Can I switch from Trulicity (dulaglutide) to Victoza (liraglutide) due to cost?

Switching from Trulicity to Victoza Due to Cost

Yes, you can switch from Trulicity (dulaglutide) to Victoza (liraglutide) due to cost considerations, as both are GLP-1 receptor agonists with similar efficacy profiles but different pricing structures.

Comparison of Medications

Efficacy

• Both medications are GLP-1 receptor agonists with similar glycemic control capabilities:
  • Dulaglutide (Trulicity): Once-weekly injection with HbA1c reduction of approximately 1.42% 1
  • Liraglutide (Victoza): Once-daily injection with HbA1c reduction of approximately 1.36% 1
  • Head-to-head trials show dulaglutide is non-inferior to liraglutide for glycemic control 1

Cost Considerations

• Significant price difference exists between these medications:
  • Dulaglutide (Trulicity): Average Wholesale Price (AWP) of approximately $622 per month 2
  • Liraglutide (Victoza): AWP of approximately $1,619 per month for the 3.0 mg dose 2, but lower doses used for diabetes (1.2-1.8 mg) would be less expensive
  • Generic liraglutide may be available, potentially offering additional cost savings 2

Switching Process

Dosing Transition

1. Discontinue Trulicity: Since dulaglutide is a once-weekly medication with a half-life of 4.7 days 2, plan the transition carefully
2. Start Victoza: Begin with the initial dose of 0.6 mg daily for one week
3. Titrate Victoza: Increase to 1.2 mg daily after one week, and if needed, to 1.8 mg daily for optimal glycemic control

Monitoring After Switch

• Check blood glucose more frequently during the first 2 weeks of transition
• Schedule follow-up within 4 weeks to assess:
  • Glycemic control
  • Gastrointestinal side effects
  • Weight changes
  • Need for dose adjustments

Clinical Considerations

Advantages of Victoza

• Once-daily dosing (vs. once-weekly for Trulicity)
• Demonstrated cardiovascular benefits: Liraglutide is recommended for patients with T2DM and cardiovascular disease to reduce the risk of death 2
• Potential cost savings depending on insurance coverage and available discounts

Potential Disadvantages

• More frequent injections (daily vs. weekly)
• Similar side effect profile to Trulicity, primarily gastrointestinal symptoms
• May require more careful titration to minimize side effects

Side Effects and Safety

Both medications share similar side effect profiles:

• Common side effects: Nausea (18-20%), diarrhea (12%), vomiting (7-8%) 1
• Both have low risk of hypoglycemia when used as monotherapy
• Both carry warnings regarding risk of thyroid C-cell tumors and pancreatitis 2

Special Considerations

Perioperative Management

• Both medications may delay gastric emptying, which could increase risk of pulmonary aspiration during anesthesia 2
• For elective procedures, consider timing of medication administration

Renal Function

• Liraglutide can be used without dose adjustment in patients with mild to moderate renal impairment, but is not recommended in severe renal impairment 3

Important Caveats

• Insurance coverage and formulary status should be verified before switching
• Some patients may experience different side effect profiles between the two medications despite their similar mechanisms
• If cost is the primary concern, also consider other GLP-1 RAs that might be on your insurance formulary

The transition from Trulicity to Victoza is generally well-tolerated and maintains similar glycemic control while potentially reducing medication costs, making it a reasonable option when cost is a significant factor in treatment decisions.