Victoza: Advanced GLP-1 Therapy for Type 2 Diabetes Control
| Product dosage: 6mg | |||
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Synonyms | |||
Victoza (liraglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. This once-daily injectable medication mimics the effects of endogenous GLP-1, enhancing glucose-dependent insulin secretion, suppressing glucagon secretion, and delaying gastric emptying. It represents a significant therapeutic option for patients requiring advanced glycemic management beyond first-line oral agents, with the added potential for cardiovascular risk reduction and weight management benefits in appropriate populations.
Features
- Active ingredient: Liraglutide 6 mg/mL
- Delivery: Prefilled, multi-dose pen injector (3 mL)
- Dosing: Once-daily subcutaneous injection
- Available strengths: 6 mg/mL delivering doses of 0.6 mg, 1.2 mg, or 1.8 mg
- Needle: 32G × 4mm (included separately)
- Storage: Refrigerate at 2°C to 8°C (36°F to 46°F); may be kept at room temperature (below 30°C/86°F) for up to 30 days
- Manufacturer: Novo Nordisk
Benefits
- Significant reduction in HbA1c levels (typically 1.0% to 1.5%) when used as monotherapy or in combination with other antidiabetic agents
- Weight loss effect through reduced appetite and slowed gastric emptying, with average reductions of 2-3 kg observed in clinical trials
- Lower risk of hypoglycemia compared to insulin and sulfonylureas when used without these medications
- Cardiovascular risk reduction benefit demonstrated in the LEADER trial, showing decreased major adverse cardiovascular events in high-risk patients
- Once-daily dosing convenience with flexible administration timing (same time each day recommended)
- Potential preservation of beta-cell function through GLP-1 receptor agonism
Common use
Victoza is primarily prescribed for adults with type 2 diabetes mellitus whose blood glucose remains inadequately controlled despite lifestyle modifications and oral antidiabetic medications such as metformin, sulfonylureas, or thiazolidinediones. It may be used as monotherapy or in combination with these agents, though dosage adjustments of concomitant medications may be necessary. Clinical evidence supports its use in patients with established cardiovascular disease to reduce the risk of major adverse cardiovascular events. The medication is not indicated for type 1 diabetes mellitus or diabetic ketoacidosis treatment.
Dosage and direction
Initial dose: 0.6 mg subcutaneously once daily for at least one week. This starting dose is intended to reduce gastrointestinal symptoms and is not effective for glycemic control.
Maintenance dose: Increase to 1.2 mg subcutaneously once daily after one week. If additional glycemic control is needed after at least one week at 1.2 mg, the dose may be increased to 1.8 mg once daily.
Administration technique: Inject subcutaneously in the abdomen, thigh, or upper arm. Rotate injection sites to prevent lipodystrophy. May be administered without regard to meals but should be given approximately the same time each day.
Missed dose: If a dose is missed, it should be administered as soon as possible on the same day. Do not administer two doses on the same day.
Precautions
- Pancreatitis: Discontinue promptly if pancreatitis is suspected. Do not restart if pancreatitis is confirmed
- Thyroid C-cell tumors: Liraglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors in rats. It is unknown whether Victoza causes thyroid C-cell tumors in humans
- Hypoglycemia: Risk increases when used with insulin secretagogues or insulin. Consider lowering the dose of these concomitant medications
- Renal impairment: Use with caution in patients with renal impairment. Not recommended in patients with severe renal impairment
- Hepatic impairment: Use with caution in patients with hepatic impairment
- Gastrointestinal disease: Not recommended in patients with severe gastrointestinal disease
- Hypersensitivity reactions: Serious hypersensitivity reactions have been reported
- Acute gallbladder disease: Has been reported in clinical trials. Discontinue if suspected
Contraindications
- Personal or family history of medullary thyroid carcinoma (MTC)
- Patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
- History of hypersensitivity to liraglutide or any product components
- Pregnancy: Based on animal data, may cause fetal harm
Possible side effects
Very common (≥1/10): Nausea, diarrhea, vomiting, constipation Common (≥1/100 to <1/10): Hypoglycemia (when used with sulfonylureas), decreased appetite, dyspepsia, gastritis, abdominal pain, abdominal distension, eructation, flatulence, gastroesophageal reflux disease, fatigue, dizziness, headache, injection site reactions Uncommon (≥1/1,000 to <1/100): Acute pancreatitis, tachycardia, allergic reactions, angioedema, urticaria Rare (≥1/10,000 to <1/1,000): Medullary thyroid carcinoma
Drug interaction
- Oral medications: Victoza delays gastric emptying and may impact absorption of orally administered drugs. Use with caution with drugs requiring rapid gastrointestinal absorption or with a narrow therapeutic index
- Insulin: Increased risk of hypoglycemia. Dose reduction of insulin may be required
- Sulfonylureas: Increased risk of hypoglycemia. Consider reducing sulfonylurea dose
- Warfarin: Monitor INR more frequently when initiating or changing Victoza dose
- CYP450 substrates: Liraglutide does not inhibit or induce CYP450 enzymes
Missed dose
If a dose is missed, it should be administered as soon as possible on the same day. Do not administer two doses on the same day. Resume the regular dosing schedule the following day. The missed dose should not be made up by increasing the next dose.
Overdose
Effects of overdose may include severe nausea, vomiting, and hypoglycemia. In clinical trials, doses up to 15 mg daily have been administered and resulted in increased gastrointestinal adverse reactions. Hypoglycemia may occur when used in combination with sulfonylureas or insulin. In case of overdose, appropriate supportive treatment should be initiated according to the patient’s clinical signs and symptoms.
Storage
- Store unused Victoza pens in the refrigerator at 2°C to 8°C (36°F to 46°F)
- Do not freeze; discard if frozen
- Protect from light
- After first use, store at room temperature below 30°C (86°F) or refrigerate
- Discard 30 days after first use, even if some medicine remains
- Keep out of reach of children
- Do not use after expiration date
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Victoza is available by prescription only and should be used under the supervision of a qualified healthcare professional. Individual results may vary. Patients should consult their healthcare provider for personalized medical advice, including potential risks and benefits specific to their medical condition. Never disregard professional medical advice or delay seeking it because of information contained herein.
Reviews
Clinical trial data from the LEADER study involving 9,340 patients with type 2 diabetes showed Victoza significantly reduced the primary composite outcome of first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke compared to placebo (13.0% vs. 14.9%; hazard ratio 0.87). The mean HbA1c reduction was 1.06 percentage points greater with Victoza than with placebo at 36 months. Real-world evidence studies have demonstrated similar efficacy and safety profiles to randomized controlled trials, with particular benefit noted in patients with established cardiovascular disease. Patient-reported outcomes indicate improved quality of life measures related to glycemic control and weight management, though gastrointestinal side effects remain a consideration in treatment persistence.