What is the recommended initial dosing for Victoza (liraglutide)?

Victoza Initial Dosing

Start Victoza at 0.6 mg subcutaneously once daily for the first week, then increase to 1.2 mg daily after one week, with optional escalation to 1.8 mg daily if additional glycemic control is needed after at least one more week at 1.2 mg. 1

Starting Dose and Rationale

• Begin with 0.6 mg subcutaneously once daily for 7 days 2, 1
• This initial dose is specifically designed to reduce gastrointestinal symptoms during titration and is not effective for glycemic control—it serves only as a tolerance-building step 1
• The slow titration minimizes nausea (which occurs in 40% of patients) and vomiting (16% of patients) 2

Dose Escalation Schedule

• After one week at 0.6 mg, increase to 1.2 mg once daily 2, 1
• If additional glycemic control is required, escalate to the maximum dose of 1.8 mg daily after at least one week at 1.2 mg 1
• For obesity indication (Saxenda), the target is 3.0 mg daily with weekly 0.6 mg increments, but this is a different formulation than Victoza 2, 3

Administration Instructions

• Inject subcutaneously once daily at any time of day, independent of meals 2, 1
• Acceptable injection sites include abdomen, thigh, or upper arm 2, 1
• Rotate injection sites within the same region to reduce risk of cutaneous amyloidosis 1
• No dosage adjustment needed when changing injection site or timing 1

Critical Prescribing Considerations

Concomitant Medications

• Reduce doses of insulin or sulfonylureas when initiating Victoza to prevent hypoglycemia 2
• Do not use with other GLP-1 receptor agonists or DPP-4 inhibitors 2
• When using with insulin, administer as separate injections—never mix 1

Monitoring Requirements

• Monitor body weight every 4 weeks during dose escalation 2
• Assess gastrointestinal symptoms at each visit 2
• If patient has type 2 diabetes, monitor glucose levels more frequently during titration, especially with concomitant insulin or sulfonylureas 2

Missed Dose Protocol

• If a dose is missed, resume the regular once-daily schedule with the next dose—do not double up 1
• If more than 3 days have elapsed since the last dose, restart at 0.6 mg daily and re-titrate to mitigate gastrointestinal symptoms 1

Contraindications

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

Common Pitfalls to Avoid

• Do not skip the 0.6 mg starting dose—jumping directly to 1.2 mg significantly increases gastrointestinal side effects 1, 4
• Do not advance dosing faster than weekly intervals—this is the minimum time needed for tolerance 2, 1
• Gastrointestinal symptoms typically diminish over time and rarely require discontinuation 5, 4
• If nausea persists, maintain the current dose longer before advancing rather than discontinuing therapy 6