Victoza

What is Victoza (liraglutide)?

Victoza is a non-insulin injectable medicine prescribed to patients with type 2 diabetes aged ten years and older.

The drug works by lowering blood sugar levels. It does this in two ways:

1. By helping the pancreas secrete more insulin when needed

2. By slowing digestion which also slows the release of sugar into the bloodstream

3. Reducing glucagon secretion from the pancreas

Glucagon is a hormone that increases your blood glucose levels. People with diabetes already secrete more glucagon than normal, causing raised blood glucose levels. Victoza can help combat this.

What is Victoza used to treat?

Doctors prescribe Victoza to people with type 2 diabetes as it helps lower blood sugar levels.

The medicine is also used to reduce your risk of developing diabetes-related cardiovascular complications, such as heart attack and stroke.

The drug is unsuitable for patients with type 1 diabetes, an autoimmune disease that causes the immune system to attack insulin-secreting cells in the pancreas, leading to very low or no insulin in the body.

How do you take Victoza?

Victoza is an injectable solution available in pre-filled pens. Each pen contains 18mg of liraglutide per 3ml.

Your doctor will prescribe a dose of either 0.6mg, 1.2mg, or 1.8mg.

You should inject Victoza once a day into your abdomen, thigh, or upper arm.

The typical starting dosage for Victoza is 0.6mg, injected once a day for one week. After this week, your doctor will evaluate your blood sugar levels. They may increase your dose to 1.2mg per day, or 1.8mg if needed.

Ultimately, your doctor will try to keep you on the lowest dose that can achieve the best results for you.

Seeing results

You may notice changes in your blood sugar levels within one or two weeks of taking this medication.

Potential side effects of Victoza

Mild, more common side-effects of Victoza may include:

• Nausea

• Headaches

• Dizziness

• Vomiting

• Diarrhea

• Constipation

• Loss or lack of appetite

• Headache

• Fatigue

These side effects may go away on their own. Speak to your doctor if they continue or worsen.

Some people develop mild hypoglycemia when taking Victoza. The condition can be serious, and your risk is higher¹ if you also take other diabetes medications.

Hypoglycemia symptoms can include drowsiness, difficulty concentrating, cold sweats, excessive hunger, and fatigue.

Other possible serious side effects include:

• Thyroid tumors and thyroid cancer: Symptoms include a hoarse voice, trouble swallowing, and an enlarged thyroid. People with any personal or family history of thyroid tumors, particularly carcinoma, should avoid taking the drug.

• Pancreatitis, or inflammation of the pancreas: Symptoms can include fever, vomiting, bloating, and severe pain in the abdomen.

• Gallbladder disease: Symptoms can include pain in the abdomen, jaundice, nausea, vomiting, fever, and diarrhea.

• Kidney problems: Symptoms can include trouble urinating, swollen feet or lower legs, nausea, and shortness of breath.

• Allergic reaction: Symptoms can include a severe rash, itching, swelling of your face, lips, tongue, or throat, difficulty swallowing, trouble breathing, rapid heartbeat, and dizziness.

Long-term use of Victoza

Your doctor may prescribe Victoza for long-term use if you respond well to the drug. It could help you improve your body metabolism and maintain a lower body weight, which is important for managing type 2 diabetes.

Victoza is generally considered safe for long-term use, but some recent evidence suggests it could have some negative impact in the long run.

An animal study published in 2016² found long-term daily use of Victoza initially improves the function of insulin-secreting cells in the pancreas. However, this is followed by gradual deterioration of their function over time, eventually raising blood sugar levels.

Human research needs to be carried out to confirm this.

Missed doses

If you missed a dose, skip it and return to your regular dosing schedule the next day. 

You must never take two doses at once. Try to remember to take your dose on time, and don’t skip your dose for three days or more.

Contact your doctor for guidance if your dosing schedule is severely disrupted — for example, if you miss more than three daily doses. Your doctor may reduce your dose to the initial starting dose (0.6mg) to avoid causing hypoglycemia.

Overdoses

Taking too much Victoza may cause nausea and vomiting, abdominal pains, increased sweating, and severely low blood sugar levels.

If you or someone else has taken too much Victoza, seek emergency medical help immediately.

What to discuss with your doctor before taking Victoza

Here are some of the things you must discuss with your doctor before taking this medication:

• Your personal and family medical history.

• Thyroid problems: You must tell your doctor if you have a history of thyroid problems or if family members do.

• Tell your physician if you have multiple endocrine neoplasia type 2 (tumors in your glands).

• Other medical conditions: Tell your doctor if you have problems with your kidneys, liver, pancreas, gallbladder, stomach, heart, or any other health condition. Tell your doctor if you are taking medications for these conditions. They must also know if you have high triglycerides, a type of fat in the blood.

• Medications: Ensure your doctor is aware if you are taking any other medications (prescription or over-the-counter), vitamins, nutritional supplements, or herbal remedies.

• Pregnancy: Inform your doctor if you are pregnant or have plans to become pregnant.

• Breastfeeding: Tell your doctor if you are currently breastfeeding.

• Alcohol consumption: Alcohol can increase your risk of developing hypoglycemia when taking Victoza, so tell your doctor if you drink regularly or in large amounts.

Stopping Victoza

Type-2 diabetes is a lifelong condition, so you may need to take Victoza continuously.

You should not stop taking Victoza without first consulting your doctor, as doing so could cause unwanted effects, like high blood sugar levels.

Stopping Victoza abruptly may cause nausea that lasts for a few days.

Victoza and pregnancy

The FDA recommends prescribing Victoza during pregnancy only if the benefits outweigh the potential risks.³

The drug is not listed by the FDA under a specific pregnancy category, but some animal studies have shown Victoza may harm the fetus either through the risk of birth defects or miscarriage.

However, not enough research has been carried out to confirm the same for humans.

Animal studies have also shown the drug passes into breast milk,³ but it is not known if this also occurs in humans. Ask your doctor if it is safe for you to breastfeed when taking Victoza.

Interactions with other drugs

Taking Victoza with the following medications can directly affect their blood concentration level, metabolism, or excretion. This could impact how effective they are.

These medications include:

• Atorvastatin (Lipitor)

• Acetaminophen (Panadol, Tylenol, and others)

• Lisinopril (Prinivil, Zestril, and others)

• Griseofulvin (Grifulvin V or Gris-Peg)

• Digoxin (Lanoxin, Digitek, and others)

• Oral contraceptives

It is essential to inform your doctor if you are taking any of these medications before starting Victoza, so doses and schedules can be adjusted if needed.

Taking Victoza alongside some other medications that also affect blood glucose levels could cause hypoglycemia. These medications include:

• Insulin

• Sulfonylureas, like glyburide (Glynase or DiaBeta) and glimepiride (Amaryl)

• Metformin (Glucophage, Fortamet, and others)

• Some diuretics, such as furosemide (Lasix) and hydrochlorothiazide (Oretic, Microzide, or other combination products)

• Levothyroxine (Levo-T, Synthroid, and others)

If you must take these medicines, you will need continuous monitoring. Your doctor may adjust your medication dosages to avoid complications.

Allergy information

In rare cases, Victoza can cause severe allergic reactions. Symptoms may include:

• Skin rashes

• Itching

• Difficulty breathing

• Swelling in the lips, tongue, and throat

Seek urgent medical help if you develop symptoms of an allergic reaction to Victoza.

Clinical trial history⁴

The FDA approved Victoza for use in adults based on five double-blind, randomized, controlled clinical studies. One trial lasted 52 weeks and four lasted 26 weeks. There were 3,978 participants in total.

The 52-week monotherapy trial enrolled 746 patients randomly assigned to one of three groups: Victoza 1.6mg, Victoza 1.8mg, or glimepiride 8mg.

Patients randomized to take glimepiride were initially treated with 2mg daily for two weeks, then increased to 4mg daily for another two weeks, and finally increased to 8mg daily.

Treatment with Victoza 1.8mg and Victoza 1.2mg resulted in a statistically significant reduction in blood glucose levels compared to glimepiride.

In combination with metformin

A 26-week trial enrolled 1,091 patients randomized to take metformin with Victoza 0.6mg, 1.2mg, or 1.8mg, glimepiride 4mg (the half-maximal dose), or placebo.

Participants who took 1.2mg or 1.8mg of Victoza with metformin demonstrated a significant mean decrease in blood sugar levels compared to those who took the lowest dose of Victoza, placebo, and glimepiride.

In combination with a sulfonylurea

A 26-week trial enrolled 1,041 patients randomized to take a sulfonylurea (glimepiride) with Victoza 0.6mg, 1.2mg, or 1.8mg, rosiglitazone 4mg daily, or placebo.

Treatment with Victoza 1.2mg and 1.8mg as an add-on to glimepiride resulted in a statistically signif­icant reduction in mean blood sugar levels compared to placebo.

Add-on to metformin and sulfonylurea

581 patients were randomly assigned to take Victoza 1.2mg, insulin glargine, or placebo as an add-on to met­formin and glimepiride. Compared to a placebo with metformin and glimepiride, treatment with Victoza caused a more significant mean reduction in blood sugar levels.

Tips and advice for taking Victoza

Here are some tips and advice to help you take Victoza safely and get the best results:

• Follow your doctor’s instructions and the packet instructions carefully when using the Victoza pen, especially if you are new to using this drug.

• Always ensure the drug is clear, colorless, and free from impurities.

• Inject at the same time each day.

• When injecting insulin, do not inject it where you inject Victoza. Leave several inches between the two spots.

• Never share your Victoza pen with others.

• Store your unused Victoza pens in the refrigerator.

• If the injection hurts, try injecting it at room temperature the next time and not from the fridge. Do not return Victoza to the fridge after leaving it to adjust to room temperature.

• Do not stop taking Victoza unless your doctor tells you it’s safe to do so.