Drug Detail:Liraglutide (Liraglutide [ lir-a-gloo-tide ])
Drug Class: Incretin mimetics
1. How it works
- Liraglutide may be used to treat type 2 diabetes in adults and children over the age of 10 or to reduce the risk of future cardiovascular events.
- Liraglutide mimics the actions of GLP-1, a naturally occurring hormone that helps to regulate blood glucose levels. By binding to and activating the GLP-1 receptor, liraglutide stimulates insulin secretion and lowers glucagon secretion when blood glucose levels are high. It also causes a slowing down in how fast the stomach empties.
- Liraglutide belongs to the class of medicines called GLP-1 receptor agonists. It may also be called an incretin mimetic.
2. Upsides
- Liraglutide may be used in the treatment of type 2 diabetes in adults and children aged 10 years and older alongside diet modification and increased exercise.
- Liraglutide may also be given to reduce the risk of future cardiovascular events, such as a heart attack or stroke, in adults with type 2 diabetes who also have heart disease.
- Effective at reducing blood glucose levels and it also reduces body weight.
- The dosage of liraglutide does not need to be adjusted in people with kidney or liver disease; however, kidney function should be monitored.
3. Downsides
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
- Common side effects of liraglutide include hypoglycemia (low blood sugar levels), nausea, diarrhea, headache, blocked nose, vomiting, decreased appetite, dyspepsia, upper respiratory tract infection, constipation, and back pain.
- Liraglutide needs to be given by injection under the skin (subcutaneous). However, self-administration is easy to learn for most people.
- The dosage of liraglutide needs to be increased slowly over a couple of weeks, starting with 0.6 mg/day and increasing at weekly intervals by 0.6mg to reach 1.2mg or 1.8mg if necessary and tolerated. Liraglutide is only effective at dosages greater than or equal to 1.2mg.
- Liraglutide does not take the place of insulin and is not effective in people with type 1 diabetes or for the treatment of diabetic ketoacidosis. Liraglutide may increase the risk of developing diabetic ketoacidosis.
- Animal studies have reported thyroid C-cell tumors in rats given liraglutide. Cases of thyroid-C-cell tumors have been reported in people taking Liraglutide outside of a clinical trial, but there is not enough data to establish or exclude a causal relationship with liraglutide. Liraglutide should not be used in people with a history of thyroid cancer or those with Multiple Endocrine Neoplasia syndrome type 2.
- Liraglutide may increase the risk of pancreatitis. If this occurs, liraglutide should be discontinued and not restarted. There have also been reports of kidney damage, which may require hemodialysis, in people treated with GLP-1 receptor agonists (RA), such as liraglutide. Anaphylaxis and angioedema have also been reported with GLP-1 RAs and the initial administration of liraglutide should preferably be done in a medical facility.
- Liraglutide has not been adequately studied in pregnant women and should not be used unless the perceived benefits outweigh the risks of uncontrolled diabetes, which include preeclampsia, spontaneous abortions, and preterm delivery.
- Liraglutide is given by injection subcutaneously (under the skin), once daily.
- There is currently no generic version of liraglutide but it is available under the brand name Victoza.
Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects
4. Tips
- Ask your doctor or nurse to show you how to self-administer Liraglutide before you first do it yourself. Liraglutide should be injected just under the skin into the abdomen, thigh, or upper arm. Change injection sites each day so that you are not injecting into the same bit of skin every day. Always inspect the injection and do not use liraglutide if it contains particles or discoloration is seen.
- If you also need to self-administer insulin, administer the insulin at a different site to liraglutide, at least 15cm apart. Never mix insulin with liraglutide and never share your injection with another person. Taking liraglutide with insulin (as well as other medications such as sulfonylureas that also lower blood sugar levels) increases your risk of hypoglycemia (low blood sugar levels) so monitor yourself for symptoms of low blood sugar which include sweating, shaking, dizziness, a fast heartbeat, and mood changes.
- Report any symptoms of a possible thyroid tumor (such as a lump in the neck, shortness of breath, difficulty swallowing, or persistent hoarseness) to your doctor immediately.
- If you develop persistent, severe, abdominal pain, which may radiate to the back or be accompanied by vomiting, ring your doctor immediately as liraglutide can increase your risk of developing pancreatitis.
- If you are a woman, use adequate contraception to ensure you do not become pregnant while taking liraglutide. For a planned pregnancy, it is recommended liraglutide be discontinued at least two months before conception. Tell your doctor if you inadvertently become pregnant while taking liraglutide.
5. Response and effectiveness
- Trials have reported that liraglutide significantly improves HbA1c values and fasting plasma glucose levels more than a placebo (a pretend medication).
- Only dosages of at least 1.2 mg/day are effective at lowering blood glucose levels.
- In comparative trials, liraglutide 1.8mg and 1.2mg lowered HbA1c levels significantly more than glimepiride 8mg/day. The number of trial participants who discontinued therapy because it was ineffective was 3.6% taking liraglutide 1.8mg, 6% taking liraglutide 1.2mg, and 10.1% taking glimepiride 8mg. Fasting plasma glucose levels decreased by an average of 26 from baseline in the liraglutide 1.8mg group, 15 from baseline in the liraglutide 1.2mg group, and 5 from baseline in the glimepiride 8mg group.
6. Interactions
Medicines that interact with liraglutide may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with liraglutide. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.
Common medications that may interact with liraglutide include:
- acetazolamide
- anticonvulsants such as phenytoin
- antidepressants such as tricyclic antidepressants (such as amitriptyline, and nortriptyline) or monoamine oxidase inhibitors (MAOI) (eg, selegiline, isocarboxazid, and phenelzine)
- antipsychotics, such as aripiprazole
- beta-blockers, such as atenolol, labetalol, and metoprolol, may enhance the hypoglycemic effects
- bexarotene
- ciprofloxacin
- corticosteroids, such as prednisone or cortisone
- diuretics, such as bumetanide, HCTZ, and bendroflumethiazide
- HIV medications, such as amprenavir, atazanavir, and fosamprenavir
- hormones, such as ethinylestradiol and hydroxyprogesterone
- insulin (may increase the risk of hypoglycemia)
- isoniazid
- other medications that affect blood sugar levels or are used for diabetes, such as glimepiride, or metformin.
Liraglutide may also enhance the toxic effects of alcohol, causing flushing.
Also, because liraglutide causes a delay in gastric emptying, it may impact the absorption of any medication taken orally. However, in clinical trials, this did not appear to change the effects of other medications.
Note that this list is not all-inclusive and includes only common medications that may interact with liraglutide. You should refer to the prescribing information for liraglutide for a complete list of interactions.