From the Guidelines
Liraglutide for weight loss is typically started at a dose of 0.6 mg injected subcutaneously once daily for one week, then increased weekly by 0.6 mg until reaching the target dose of 3.0 mg daily. The gradual dose escalation helps minimize gastrointestinal side effects like nausea and vomiting.
Dosing Schedule
The full schedule is:
- 0.6 mg daily for week 1,
- 1.2 mg daily for week 2,
- 1.8 mg daily for week 3,
- 2.4 mg daily for week 4, and
- finally 3.0 mg daily for week 5 and beyond, as recommended by the AGA clinical practice guideline on pharmacological interventions for adults with obesity 1. The medication should be injected at any time of day, independent of meals, using the pre-filled pen device.
Treatment Discontinuation
Treatment should be discontinued if patients don't lose at least 4% of their initial body weight after 16 weeks at the 3.0 mg dose.
Mechanism of Action
Liraglutide works by mimicking GLP-1, a hormone that regulates appetite and food intake by acting on receptors in the brain to increase feelings of fullness and reduce hunger, leading to decreased caloric intake and weight loss, as described in the study on practical use of pharmacotherapy for obesity 1.
Clinical Considerations
To minimize risk of GI adverse effects, gradual dose titration is recommended for liraglutide, as stated in the AGA clinical practice guideline on pharmacological interventions for adults with obesity 1. Clinical judgment is recommended for adjusting the titration schedule as needed for an individual patient’s response, tolerance, and adverse effects. If more than 2 consecutive doses are missed, clinical judgment is required to decide on subsequent dosing. Based on expert opinion, resuming at the same dose can be considered if a patient has tolerated the medication well, otherwise, prescribers should consider lowering the next dose, as recommended in the guideline on pharmacological interventions for adults with obesity 1.
From the Research
Liraglutide Dosing for Weight Loss
- The dosing of liraglutide for weight loss has been studied in several clinical trials, with varying doses and populations 2, 3, 4, 5, 6.
- In a study of overweight and obese patients with type 2 diabetes, the starting dose of liraglutide was 0.6 mg/day for 3 days, followed by 1.2 mg for 10 days, and finally 1.8 mg/day for 22 weeks 2.
- Another study used a dose of 3.0 mg of liraglutide once daily, with a significant reduction in body weight and improvement in glycemic control 3.
- A review of the efficacy and safety of liraglutide for weight loss found that doses of 1.2 to 3.0 mg once daily were effective in increasing weight loss among overweight and obese patients 5.
- The clinical pearls for initiating liraglutide therapy suggest that the dose should be titrated to minimize adverse effects, such as nausea, and that overweight or obese patients with type 2 diabetes are good candidates for liraglutide therapy due to its association with weight loss and improved β-cell function 6.
Key Findings
- Liraglutide doses of 1.2 to 3.0 mg once daily are effective for weight loss in overweight and obese patients 3, 5.
- The starting dose of liraglutide can be 0.6 mg/day, with titration to higher doses as needed 2.
- Liraglutide is associated with significant reductions in body weight, improvements in glycemic control, and improvements in lipid profiles 2, 3, 4.
- Common adverse effects of liraglutide include nausea, vomiting, and gastrointestinal symptoms, which are usually dose-dependent and transient 3, 5, 6.