What is the starting dose for Saxenda (liraglutide) for weight loss?

Starting Dose for Saxenda (Liraglutide) for Weight Loss

Saxenda should be initiated at 0.6 mg subcutaneously once daily, with weekly dose escalations of 0.6 mg increments until reaching the maintenance dose of 3.0 mg daily. 1, 2, 3

Dose Titration Schedule

The standardized titration protocol is:

• Week 1: 0.6 mg daily 1, 2, 3
• Week 2: 1.2 mg daily 1, 2, 3
• Week 3: 1.8 mg daily 1, 2, 3
• Week 4: 2.4 mg daily 1, 2, 3
• Week 5 and beyond: 3.0 mg daily (maintenance dose) 1, 2, 3

Rationale for Gradual Titration

This slow dose escalation is essential to minimize gastrointestinal side effects, particularly nausea, vomiting, and diarrhea, which are the most common adverse effects of liraglutide. 2, 3, 4 The weekly incremental approach allows patients to develop tolerance to the medication while reducing treatment discontinuation rates. 2

Administration Details

• Saxenda is administered as a once-daily subcutaneous injection using a prefilled pen. 1
• The medication can be injected at any time of day, with or without meals, but should be administered at approximately the same time each day. 3
• Injection sites include the abdomen, thigh, or upper arm. 3

Patient Selection Criteria

Saxenda is indicated for patients with:

• BMI ≥30 kg/m² (obese), OR 1, 2, 3
• BMI ≥27 kg/m² with at least one weight-related comorbidity such as hypertension, type 2 diabetes, dyslipidemia, or obstructive sleep apnea 1, 2, 3

Critical Monitoring Points

Assess treatment response at 16 weeks: if the patient has not achieved at least 4-5% weight loss from baseline, discontinue Saxenda as it is unlikely to provide meaningful benefit. 1, 3 This early assessment prevents unnecessary exposure to medication risks and costs in non-responders.

Important Contraindications

Saxenda is absolutely contraindicated in patients with:

• Personal or family history of medullary thyroid carcinoma 1, 3
• Multiple endocrine neoplasia syndrome type 2 1, 3
• Pregnancy (black box warning for thyroid C-cell tumors in rodents) 1, 3

Common Pitfalls to Avoid

• Do not skip the titration schedule or advance doses too quickly, as this dramatically increases gastrointestinal side effects and treatment discontinuation. 2, 4
• Do not use Saxenda as monotherapy—it must be combined with reduced-calorie diet and increased physical activity for optimal efficacy. 3, 5, 6
• Monitor for pancreatitis symptoms (severe abdominal pain) and discontinue immediately if suspected, though causality has not been definitively established. 1, 3
• Ensure adequate hydration in patients taking insulin or sulfonylureas due to increased hypoglycemia risk. 1
• Counsel patients about cost: the average wholesale price is approximately $1,385-$1,619 per month for the maintenance dose. 1, 3

Expected Outcomes

With the full 3.0 mg daily dose, patients can expect:

• Mean weight loss of 5.8-8.0% from baseline at 56 weeks 1, 3
• 50-76% of patients achieve ≥5% weight loss (placebo-subtracted proportion: 29-46%) 5
• Additional metabolic benefits including improved waist circumference, blood pressure, insulin resistance, and lipid profiles 1, 5, 6