Saxenda (Liraglutide 3.0 mg) Indication
Saxenda is FDA-approved for chronic weight management in adults with obesity (BMI ≥30 kg/m²) or overweight (BMI ≥27 kg/m²) with at least one weight-related comorbidity, used as an adjunct to reduced-calorie diet and increased physical activity. 1, 2, 3
Primary Indication and Patient Selection
Saxenda (liraglutide 3.0 mg) is specifically indicated for:
- Adults with BMI ≥30 kg/m² (obesity) regardless of comorbidities 1, 2
- Adults with BMI ≥27 kg/m² (overweight) who have at least one weight-related comorbidity including:
The American Gastroenterological Association provides a conditional recommendation for liraglutide 3.0 mg in patients who have had inadequate response to lifestyle interventions alone. 1, 5
Mechanism Supporting Weight Loss
Liraglutide is a GLP-1 receptor agonist with 97% homology to human GLP-1 that promotes weight loss through multiple mechanisms: 6, 3
- Appetite suppression via activation of GLP-1 receptors in the hypothalamus and brainstem 6, 7
- Increased satiety and satiation through central nervous system effects 6, 5
- Delayed gastric emptying leading to prolonged fullness 6, 3
- Reduction in caloric intake independent of glucose-lowering effects 5
Expected Weight Loss Outcomes
Clinical trial data demonstrate clinically meaningful weight reduction:
- Mean weight loss of 5.4-8.0% at 56 weeks compared to baseline 1, 8
- Placebo-subtracted weight loss of 3.9-6.0% 8
- 50-76% of patients achieve ≥5% weight loss (placebo-subtracted proportion: 29-46%) 8
- Proportion achieving ≥10% weight loss is 2.67 times higher than placebo 1
The American Gastroenterological Association notes that liraglutide produces approximately 5-8% weight loss, which is less than the 15% achieved with semaglutide 2.4 mg. 6, 2
Dosing Protocol
Start at 0.6 mg subcutaneous injection daily for 1 week, then increase by 0.6 mg weekly until reaching the target maintenance dose of 3.0 mg daily: 1, 6, 2
- Week 1: 0.6 mg daily
- Week 2: 1.2 mg daily
- Week 3: 1.8 mg daily
- Week 4: 2.4 mg daily
- Week 5 onward: 3.0 mg daily (maintenance dose)
Discontinue therapy if the patient has not achieved at least 4% weight loss after 16 weeks at the 3.0 mg dose. 5
Important Distinctions from Victoza
Saxenda (liraglutide 3.0 mg) is distinct from Victoza (liraglutide 1.2-1.8 mg): 1, 3, 7
- Victoza is FDA-approved for type 2 diabetes management at doses of 1.2 mg or 1.8 mg daily 3
- Saxenda is FDA-approved specifically for obesity management at 3.0 mg daily 1, 7, 4
- The two formulations should not be coadministered together 3
Absolute Contraindications
Do not prescribe Saxenda in patients with: 1, 2, 3
- Personal or family history of medullary thyroid carcinoma (MTC) 1, 2, 3
- Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) 1, 2, 3
- Serious hypersensitivity reaction to liraglutide or any excipients 3
- Pregnancy 1
Common and Serious Adverse Effects
Most common adverse effects (gastrointestinal, occurring in >5% of patients): 1, 2
- Nausea (40% vs 14.8% placebo) 1
- Vomiting (16% vs 4.3% placebo) 1
- Diarrhea 1, 2
- Constipation 1, 2
- Headache 1, 2
Serious safety concerns requiring monitoring: 1, 2, 3
- Pancreatitis (including fatal and non-fatal hemorrhagic or necrotizing pancreatitis) - discontinue promptly if suspected 1, 3
- Acute gallbladder disease (cholelithiasis, cholecystitis) 1, 3
- Acute kidney injury (usually associated with dehydration from GI symptoms) 3
- Pulmonary aspiration risk during general anesthesia or deep sedation due to delayed gastric emptying that persists with chronic use 5, 3
Special Populations and Clinical Considerations
Patients with type 2 diabetes: 1, 6, 2
- Liraglutide provides dual benefit of weight loss and glucose control 1, 6
- Reduces HbA1c by approximately 0.5-0.93% 1
- Should not be used with other GLP-1 receptor agonists or DPP-4 inhibitors 1
Gradual dose titration is essential to minimize gastrointestinal side effects, which are the primary reason for treatment discontinuation. 1, 6
Delayed gastric emptying persists even with chronic use, requiring special consideration for perioperative planning and aspiration risk. 5, 3
Practical Barriers to Use
- Average wholesale price approximately $1,385 per month for maintenance dose 5, 2
- Medicare currently excludes coverage of FDA-approved anti-obesity medications for obesity diagnosis alone 5
- Global shortages of GLP-1 receptor agonists currently exist 5
- Requires daily subcutaneous injection, which may represent a barrier for some patients 9