamil
- Tranylcypromine
- Triamcinolone
- Triamterene
- Trifluoperazine
- Valsartan
- Ziprasidone