What are the side effects of Victoza (liraglutide) and how should they be managed?

Victoza Side Effects and Management

Victoza (liraglutide) most commonly causes gastrointestinal side effects—particularly nausea, diarrhea, and vomiting—which are typically mild to moderate, occur during dose escalation, and diminish over time with slow titration. 1, 2

Common Gastrointestinal Side Effects

The predominant adverse effects are gastrointestinal and include:

• Nausea occurs in approximately 40% of patients, representing the most frequent side effect 1, 3, 2
• Diarrhea is common and typically mild to moderate in severity 1, 2
• Vomiting occurs in approximately 16% of patients 1, 3
• Decreased appetite, indigestion, and constipation are also frequently reported 2

These gastrointestinal symptoms are dose-dependent and decrease in incidence over time, usually within the first few weeks of treatment 1, 4, 5. Most events are transient and rarely require discontinuation of therapy 4, 6, 7.

Serious but Rare Adverse Effects

Pancreatitis

• Stop Victoza immediately if you experience severe, persistent abdominal pain that may radiate to the back, with or without vomiting 2
• Pancreatitis has been reported in clinical trials, though causality has not been definitively established 1

Hypoglycemia

• Risk is higher when Victoza is combined with sulfonylureas or insulin 1, 2
• In children 10 years and older, hypoglycemia risk may be elevated with Victoza regardless of concomitant medications 2
• Signs include dizziness, sweating, confusion, headache, blurred vision, shakiness, fast heartbeat, and weakness 2

Kidney Problems

• Diarrhea, nausea, and vomiting may cause dehydration, which can worsen existing kidney problems 2
• Monitor renal function, especially in patients experiencing gastrointestinal symptoms 1

Gallbladder Disease

• Gallbladder problems including cholelithiasis and cholecystitis have been reported 1, 2
• Seek immediate care for upper abdominal pain, yellowing of skin or eyes, fever, or clay-colored stools 2

Serious Allergic Reactions

• Stop Victoza and seek emergency care if you develop swelling of face/lips/tongue/throat, breathing difficulties, severe rash, fainting, or very rapid heartbeat 2

Thyroid C-Cell Tumors

• Black box warning: Risk of thyroid C-cell tumors observed in rodent studies; human relevance not determined 1
• Contraindicated in patients with personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 (MEN2) 1, 2

Aspiration Risk During Surgery

• Victoza may increase the chance of food getting into the lungs during surgery or procedures requiring anesthesia due to delayed gastric emptying 2
• Inform all healthcare providers that you are taking Victoza before any scheduled procedures 2

Strategies to Minimize Side Effects

Slow Dose Titration

• Start at 0.6 mg daily for at least 7 days to improve gastrointestinal tolerability 3, 8, 6
• Increase to 1.2 mg daily after the first week 3, 8
• May increase to maximum dose of 1.8 mg daily if needed for glycemic control 3, 8
• If nausea persists, maintain the current dose longer before advancing rather than discontinuing therapy, as symptoms typically diminish over time 3

Concomitant Medication Adjustments

• Reduce sulfonylurea doses when initiating Victoza to lower hypoglycemia risk 1, 8
• Reduce insulin doses by approximately 20% when starting Victoza to prevent hypoglycemia 1
• Do not use Victoza with other GLP-1 receptor agonists or DPP-4 inhibitors 3

Administration Guidelines

• Inject subcutaneously once daily at any time of day, independent of meals 3, 8
• Rotate injection sites within abdomen, thigh, or upper arm 3
• Always use a new needle for each injection and remove needle after use to prevent contamination and infection 2
• Do not share your Victoza pen with others, even if the needle is changed 2

Monitoring Requirements

• Monitor body weight every 4 weeks during dose escalation 3
• Assess gastrointestinal symptoms at each visit 3
• If using with insulin or sulfonylureas, monitor glucose levels more frequently during titration 3
• Monitor for signs of pancreatitis, gallbladder disease, and kidney problems 1, 2

When to Contact Your Healthcare Provider

• Persistent severe abdominal pain (possible pancreatitis) 2
• Signs of hypoglycemia that do not resolve 2
• Symptoms of dehydration from persistent vomiting or diarrhea 2
• Signs of allergic reaction 2
• Upper abdominal pain or jaundice (possible gallbladder disease) 2
• Gastrointestinal side effects that do not improve over time or significantly impact quality of life 1, 7

Special Populations

• Contraindicated in pregnancy and breastfeeding 3
• Limited experience in patients over 75 years of age 8
• Use with caution in patients with renal impairment, particularly when experiencing gastrointestinal symptoms that may cause dehydration 1, 2