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).

1. 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).
2. 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).