Liraglutide Dosing for Type 2 Diabetes
For type 2 diabetes, liraglutide should be initiated at 0.6 mg daily by subcutaneous injection, then increased to 1.2 mg after one week, with a maximum dose of 1.8 mg daily if needed for glycemic control. 1, 2
Dosing Protocol
Initial Dosing and Titration
- Start with 0.6 mg subcutaneous injection once daily for at least 1 week
- Increase to 1.2 mg once daily after at least 1 week
- May further increase to 1.8 mg once daily if needed for additional glycemic control
- Administer at any time of day, independent of meals 2
Dose Considerations
- The 0.6 mg starting dose is not effective for glycemic control but is used to improve gastrointestinal tolerability 2
- The 1.2 mg dose is the standard effective dose for most patients with type 2 diabetes
- The 1.8 mg dose provides minimal additional glycemic benefit for most patients but may be beneficial for some 2
Administration Details
- Administer via subcutaneous injection in abdomen, thigh, or upper arm
- Injection site does not significantly affect drug absorption (AUC equivalent between upper arm and abdomen, and between upper arm and thigh) 1
- Once-daily administration is sufficient due to liraglutide's 13-hour half-life 1
- No need for dose adjustment based on age, gender, or ethnicity 1, 3
Special Populations
Renal Impairment
- No dose adjustment required for mild, moderate, or severe renal impairment
- Can be used in patients with eGFR ≥15 mL/min/1.73 m² without dose adjustment 4
Hepatic Impairment
- Use with caution in patients with hepatic impairment
- Reduced exposure may occur in patients with hepatic impairment 3
Elderly Patients
- No dose adjustment required based on age
- Limited therapeutic experience in patients over 75 years of age 2
Pediatric Patients
- FDA approved for pediatric patients aged 10 years or older with type 2 diabetes 5
- Pharmacokinetic profile in pediatric patients (10-17 years) is consistent with that in adults 1
Monitoring
- Daily blood glucose monitoring is not required unless liraglutide is used with a sulfonylurea 2
- Monitor for gastrointestinal side effects, particularly during dose escalation
- If used with sulfonylureas, consider reducing sulfonylurea dose to minimize hypoglycemia risk 2
Common Pitfalls and Caveats
- Gastrointestinal side effects (nausea, vomiting, diarrhea) are common but typically diminish over time 2
- Risk of hypoglycemia is low when used as monotherapy but increases when combined with sulfonylureas 2
- Liraglutide slows gastric emptying, which may affect absorption of concomitant oral medications 2
- For patients with severe insulin resistance requiring high insulin doses, liraglutide can significantly reduce insulin requirements and improve glycemic control 6
By following this structured dosing approach, patients with type 2 diabetes can achieve optimal glycemic control while minimizing side effects from liraglutide therapy.