STEPS

New Drug Reviews

Liraglutide (Saxenda) for Weight Loss

 


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Am Fam Physician. 2016 Jul 15;94(2):161-166.

Liraglutide (Saxenda) is a glucagon-like peptide-1 (GLP-1) receptor agonist that, in addition to stimulating insulin release and inhibiting glucagon secretion, slows gastric emptying and increases satiety after eating. It is labeled as an adjunct to diet and exercise for weight management in overweight or obese adults. It is a higher-dose version of the same product used to treat type 2 diabetes mellitus.

View/Print Table

DrugDosageDose formCost*

Liraglutide (Saxenda)

0.6 mg once daily for one week, increasing by 0.6 mg weekly to target dosage of 3 mg once daily

Prefilled, multidose pen for subcutaneous injection containing 0.6-mg, 1.2-mg, 1.8-mg, 2.4-mg, or 3-mg dose

Approximately $1,194


*—Estimated retail price of one month's treatment based on information obtained at http://www.goodrx.com (accessed June 2, 2016).

DrugDosageDose formCost*

Liraglutide (Saxenda)

0.6 mg once daily for one week, increasing by 0.6 mg weekly to target dosage of 3 mg once daily

Prefilled, multidose pen for subcutaneous injection containing 0.6-mg, 1.2-mg, 1.8-mg, 2.4-mg, or 3-mg dose

Approximately $1,194


*—Estimated retail price of one month's treatment based on information obtained at http://www.goodrx.com (accessed June 2, 2016).

SAFETY

Safety concerns with liraglutide include acute gallbladder disease, acute pancreatitis, and risk of severe hypoglycemia.13 Gallbladder disease and cholecystitis can occur in patients rapidly losing weight by any means, but the rates are higher in patients using liraglutide (number needed to harm [NNH] = 100 and 250, respectively) and rise with increasing weight loss.1,2 The risk of pancreatitis is relatively low (0.3%), but transient elevations of pancreatic enzymes of uncertain clinical significance can occur.13 Although sulfonylureas and other insulin secretagogues are not contraindicated for use with liraglutide, their dose should be lowered by at least 50% if they are continued while patients are taking liraglutide. Both severe (NNH = 143) and symptomatic (NNH = 10) hypoglycemia have occurred in patients with type 2 diabetes who are taking sulfonylureas and liraglutide for weight loss.1,2 Liraglutide should not be used in patients taking insulin.1,2 Kidney injury may occur in volume-depleted patients.1 Liraglutide is contraindicated in patients with a family or personal history of medullary thyroid cancers as well as multiple endocrine neoplasia syndrome type 2 because of reports of thyroid tumors in animals.1 As with other GLP-1 receptor agonists, transient pulse elevations of uncertain clinical significance have been reported, with return to baseline after cessation of liraglutide therapy.13 Long-term safety (greater than two years) has not been studied.

Liraglutide is a U.S. Food and Drug Administration pregnancy category X drug. Because it is unknown if the medication is excreted in breast milk, it should not be taken by breastfeeding women.

Address correspondence to J. Suzin Whitten, MD, at su.zinwhitten@gmail.com. Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Daily Med. Drug label information: Saxenda (liraglutide injection, solution). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3946d389-0926-4f77-a708-0acb8153b143. Accessed January 8, 2016....

2. Davies MJ, Bergenstal R, Bode B, et al.; NN8022-1922 Study Group. Efficacy of liraglutide for weight loss among patients with type 2 diabetes: the SCALE diabetes randomized clinical trial [published correction appears in JAMA. 2016;315(1):90]. JAMA. 2015;314(7):687–699.

3. Pi-Sunyer X, Astrup A, Fujioka K, et al.; SCALE Obesity and Prediabetes NN8022-1839 Study Group. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med. 2015;373(1):11–22.

4. Lean ME, Carraro R, Finer N, et al.; NN8022-1807 Investigators. Tolerability of nausea and vomiting and associations with weight loss in a randomized trial of liraglutide in obese, non-diabetic adults. Int J Obes (Lond). 2014;38(5):689–697.

5. Astrup A, Carraro R, Finer N, et al.; NN8022-1807 Investigators. Safety, tolerability and sustained weight loss over 2 years with the once-daily human GLP-1 analog, liraglutide. Int J Obes (Lond). 2012;36(6):843–854.

STEPS new drug reviews cover Safety, Tolerability, Effectiveness, Price, and Simplicity. Each independent review is provided by authors who have no financial association with the drug manufacturer.

This series is coordinated by Allen F. Shaughnessy, PharmD, MMedEd, Contributing Editor.

A collection of STEPS published in AFP is available at http://www.aafp.org/afp/steps.



 

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