What condition is the patient at increased risk for with liraglutide (glucagon-like peptide-1 receptor agonist) therapy?

Liraglutide Increases Risk of Acute Pancreatitis

Liraglutide therapy significantly increases the risk of acute pancreatitis in this patient, requiring careful monitoring and patient education about warning signs. 1, 2

Mechanism and Risk Assessment

Liraglutide is a GLP-1 receptor agonist that has been associated with pancreatitis through several mechanisms:

• Post-marketing surveillance has identified cases of acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis, in patients treated with liraglutide 2
• In glycemic control trials, the incidence of pancreatitis was higher with liraglutide (2.7 cases per 1,000 patient-years) compared to glimepiride (0.5 cases per 1,000 patient-years) 2
• The FDA label specifically warns about this risk and recommends careful monitoring 2

Risk Factors in This Patient

This 54-year-old male has several risk factors that may increase his susceptibility to liraglutide-induced pancreatitis:

• Type 2 diabetes mellitus
• Obesity (BMI 39)
• Acanthosis nigricans (indicating insulin resistance)

Clinical Presentation and Monitoring

Patients with liraglutide-induced pancreatitis typically present with:

• Persistent severe abdominal pain (may radiate to the back)
• Nausea and vomiting
• Elevated serum amylase and lipase levels

Management Recommendations

1. Patient Education:

   • Instruct the patient to immediately report persistent severe abdominal pain (with or without vomiting)
   • Emphasize that this is a serious adverse effect requiring prompt medical attention

2. Monitoring Protocol:

   • Baseline pancreatic enzyme levels before initiating therapy
   • Regular follow-up visits to assess for symptoms
   • Low threshold for checking amylase and lipase if symptoms develop

3. If Pancreatitis Is Suspected:

   • Promptly discontinue liraglutide
   • Initiate appropriate management for pancreatitis
   • Do not restart liraglutide if pancreatitis is confirmed 2

Other Potential Adverse Effects

While pancreatitis is the most serious concern, the patient should also be monitored for:

• Gastrointestinal side effects (nausea, vomiting, diarrhea) - most common adverse effects 1
• Acute gallbladder disease (cholelithiasis, cholecystitis) 2
• Hypoglycemia (especially with concurrent sulfonylurea use) 1
• Acute kidney injury (particularly with dehydration from GI side effects) 2
• Delayed gastric emptying (relevant for perioperative risk) 1

Evidence Quality and Considerations

The association between liraglutide and pancreatitis is well-documented in:

• FDA drug labeling with specific warnings 2
• Clinical guidelines from the American College of Cardiology 1
• Multiple case reports in the literature 3, 4, 5, 6, 7

While the absolute risk is relatively low, the potential severity of pancreatitis (including fatal cases) makes this an important consideration when prescribing liraglutide, particularly in patients with additional risk factors.