From the Guidelines
When transitioning from Saxenda (liraglutide) to Wegovy (semaglutide), the recommended protocol is to discontinue Saxenda completely before starting Wegovy, with a gradual titration of Wegovy to minimize gastrointestinal side effects, as supported by the most recent evidence from 2023 1. The transition process should involve stopping Saxenda and then initiating Wegovy at its starting dose of 0.25 mg once weekly for the first month, regardless of the previous Saxenda dose.
- Key considerations during this transition include:
- No overlap period between Saxenda and Wegovy is recommended due to their similar mechanisms of action as GLP-1 receptor agonists, which could increase adverse effects without additional benefits 1.
- Patients should follow the standard Wegovy dose escalation schedule after the first month: 0.5 mg once weekly for the second month, 1 mg once weekly for the third month, 1.7 mg once weekly for the fourth month, and finally reaching the maintenance dose of 2.4 mg once weekly by the fifth month.
- Monitoring for continued efficacy in weight management during the transition is crucial, and any significant weight gain during the initial lower doses of Wegovy should be expected and considered temporary, as long-term use of semaglutide has been shown to result in significant weight loss and improvement in weight-related comorbidities 1.
- The importance of adequate hydration and continued adherence to dietary and lifestyle modifications throughout the transition process cannot be overstated, as these factors contribute to the overall success of weight management with GLP-1 receptor agonists like semaglutide and liraglutide 1.
From the Research
Transitioning from Saxenda to Wegovy
- The recommended protocol for transitioning a patient from Saxenda (liraglutide) to Wegovy (semaglutide) is not explicitly stated in the provided studies, but we can look at the efficacy and safety of both medications in promoting weight loss.
- Studies have shown that semaglutide is more effective than liraglutide in achieving weight loss, with a greater percentage of participants achieving 10% or more weight loss 2, 3.
- A systematic review and meta-analysis found that semaglutide 2.4mg had the best weight loss efficacy, followed by liraglutide 3.0mg 4.
- The molecular mechanisms of semaglutide and liraglutide involve appetite regulation, insulin secretion, glucose homeostasis, energy expenditure, and lipid metabolism, which contribute to their weight loss effects 5.
- When transitioning from Saxenda to Wegovy, it is essential to consider the dosage and titration schedule, as well as the potential for adverse events, such as gastrointestinal symptoms 2, 3.
- A study comparing tirzepatide to semaglutide found that tirzepatide was superior in reducing body weight and waist circumference, but this does not directly inform the transition from Saxenda to Wegovy 6.
Key Considerations
- Efficacy: Semaglutide has been shown to be more effective than liraglutide in achieving weight loss.
- Safety: Both medications have similar adverse event profiles, with gastrointestinal symptoms being the most common.
- Dosage and Titration: The dosage and titration schedule for semaglutide and liraglutide differ, and should be carefully considered when transitioning between the two medications.
- Individual Patient Factors: The decision to transition a patient from Saxenda to Wegovy should be based on individual patient factors, such as response to treatment, adverse events, and medical history.