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

Recommended Dosing and Usage of Victoza (Liraglutide) for Type 2 Diabetes

The recommended dosing regimen for Victoza (liraglutide) in adults with type 2 diabetes is to start at 0.6 mg subcutaneously once daily for one week, then increase to 1.2 mg daily, with further titration to 1.8 mg daily if needed for glycemic control. 1

Dosing Schedule and Administration

• Initial dose: 0.6 mg subcutaneously once daily for one week (this starting dose is intended to reduce gastrointestinal side effects during titration and is 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
• Administer at any time of day, independent of meals 1
• Inject subcutaneously in the abdomen, thigh, or upper arm 1
• When using with insulin, administer as separate injections (never mix) 1

Special Populations

Pediatric Patients (10 years and older)

• Start at 0.6 mg subcutaneously once daily 1
• Increase in 0.6 mg increments after at least one week on the current dose 1
• Maximum recommended dose: 1.8 mg subcutaneously once daily 1

Renal Impairment

• No dose adjustment is necessary for patients with mild, moderate, or severe renal impairment, though drug exposure may be reduced 2
• Limited data are available for patients with end-stage renal disease 1

Hepatic Impairment

• No dose adjustment is necessary, though drug exposure may be reduced 2

Missed Dose Management

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

Clinical Benefits Beyond Glycemic Control

• Liraglutide has been shown to reduce the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) in adults with type 2 diabetes with established cardiovascular disease 3, 1
• The LEADER trial demonstrated that liraglutide reduced deaths from cardiovascular causes (4.7% vs 6.0% with placebo, HR 0.78) 3
• Liraglutide therapy is associated with moderate weight loss, which can be beneficial for overweight and obese patients with type 2 diabetes 4
• Systolic blood pressure reduction has been observed with liraglutide treatment 4

Monitoring and Safety Considerations

• Most common adverse events are gastrointestinal, particularly nausea, which typically decreases over time 5
• Risk of hypoglycemia is low when used as monotherapy due to its glucose-dependent mechanism of action 2
• When used with insulin or insulin secretagogues (e.g., sulfonylureas), consider reducing the dose of these agents to minimize hypoglycemia risk 3
• Liraglutide is contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) 1
• Routine monitoring of serum calcitonin or thyroid ultrasound is of uncertain value for early detection of MTC 1

Important Administration Instructions

• Visually inspect the solution before each injection - use only if clear, colorless, and free of particles 1
• Rotate injection sites within the same region to reduce the risk of cutaneous amyloidosis 1
• Store the unused pen in the refrigerator (36°F to 46°F or 2°C to 8°C) 1
• After initial use, the pen can be stored at room temperature (below 86°F or 30°C) or in the refrigerator for up to 30 days 1

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