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Drugs, Supplies and Delivery
Liraglutide (Victoza® Injection)
Liraglutide, marketed as Victoza®, is a glucagon-like peptide-1 (GLP-1) receptor agonist administered via subcutaneous injection. It is widely used for the management of type 2 diabetes mellitus (T2DM) and has demonstrated cardiovascular benefits in high-risk patients. This article synthesizes evidence from the British National Formulary (BNF), Lippincott Textbook of Pharmacology, and Lange Basic & Clinical Pharmacology to detail its pharmacology, clinical applications, and safety profile.
Liraglutide mimics endogenous GLP-1, a hormone that enhances glucose-dependent insulin secretion and suppresses glucagon release. Key mechanisms include:
- Insulin Secretion: Binds to pancreatic β-cell GLP-1 receptors, activating cyclic AMP (cAMP) to stimulate insulin release in response to elevated blood glucose (Lippincott).
- Glucagon Suppression: Reduces inappropriate glucagon secretion from α-cells, lowering hepatic glucose output.
- Gastric Emptying: Slows gastric motility, reducing postprandial glucose spikes and promoting satiety (Lange).
- Cardiovascular Protection: Reduces major adverse cardiovascular events (MACE) in patients with T2DM and established cardiovascular disease, as shown in the LEADER trial (BNF).
- Type 2 Diabetes Mellitus:
- Adjunctive therapy to diet, exercise, and other glucose-lowering agents (e.g., metformin, insulin) when glycemic targets are unmet.
- Preferred for patients with cardiovascular disease due to proven MACE reduction (BNF).
- Weight Management (Off-Label):
- Promotes weight loss via appetite suppression (higher doses approved as Saxenda® for obesity).
- Administration: Subcutaneous injection (abdomen, thigh, or upper arm) once daily.
- Titration:
- Initial: 0.6 mg daily for 1 week to minimize gastrointestinal (GI) side effects.
- Maintenance: Increase to 1.2 mg or 1.8 mg daily based on tolerance and glycemic response (BNF).
- Special Populations:
- Renal Impairment: No dose adjustment for mild-to-moderate impairment; use caution in severe impairment (eGFR <30 mL/min/1.73m²).
- Hepatic Impairment: No adjustment required.
Elderly: Monitor closely for hypoglycemia and GI effects
- Gastrointestinal: Nausea (20–40%), vomiting, diarrhea (most frequent during dose escalation).
- Headache, dizziness.
Serious:
- Pancreatitis: Monitor for severe abdominal pain; discontinue if confirmed.
- Thyroid C-Cell Tumors: Contraindicated in personal/family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia type 2 (MEN 2).
- Acute Kidney Injury: Linked to dehydration from GI adverse effects (BNF).
- Hypoglycemia: Risk increases with concurrent insulin or sulfonylureas (Lippincott).
- Contraindications:
- Personal/family history of MTC or MEN 2.
Hypersensitivity to liraglutide or GLP-1 agonists
- Renal function, pancreatic enzymes, and HbA1c.
- Thyroid nodules (via palpation or imaging).
Unopened vials/pens: Refrigerate (2–8°C).
In-use: Store at room temperature (<30°C) for up to 28 days
- Pregnancy: Category C; avoid unless benefits outweigh risks.
- Lactation: Discontinue due to insufficient safety data (Lange).
- Oral Medications: Delayed absorption of drugs requiring rapid GI uptake (e.g., antibiotics, oral contraceptives). Administer 1 hour before liraglutide.
- Insulin/Sulfonylureas: Increased hypoglycemia risk; consider dose reduction.
- ACE Inhibitors/Diuretics: May exacerbate dehydration and renal impairment (BNF).
- Generic: Liraglutide.
- Brand Names: Victoza® (for T2DM), Saxenda® (for obesity).
