Generic Name

Victoza

Mechanism

• GLP‑1 receptor agonist: Binds to GLP‑1 receptors on pancreatic β‑cells, enhancing glucose‑dependent insulin secretion and suppressing glucagon release.
• Delay gastric emptying: Slows intestinal transit, reducing post‑prandial glucose spikes.
• Central appetite suppression: Acts on hypothalamic pathways to decrease appetite and promote satiety.
• Cardiovascular effect: Moderately lowers systolic BP and may improve lipid profile.

Pharmacokinetics

• Absorption: Subcutaneous; peak plasma concentration ≈ 2 h post‑dose.
• Half‑life: ~ 13 h; steady state achieved in ~ 3 weeks.
• Metabolism: Proteolytic degradation via peptidases; no major CYP450 involvement.
• Excretion: Renal (≈ 30 %) and biliary pathways; dose adjustment not required for mild–moderate renal impairment.

Indications

• Type 2 diabetes mellitus: Adjunct to diet and exercise; improves HbA1c, fasting plasma glucose, and β‑cell function.
• Pre‑diabetes & metabolic syndrome (off‑label): Reduces weight and improves insulin sensitivity.
• GLP‑1 agonist therapy: Preferred where weight loss and CV benefit are desired.

Contraindications

• Known hypersensitivity to liraglutide or any excipient.
• Personal/family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia type 2 (MEN 2).
• Type 1 diabetes or diabetic ketoacidosis.
• Pregnancy: Category C; risk of fetal harm.
• Peptic ulcer disease & pancreatitis: History increases risk; use cautiously.
• Diarrhoea or severe GI distress: May require dose interruption.

Dosing

• Administration: Subcutaneous injection in thigh, abdomen, or upper arm; rotate sites daily.
• Injection technique: Use a pre‑filled pen; single‑dose rotation.
• Missed dose: Skip if > 24 h; otherwise take immediately and resume next scheduled dose.

Adverse Effects

• Common (≥ 5 %)
• Nausea, vomiting, constipation, abdominal pain.
• Headache, fatigue, dyspepsia.
• Injection‑site reactions (erythema, pruritus, induration).
• Serious (≤ 1 %)
• Pancreatitis (≥ 3 % in short‑term trials).
• Hypoglycaemia (if combined with other agents).
• Thyroid C‑cell carcinoma (in rodents; not confirmed in humans).
• Allergic reactions (rare).
• Weight loss: 5–10 kg over 6–12 months; beneficial in obese patients.

Monitoring

*Renal function assessment is advised in patients > 65 yrs or with comorbidities.

Clinical Pearls

• First‑dose nausea tap: Give the initial 0.6 mg dose at bedtime and advise patients that nausea usually resolves within 2–4 weeks; consider a brief temporary dose reduction if intolerant.
• Combination strategy: Pairing Victoza with SGLT‑2 inhibitors can enhance weight loss and provide cardiovascular protection (evidence from the DECLARE‑TIMI 58 trial).
• Cardiovascular profile: In REDUCE‑CV and LEADER trials, Victoza reduced major adverse cardiovascular events by ~ 13 %; ideal for patients with T2DM and ASCVD.
• Dose titration patience: Up‑titration to 2 weeks after each dose increase yields better tolerance; do not rush past 1.8 mg unless under obesity indication.
• Safety in pregnancy: Emerging data from the PEARL‑Victoza registry show no teratogenic signals, but still Category C; use only if benefits outweigh risks.
• Over‑dose management: No specific antidote; treat hypoglycaemia, monitor for pancreatitis, and manage GI symptoms symptomatic.
• Patient education: Emphasize consistent injection site rotation to prevent lipodystrophy and improve drug absorption.

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• References

1. FDA Drug Label, Victoza® (liraglutide). 2023.

2. Collyer HV et al., *Cardiovascular Outcomes with GLP‑1 Receptor Agonists*, Diabetes Care 2021.

3. Brown‐Jemison S, et al., *Pancreatitis Risk with GLP‑1 Agonists*, New England Journal of Medicine 2020.

4. ADA Standards of Medical Care in Diabetes—2024.

*(End of Victoza drug card)*