What are the doses and administration frequencies of semaglutide (Glucagon-like peptide-1 (GLP-1) receptor agonist) and liraglutide (GLP-1 receptor agonist)?

Dosing and Administration of Semaglutide and Liraglutide

For optimal clinical outcomes, semaglutide is administered once weekly while liraglutide is administered once daily, with both medications requiring gradual dose titration to minimize gastrointestinal side effects.

Semaglutide Dosing

Subcutaneous (Injectable) Semaglutide

• Initial dose: 0.25 mg subcutaneously once weekly
• Titration schedule:
  • After 4 weeks, increase to 0.5 mg once weekly
  • For type 2 diabetes: May increase to 1.0 mg once weekly if needed for glycemic control 1, 2
  • For obesity management: May increase to 2.4 mg once weekly 1
• Maintenance dose:
  • Type 2 diabetes: 0.5-1.0 mg once weekly
  • Obesity management: 2.4 mg once weekly

Oral Semaglutide

• Not yet FDA approved for obesity alone, but in clinical trials:
  • Dose: 50 mg once daily 1
  • Achieved 15.1% weight loss vs 2.4% for placebo

Liraglutide Dosing

• Initial dose: 0.6 mg subcutaneously once daily
• Titration schedule:
  • For type 2 diabetes: After 1 week, increase to 1.2 mg daily; may increase to 1.8 mg daily if needed 1, 3
  • For obesity management: Titrate weekly by 0.6 mg increments to target dose of 3.0 mg daily 1
• Maintenance dose:
  • Type 2 diabetes: 1.2-1.8 mg once daily
  • Obesity management: 3.0 mg once daily

Key Clinical Considerations

Efficacy Comparison

• Semaglutide demonstrates superior weight loss compared to liraglutide:
  • Subcutaneous semaglutide 2.4 mg weekly achieved 14.9% weight loss vs 8.0% with liraglutide 3.0 mg daily 1
  • Even lower doses of semaglutide (0.5 mg weekly) showed comparable weight loss to liraglutide 3.0 mg daily in real-world settings (5.28 kg vs 5.72 kg over 3 months) 4

Administration Tips

• Semaglutide: Administer once weekly on the same day each week, with or without meals
• Liraglutide: Administer once daily at any time of day, independent of meals
• Both medications should be injected subcutaneously in the abdomen, thigh, or upper arm

Dose Modifications

• Renal impairment:
  • Semaglutide: No dosage adjustment required for mild to moderate renal impairment; limited data in end-stage renal disease 1
  • Liraglutide: No dosage adjustment required for renal impairment; limited data in end-stage renal disease 1

Common Side Effects

• Both medications commonly cause gastrointestinal side effects:
  • Nausea, vomiting, diarrhea, constipation
  • Side effects are typically dose-dependent and transient
  • Slow titration helps minimize these effects 1

Important Precautions

• Contraindications for both medications 1:

  • Personal or family history of medullary thyroid carcinoma
  • Multiple endocrine neoplasia syndrome type 2
  • Serious hypersensitivity to the medication
  • Pregnancy or breastfeeding

• Monitoring recommendations:

  • Assess effectiveness at least monthly for the first 3 months and quarterly thereafter 1
  • Monitor for pancreatitis, gallbladder disease, and diabetic retinopathy complications

Practical Considerations

• Semaglutide's once-weekly dosing may improve adherence compared to daily liraglutide
• Cost and insurance coverage often influence treatment decisions (monthly cost for maximum doses: approximately $1,619 for both semaglutide and liraglutide) 1
• Gradual dose titration is essential to minimize gastrointestinal side effects with both medications

Remember that both medications have demonstrated cardiovascular benefits in patients with type 2 diabetes and established cardiovascular disease 1, 2.