Recommended Dosing for Switching from Trulicity 3mg to Victoza
When switching a patient from Trulicity (dulaglutide) 3mg to Victoza (liraglutide) due to cost considerations, the recommended starting dose is 0.6mg daily for one week, then titrating up to 1.2mg daily (usual maintenance dose), with the option to increase to 1.8mg daily if needed for glycemic control. 1
Dosing Schedule for Victoza (Liraglutide)
- Start with 0.6mg subcutaneous injection once daily for 1 week 1
- After one week, increase to 1.2mg once daily (standard maintenance dose) 2
- If necessary for glycemic control, may increase to maximum dose of 1.8mg once daily 1, 2
Administration Considerations
- Victoza is administered as a subcutaneous injection once daily, unlike Trulicity which is given weekly 1
- Slower dose titration may be effective in managing gastrointestinal side effects if they occur 1
- If nausea or other gastrointestinal symptoms develop during titration, reduce to the previous tolerable dose 1
Efficacy Considerations
- Liraglutide 1.8mg daily has been shown to reduce HbA1c by approximately 1.36% in clinical trials 3
- Dulaglutide 1.5mg weekly and liraglutide 1.8mg daily have demonstrated similar glycemic efficacy in head-to-head trials (HbA1c reduction of -1.42% vs -1.36% respectively) 3
- Despite the difference in dosing frequency, glycemic control should be maintained with proper dosing of Victoza 3, 4
Side Effect Profile
- Most common side effects of liraglutide include nausea, vomiting, diarrhea, constipation, and upper abdominal pain 1, 5
- Gastrointestinal side effects typically occur within the first month of treatment 5
- Liraglutide has been associated with a higher rate of severe gastrointestinal adverse events (23.31%) compared to dulaglutide (12.29%) 5
- Proper dose titration can help minimize these side effects 1
Monitoring Recommendations
- Monitor for gastrointestinal side effects, particularly during the first month of treatment 5
- Assess glycemic control after switching to ensure adequate management 1
- Be vigilant for signs of pancreatitis, which has been reported with liraglutide use 5
- Consider monitoring for potential consequences of delayed gastric emptying, which may affect absorption of other oral medications 1
Cost Considerations
- While the switch is being made due to cost considerations, be aware that the maximum approved daily dose of liraglutide (1.8mg) had a National Average Drug Acquisition Cost of approximately $835-$1,077 per month (as of recent data) 1
- Ensure patient has access to proper insurance coverage or patient assistance programs for Victoza
Remember that proper dose titration is crucial to minimize gastrointestinal side effects while maintaining glycemic efficacy when switching from Trulicity to Victoza.