What is the recommended use and dosage of Liraglutide (Glucagon-like peptide-1 (GLP-1) receptor agonist) for patients with type 2 diabetes?

Liraglutide for Type 2 Diabetes: Recommended Use and Dosage

For patients with type 2 diabetes, liraglutide (Victoza) should be initiated at 0.6 mg subcutaneously once daily for one week, then increased to 1.2 mg daily, with further titration to 1.8 mg daily after at least one week if additional glycemic control is required. 1

Dosing Protocol

Initial Titration Schedule

• Start with 0.6 mg subcutaneously once daily for one week (to reduce gastrointestinal side effects)
• Increase to 1.2 mg subcutaneously once daily after one week
• If additional glycemic control is needed, increase to maximum dose of 1.8 mg subcutaneously once daily after at least one week at 1.2 mg 1

Administration Guidelines

• Inject subcutaneously in abdomen, thigh, or upper arm
• Administer at any time of day, independent of meals
• Rotate injection sites within the same region to reduce risk of cutaneous amyloidosis
• When using with insulin, administer as separate injections (never mix) 1

Clinical Benefits

Liraglutide offers several advantages for patients with type 2 diabetes:

1. Glycemic Control: Reduces HbA1c by up to 1.5% from baseline 2
2. Weight Management: Associated with weight loss of 1.8-3.4 kg 2
3. Cardiovascular Benefits: Reduces risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) in adults with established cardiovascular disease 1
4. Low Hypoglycemia Risk: Due to its glucose-dependent mechanism of action 3
5. Beta-cell Function: May improve pancreatic beta cell function, potentially delaying disease progression 2

Monitoring and Discontinuation

• Evaluate glycemic response after 3 months on maximum tolerated dose
• Consider discontinuation if inadequate glycemic response after 12 weeks at 1.8 mg daily 1
• If more than 3 days have elapsed since the last dose, reinitiate at 0.6 mg once daily to mitigate gastrointestinal symptoms 1

Common Adverse Effects

The most common side effects include:

• Gastrointestinal symptoms: nausea (most common), vomiting, diarrhea
• These symptoms tend to be most pronounced during initial therapy and typically diminish over time 4

Special Considerations and Contraindications

Contraindications

• Personal or family history of medullary thyroid carcinoma (MTC)
• Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
• Serious hypersensitivity to liraglutide or any excipients 1

Cautions

• Pancreatitis: Discontinue promptly if suspected; do not restart if confirmed
• Renal impairment: Use caution when initiating or escalating doses
• Hypoglycemia: Risk increases when used with insulin secretagogues or insulin
• Gallbladder disease: Monitor for symptoms of cholelithiasis or cholecystitis 1

Pediatric Use

For patients aged 10 years and older with type 2 diabetes:

• Start at 0.6 mg subcutaneously once daily
• If additional glycemic control is required, increase in 0.6 mg increments after at least one week
• Maximum recommended dosage is 1.8 mg subcutaneously once daily 1
• FDA approved liraglutide for pediatric patients aged 10 years or older with type 2 diabetes in 2019 5

Combination Therapy

Liraglutide is effective both as monotherapy and in combination with oral antidiabetic medications:

• When combined with basal insulin, it results in better glycemic control than either agent alone 5
• Exenatide (another GLP-1 receptor agonist) plus basal insulin resulted in higher percentage of blood glucose within target range compared with exenatide alone and basal-bolus insulin (78% vs 62% vs 63%) 5

Remember that liraglutide should not be coadministered with other liraglutide-containing products, and it is not indicated for type 1 diabetes mellitus 1.