Liraglutide (Victoza/Saxenda) for Diabetes & Weight Management — Weight & Metabolism
FDA-approved GLP-1 receptor agonist for type 2 diabetes and chronic weight management with proven cardiovascular benefits.
Overview
Liraglutide is a GLP-1 receptor agonist with 97% homology to native human GLP-1, FDA-approved as Victoza (1.8mg) for type 2 diabetes and Saxenda (3.0mg) for chronic weight management. The LEADER trial (n=9,340, median 3.8 years follow-up) demonstrated a 13% reduction in cardiovascular death, non-fatal MI, and non-fatal stroke (HR 0.87, 95% CI 0.78-0.97, p=0.01) and 22% reduction in CV death alone. The SCALE Obesity and Prediabetes trial showed 8.0% mean weight loss vs 2.6% placebo at 56 weeks, with 63.2% of patients achieving >=5% weight loss. Liraglutide also reduced progression from prediabetes to T2DM by 79% over 3 years. HbA1c reductions of 1.0-1.5% demonstrated across LEAD trials. PMID: 27295427, 25925141, 28215582.
Indications
- Type 2 diabetes mellitus inadequately controlled with diet/exercise (Victoza 1.8mg)
- Chronic weight management in adults with BMI >=30 or BMI >=27 with comorbidities (Saxenda 3.0mg)
- Cardiovascular risk reduction in T2DM patients with established CVD
- Prevention of type 2 diabetes in patients with prediabetes and obesity
Mechanism of Action
Impaired incretin signaling, insulin resistance, and dysregulated appetite drive hyperglycemia and weight gain
Dosing
| Compound | Dose | Frequency | Notes |
|---|---|---|---|
| Liraglutide | 0.6 mg | Once daily for 1 week | Starting dose for GI tolerance; not effective for glycemic control at this dose |
| Liraglutide | 1.2 mg | Once daily | First therapeutic dose; adequate for many patients |
| Liraglutide | 1.8 mg | Once daily | Maximum diabetes dose; additional HbA1c reduction of ~0.2% vs 1.2mg |
| Liraglutide | 0.6 mg -> 3.0 mg | Once daily, increase by 0.6mg weekly | Titrate over 5 weeks: 0.6 -> 1.2 -> 1.8 -> 2.4 -> 3.0mg; discontinue if <4% weight loss at 16 weeks |
Evidence Grade
GRADE A
Safety & Contraindications
- FDA-approved with extensive post-marketing safety data since 2010 (Victoza) and 2014 (Saxenda)
- Black box warning: thyroid C-cell tumors in rodents; contraindicated in personal/family history of MTC or MEN2
- Common GI side effects: nausea (39%), diarrhea (21%), vomiting (16%) - usually transient with titration
- Risk of pancreatitis: discontinue if suspected; monitor for persistent severe abdominal pain
- May cause hypoglycemia when combined with sulfonylureas or insulin - dose adjustment required
- Contraindicated in pregnancy (Category X); discontinue at least 2 months before planned conception