What is the dosing schedule for Saxenda (liraglutide) in an adult eligible for chronic weight management, and how should it be prescribed and ordered?

Saxenda Dosing and Prescribing Information

Dosing Schedule

Saxenda (liraglutide 3.0 mg) requires a gradual weekly titration starting at 0.6 mg subcutaneously once daily, increasing by 0.6 mg weekly until reaching the target maintenance dose of 3.0 mg daily. 1

The specific titration schedule is:

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

If gastrointestinal side effects (particularly nausea) persist at any dose level, maintain the current dose longer before advancing rather than discontinuing therapy, as these symptoms typically diminish over time and rarely require discontinuation. 1

Administration Instructions

Inject Saxenda subcutaneously once daily at any time of day, independent of meals, rotating injection sites within the abdomen, thigh, or upper arm. 1

The medication comes as a pre-filled pen for subcutaneous injection. 2, 3

Patient Eligibility Criteria

Saxenda is indicated for chronic weight management in adults with: 4, 5

• BMI ≥30 kg/m² (obesity), OR
• BMI ≥27 kg/m² (overweight) with at least one weight-related comorbidity such as hypertension, dyslipidemia, type 2 diabetes, or obstructive sleep apnea 4, 5

Saxenda must be used as an adjunct to a reduced-calorie diet and increased physical activity. 4, 5

Absolute Contraindications

Do not prescribe Saxenda to patients with: 1

• Personal or family history of medullary thyroid cancer
• Multiple endocrine neoplasia syndrome type 2 (MEN2)
• Pregnancy or breastfeeding 1

How to Order/Prescribe

When writing the prescription, specify:

• Medication: Saxenda (liraglutide) 3.0 mg/0.5 mL subcutaneous injection pen
• Starting dose: 0.6 mg subcutaneously once daily
• Titration instructions: Increase by 0.6 mg weekly as tolerated to target dose of 3.0 mg daily
• Quantity: Prescribe sufficient pens for the titration period (typically one pen lasts approximately 6 days at the 3.0 mg dose)
• Indication: Chronic weight management in conjunction with reduced-calorie diet and increased physical activity

Monitoring Requirements

Monitor body weight every 4 weeks during dose escalation, and assess gastrointestinal symptoms at each visit. 1

If the patient has type 2 diabetes, monitor glucose levels more frequently during titration, especially if using concomitant insulin or sulfonylureas. 1

Expected Outcomes

In clinical trials, Saxenda 3.0 mg daily resulted in 5.9-8.0% weight reduction over 56 weeks, with placebo-subtracted weight loss of 3.9-6.0%. 3 The proportion of treated patients achieving ≥5% weight loss was 50-76%. 3

Cost Considerations

The average cost is approximately $1,600 for a 30-day supply, with significant out-of-pocket expenses if insurance coverage is not available. 1, 5 Insurance authorization may be required and can be challenging, particularly for obesity management without diabetes. 6

Common Adverse Effects

Nausea occurs in approximately 40% of patients, and vomiting occurs in 16% of patients. 1 Diarrhea and constipation are also common. 1 Slow dose titration is the most effective approach to minimize these gastrointestinal symptoms. 1

Treatment Duration

Saxenda should be considered as lifelong therapy to maintain weight loss and cardiometabolic benefits, as discontinuation results in significant weight regain and worsening of cardiometabolic risk factors. 1