What is the recommended dosage and usage of Victoza (liraglutide) for patients with type 2 diabetes?

Victoza (Liraglutide) Dosage and Usage for Type 2 Diabetes

The recommended dosage of Victoza (liraglutide) for patients with type 2 diabetes is to start with 0.6 mg subcutaneously once daily for one week, then increase to 1.2 mg daily, and if additional glycemic control is needed, increase to a maximum of 1.8 mg daily after at least one week at the 1.2 mg dose. 1

Dosing Schedule and Titration

• Initial dose: 0.6 mg subcutaneously once daily for one week (intended to reduce gastrointestinal symptoms during titration, not effective for glycemic control) 1
• After one week: Increase to 1.2 mg subcutaneously once daily 1
• If additional glycemic control is required: Increase to maximum recommended dose of 1.8 mg subcutaneously once daily after at least one week at the 1.2 mg dose 1, 2
• Victoza can be administered at any time of day, independently of meals 1

Administration Guidelines

• Inject subcutaneously in the abdomen, thigh, or upper arm 1
• Rotate injection sites within the same region to reduce risk of cutaneous amyloidosis 1
• When using with insulin, administer as separate injections (never mix) 1
• If a dose is missed, resume the once-daily regimen as prescribed with the next scheduled dose (do not administer extra dose) 1
• If more than 3 days have elapsed since the last dose, reinitiate at 0.6 mg once daily to mitigate gastrointestinal symptoms 1

Clinical Benefits

• Reduces HbA1c by approximately 0.8% to 1.5% 3
• Associated with weight loss (about 2-4% of initial body weight) 3
• Improves β-cell function 3
• Low risk of hypoglycemia 3, 4
• Reduces risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) in adults with type 2 diabetes and established cardiovascular disease 1, 2

Patient Selection Considerations

• Particularly beneficial for overweight or obese patients with type 2 diabetes 3
• Good option for patients with insulin resistance 3
• Safe choice for patients at risk or with history of symptomatic or severe hypoglycemia 3
• No dosage adjustment required for renal impairment 2
• Can be used as monotherapy or in combination with other antidiabetic medications 1, 4

Common Side Effects and Management

• Nausea is the most common adverse effect (usually transient and minimized with dose titration) 3, 5
• Other gastrointestinal events may include vomiting and diarrhea 2
• Gradual dose titration helps minimize gastrointestinal side effects 5

Contraindications

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

Important Monitoring

• Monitor for thyroid C-cell tumors (counsel patients about symptoms such as mass in the neck, dysphagia, dyspnea, persistent hoarseness) 1
• Assess efficacy and safety at least monthly for the first 3 months and quarterly thereafter 6
• Increase frequency of blood glucose monitoring during changes to insulin regimen if used in combination 6

Clinical Pearls

• Liraglutide is not recommended as first-line therapy for type 2 diabetes 7
• The 24-hour pharmacokinetic profile allows for once-daily dosing with 24-hour glycemic control 8
• Effects on insulin and glucagon secretion are glucose-dependent, contributing to the low risk of hypoglycemia 8
• When used in combination with insulin secretagogues (sulfonylureas or glinides), consider reducing the dose of these agents to minimize hypoglycemia risk 2