Formulary
Liraglutide: Indications, Dosing, Side Effects and Interactions
Liraglutide binds to, and activates, the GLP-1 (glucagon-like peptide-1) receptor to increase insulin secretion, suppresses glucagon secretion, and slows...
MedNext Academy | 4 min read
Liraglutide: Indications, Dosing, Side Effects and Interactions
Liraglutide binds to, and activates, the GLP-1 (glucagon-like peptide-1) receptor to increase insulin secretion, suppresses glucagon secretion, and slows...
Drug action
Liraglutide binds to, and activates, the GLP-1 (glucagon-like peptide-1) receptor to increase insulin secretion, suppresses glucagon secretion, and slows gastric emptying.
Indications and dose
**Type 2 diabetes mellitus as monotherapy (if metformin inappropriate), or in combination with other antidiabetic drugs (including insulin) if existing treatment fails to achieve adequate glycaemic control**
- **Adult** (By Subcutaneous Injection): Initially 0.6 mg once daily for at least 1 week, then increased to 1.2 mg once daily for at least 1 week, then increased if necessary to 1.8 mg once daily.
**Adjunct in weight management [in conjunction with dietary measures and increased physical activity in individuals with a BMI of 30 kg/m2or more, or in individuals with a BMI of 27 kg/m2or more in the presence of at least one weight-related co-morbidity]**
- **Adult** (By Subcutaneous Injection): Adjunct in weight management [in conjunction with dietary measures and increased physical activity in individuals with a BMI of 30 kg/m 2 or more, or in individuals with a BMI of 27 kg/m 2 or more in the presence of at least one weight-related co-morbidity] Initially 0.6 mg once daily, then dose to be increased in steps of 0.6 mg at intervals of at least 1 week up to a maintenance dose of 3 mg once daily. Consider discontinuation if escalation to the next dose is not tolerated for 2 consecutive weeks. Discontinue if at least 5% of initial body-weight has not been lost after 12 weeks at maximum dose.
**Type 2 diabetes mellitus as monotherapy (if metformin inappropriate), or in combination with other antidiabetic drugs (including insulin) if existing treatment fails to achieve adequate glycaemic control for liraglutide**
- **Child 10-17 years** (By subcutaneous injection): Initially 0.6 mg once daily for at least 1 week, then increased to 1.2 mg once daily for at least 1 week, then increased if necessary to 1.8 mg once daily.
**Adjunct in weight management [in conjunction with dietary measures and increased physical activity in individuals with a BMI corresponding to 30 kg/m2 or more in adults, and body-weight above 60 kg] for liraglutide**
- **Child 12-17 years** (By subcutaneous injection): Initially 0.6 mg once daily, then dose to be increased in steps of 0.6 mg at intervals of at least 1 week up to a maintenance dose of 3 mg once daily or the maximum tolerated dose whichever is lower. Consider discontinuation if escalation to the next dose is not tolerated for 2 consecutive weeks. Discontinue if at least 4% of initial body-weight has not been lost after 12 weeks at maximum dose.
Cautions
General anaesthesia or deep sedation (risk of pulmonary aspiration due to delayed gastric emptying); severe congestive heart failure (no information available); thyroid disease
Contraindications
General contra-indications: Diabetic gastroparesis; inflammatory bowel disease Specific contra-indications: When used for Type 2 diabetes mellitus Diabetic ketoacidosis When used for Weight management Obesity secondary to endocrinological or eating disorders When used for Weight management Concomitant use with other products for weight management; elderly 75 years or over (limited information)
Side effects
Common or very common Appetite decreased (in patients with type 2 diabetes); asthenia; burping; constipation; diarrhoea; dizziness; dry mouth; gallbladder disorders; gastrointestinal discomfort; gastrointestinal disorders; headache; hypoglycaemia; increased risk of infection; insomnia; nausea; skin reactions; taste altered; toothache; vomiting Uncommon Dehydration; malaise; pancreatitis; renal impairment; tachycardia Frequency not known Angioedema; cutaneous amyloidosis; thyroid disorder Side-effects, further information Discontinue if symptoms of acute pancreatitis occur, such as persistent, severe abdominal pain. If pancreatitis confirmed, do not restart treatment.
Interactions
**Severe interactions:**
- Few patients treated with liraglutide reported at least one episode of severe diarrhoea.
**Other interactions (25):**
- In vitro, liraglutide has shown very low potential to be involved in pharmacokinetic interactions with other active substances related to cytochrome P450 (CYP) and plasma protein binding.
- The small delay of gastric emptying with liraglutide may influence absorption of concomitantly administered oral medicinal products.
- Interaction studies have been performed with 1.8 mg liraglutide.
- The effect on rate of gastric emptying was equivalent between liraglutide 1.8 mg and 3.0 mg, (paracetamol AUC0-300 min).
- Warfarin and other coumarin derivatives No interaction study has been performed.
- A clinically relevant interaction with active substances with poor solubility or narrow therapeutic index such as warfarin cannot be excluded.
Pregnancy
Avoid (toxicity in animal studies) M (recommendation also supported by specialist sources).
Breast feeding
Specialist sources indicate use with caution, especially if breast-feeding a neonate or preterm infant (no information available). Large molecular weight suggests limited excretion into milk and drug molecule likely to be partially destroyed in the infant's gastro-intestinal tract. Blood glucose monitoring of the infant should be considered.
Hepatic impairment
Avoid in severe impairment (risk of decreased exposure). M When used for Weight management: Use with caution in mild to moderate impairment. M
Renal impairment
When used for Type 2 diabetes mellitus: Avoid in end-stage renal disease (limited information available). M When used for Weight management: Avoid if creatinine clearance less than 30 mL/minute. M See Prescribing in renal impairment .
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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