What is the typical dosing regimen for Victoza (liraglutide) in the treatment of type 2 diabetes?

Victoza (Liraglutide) Dosing Regimen for Type 2 Diabetes

For type 2 diabetes treatment, Victoza (liraglutide) 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 if needed for glycemic control. 1

Initial Dosing and Titration Schedule

The FDA-approved dosing regimen for Victoza in type 2 diabetes follows a stepwise approach:

1. Starting dose: 0.6 mg subcutaneously once daily for one week

   • This initial dose is intended to reduce gastrointestinal side effects during titration
   • Note that the 0.6 mg dose is not effective for glycemic control in adults 1

2. First titration: After one week, increase to 1.2 mg subcutaneously once daily

   • This is the standard effective dose for many patients

3. Second titration (if needed): After at least one week at 1.2 mg, may increase to maximum recommended dose of 1.8 mg subcutaneously once daily if additional glycemic control is required 1

Administration Guidelines

• Inject subcutaneously in the abdomen, thigh, or upper arm
• Can be administered 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

Missed Dose Instructions

• If a dose is missed, resume once-daily dosing with the next scheduled dose
• Do not administer an extra dose or increase the dose to make up for missed doses
• If more than 3 days have elapsed since the last dose, reinitiate at 0.6 mg once daily to mitigate gastrointestinal symptoms 1

Efficacy Assessment

• Evaluate treatment response after 3 months
• If response is effective (typically defined as ≥5% weight loss or significant HbA1c reduction), continue treatment
• If response is insufficient (<5% weight loss after 3 months) or significant safety/tolerability issues occur, consider discontinuation or alternative approaches 2

Common Side Effects and Management

• Gastrointestinal effects: Nausea, vomiting, diarrhea (most common)

  • Usually mild to moderate in severity
  • Typically decrease in incidence over time 3
  • If severe GI symptoms occur, reduce to previous tolerable dose 2

• Other side effects: Headache, dizziness, injection site reactions

Important Contraindications

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

Special Considerations

• Renal impairment:

  • eGFR 15-29 mL/min/1.73 m²: Use caution and monitor renal function
  • eGFR <15 mL/min/1.73 m²: Not recommended 2

• Cardiovascular benefit: Liraglutide has demonstrated cardiovascular benefits in reducing major adverse cardiovascular events in adults with type 2 diabetes and established cardiovascular disease 2

• Hypoglycemia risk: Risk increases when used with insulin, sulfonylureas, or glinides 2

• Gastroparesis: Not recommended in patients with clinically meaningful gastroparesis 2

By following this structured dosing approach and monitoring for side effects, Victoza can effectively improve glycemic control in patients with type 2 diabetes while potentially offering cardiovascular benefits.