Liraglutide

Liraglutide Brand Names- Saxenda | Victoza

What is Liraglutide

Liraglutide is a synthetic glucagon-like peptide-1 receptor agonist (GLP-1 RA) and belongs to a class of antidiabetic agents called incretin mimetics.

Incretins are endogenous compounds that improve glycemic control once released into the circulation via the gut.

Liraglutide subcutaneous injection (Victoza) is used as an adjunct to diet and exercise to improve glycemic control in pediatric patients 10 years and older and adults with type 2 diabetes mellitus (DM).

It is also used to reduce the risk of non-fatal cardiovascular (CV) events and CV mortality in type 2 DM adult patients who also have CV disease.

Liraglutide monotherapy reduces A1C by an average of 0.84% to 1.14%. The addition of liraglutide as add-on therapy to other antidiabetic agents has resulted in statistically significant improvements in A1C and fasting plasma glucose. As with other agents in this class, liraglutide has a boxed warning regarding rodent C-cell tumor findings and the uncertain relevance to humans.

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

Additional therapy with a GLP-1 RA that has proven cardiovascular (CV) benefit should be considered in patients with indicators of high-risk or established CV disease, independent of baseline A1C or individualized A1C target.

Among the GLP-1 RAs, evidence of CV benefit is strongest for liraglutide, favorable for semaglutide, and less certain for exenatide; there is no evidence of CV benefit with lixisenatide.

GLP-1 RAs have high glucose-lowering efficacy, but with variation within the drug class. Evidence suggests that the effect may be greatest for semaglutide once weekly, followed by dulaglutide and liraglutide, closely followed by exenatide once weekly, and then exenatide twice daily and lixisenatide.

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).

For patients requiring an injectable medication, GLP-1 RAs are preferred to insulin due to similar or even better efficacy in A1C reduction, lower risk of hypoglycemia, and reductions in body weight.

Low-dose liraglutide (Saxenda) is used as an adjunct to lifestyle modifications for weight loss and chronic weight management in obese adults or overweight adults with at least 1 weight-related comorbid condition (e.g., hypertension, type 2 diabetes mellitus, or dyslipidemia).

According to the American Association of Clinical Endocrinologists and American College of Endocrinology (AACE/ACE) Obesity Clinical Practice Guidelines, weight loss medications should be offered as chronic treatment along with lifestyle modifications to patients with obesity when the potential benefits outweigh the risks.

Short-term pharmacotherapy has not been shown to produce longer-term health benefits and cannot be generally recommended. A generalized hierarchy for medication preferences that would apply to all overweight patients cannot currently be scientifically justified.

Individualized weight loss pharmacotherapy is recommended, based upon factors such as the specific characteristics of each weight loss medication, the presence of weight-related complications, and the medical history of the patient.

Indications

  1. obesity
  2. reduction of cardiovascular mortality
  3. type 2 diabetes mellitus
  4. weight management

Side Effects

  1. abdominal pain
  2. anaphylactoid reactions
  3. angioedema
  4. anorexia
  5. antibody formation
  6. anxiety
  7. asthenia
  8. AV block
  9. back pain
  10. bronchospasm
  11. bundle-branch block
  12. cholecystitis
  13. cholelithiasis
  14. cholestasis
  15. constipation
  16. diarrhea
  17. dizziness
  18. dysgeusia
  19. dyspepsia
  20. dyspnea
  21. edema
  22. elevated hepatic enzymes
  23. eructation
  24. erythema
  25. fatigue
  26. flatulence
  27. gastritis
  28. gastroesophageal reflux
  29. headache
  30. hepatitis
  31. hyperamylasemia
  32. hyperbilirubinemia
  33. hypertension
  34. hypoglycemia
  35. hypotension
  36. infection
  37. influenza
  38. injection site reaction
  39. insomnia
  40. malaise
  41. nausea
  42. new primary malignancy
  43. orthostatic hypotension
  44. palpitations
  45. pancreatitis
  46. pruritus
  47. rash
  48. renal failure (unspecified)
  49. sinus tachycardia
  50. sinusitis
  51. suicidal ideation
  52. urticaria
  53. vomiting
  54. xerostomia

Monitoring Parameters

  • blood glucose
  • glycosylated hemoglobin A1c (HbA1c)
  • weight

Contraindications

  • alcoholism
  • breast-feeding
  • burns
  • cardiac arrhythmias
  • children
  • cholelithiasis
  • contraception requirements
  • depression
  • diabetic ketoacidosis
  • diarrhea
  • fever
  • gallbladder disease
  • gastroparesis
  • geriatric
  • heart failure
  • hepatic disease
  • history of angioedema
  • hypoglycemia
  • hypovolemia
  • infants
  • infection
  • medullary thyroid carcinoma (MTC)
  • multiple endocrine neoplasia syndrome type 2 (MEN 2)
  • pancreatitis
  • pregnancy
  • renal disease
  • renal failure
  • renal impairment
  • schizophrenia
  • serious hypersensitivity reactions or anaphylaxis
  • suicidal ideation
  • surgery
  • tachycardia
  • thyroid C-cell tumors
  • thyroid cancer
  • thyroid disease
  • trauma
  • type 1 diabetes mellitus
  • vomiting

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