Victoza: Effective GLP-1 Therapy for Type 2 Diabetes Management
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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. It is also approved to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes and established cardiovascular disease. This injectable prescription medication works by mimicking the functions of natural incretin hormones, stimulating insulin secretion in a glucose-dependent manner, suppressing glucagon secretion, slowing gastric emptying, and promoting satiety. Its mechanism offers a multifaceted approach to diabetes management, addressing both hyperglycemia and potential cardiovascular risks.
Features
- Active ingredient: Liraglutide
- Drug class: Glucagon-like peptide-1 (GLP-1) receptor agonist
- Administration: Subcutaneous injection
- Available strengths: 6 mg/mL pre-filled pens (delivering 0.6 mg, 1.2 mg, or 1.8 mg per dose)
- Dosing frequency: Once daily
- Onset of action: Rapid absorption with peak liraglutide concentrations occurring 8-12 hours post-dosing
- Half-life: Approximately 13 hours
- Metabolism: Endogenous degradation without specific organ involvement
- Excretion: Primarily via urine and feces as metabolites
Benefits
- Demonstrates significant HbA1c reduction, with clinical trials showing decreases of 1.0% to 1.5% from baseline
- Provides cardiovascular risk reduction, showing statistically significant decrease in major adverse cardiovascular events in patients with established cardiovascular disease
- Promotes weight loss through reduced appetite and slowed gastric emptying, with average weight reduction of 2-3 kg observed in clinical studies
- Lowers the risk of hypoglycemia compared to insulin and sulfonylureas due to its glucose-dependent mechanism of action
- Offers convenient once-daily dosing regimen that can be administered at any time of day, independent of meals
- May preserve beta-cell function through multiple mechanisms including enhanced insulin biosynthesis and inhibition of beta-cell apoptosis
Common use
Victoza is primarily prescribed for the management of type 2 diabetes mellitus in adults. It is used as monotherapy or in combination with other antidiabetic medications including metformin, sulfonylureas, thiazolidinediones, or insulin when glycemic targets are not achieved with existing therapy. The medication is particularly valuable for patients who require additional glycemic control while minimizing hypoglycemia risk or those who would benefit from weight management. Additionally, Victoza is indicated for cardiovascular risk reduction in adults with type 2 diabetes and established cardiovascular disease, making it a preferred choice for patients with both metabolic and cardiovascular concerns.
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 the first week. If additional glycemic control is needed, the dose may be increased to 1.8 mg once daily after at least one week on the 1.2 mg dose.
Administration instructions:
- Administer at any time of day, independent of meals
- Inject subcutaneously in the abdomen, thigh, or upper arm
- Rotate injection sites to prevent lipodystrophy
- Use the pre-filled pen with a NovoFine needle
- Prime the pen before first use (check flow with a 2-unit test dose)
- Visually inspect the solution; it should be clear and colorless
- Do not mix with insulin or other medications
- If a dose is missed, administer as soon as remembered within 12 hours; if more than 12 hours have passed, skip the missed dose and resume the regular schedule
Precautions
Pancreatitis: Monitor patients for signs and symptoms of pancreatitis (persistent severe abdominal pain sometimes radiating to the back, with or without vomiting). Discontinue promptly if pancreatitis is suspected.
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. Patients should be counseled regarding the risk and symptoms of thyroid tumors.
Hypoglycemia: When used with insulin secretagogues or insulin, the risk of hypoglycemia increases. Consider reducing the dose of these concomitant medications.
Renal Impairment: Use with caution in patients with renal impairment. Not recommended for patients with end-stage renal disease.
Hepatic Impairment: Use with caution in patients with hepatic impairment.
Gastrointestinal Disease: Use may be associated with gastrointestinal adverse reactions. Not recommended in patients with severe gastrointestinal disease.
Hypersensitivity Reactions: Serious hypersensitivity reactions have been reported. Discontinue if suspected.
Acute Gallbladder Disease: Has been reported in clinical trials. Monitor for cholelithiasis and cholecystitis.
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
- Not for treatment of type 1 diabetes mellitus or diabetic ketoacidosis
- Not recommended during pregnancy
- Severe gastrointestinal disease, including gastroparesis
Possible side effects
Common (≥5%):
- Nausea (occurring in approximately 20% of patients, typically diminishing over time)
- Diarrhea (9%)
- Headache (9%)
- Vomiting (7%)
- Constipation (6%)
- Dyspepsia (5%)
Less common (1-5%):
- Decreased appetite
- Fatigue
- Dizziness
- Abdominal pain
- Injection site reactions
- Increased lipase
- Sinus tachycardia
Rare (<1%):
- Acute pancreatitis
- Allergic reactions
- Gallbladder disease
- Renal impairment
- Hypoglycemia (when used with insulin secretagogues)
Drug interaction
Insulin and insulin secretagogues: Increased risk of hypoglycemia. Dose reduction of these agents may be required.
Oral medications: Victoza delays gastric emptying and may impact absorption of orally administered drugs. Medications with narrow therapeutic index or those requiring careful clinical monitoring should be taken at least one hour before Victoza administration.
Warfarin: Monitor INR more frequently when initiating or changing Victoza dose due to potential for altered absorption.
Oral contraceptives: Should be taken at least one hour before Victoza injection to ensure proper absorption.
Acetaminophen: Maximum concentration may be decreased by approximately 30% when co-administered with Victoza.
Missed dose
If a dose of Victoza is missed, the patient should administer it as soon as remembered within 12 hours of the scheduled time. If more than 12 hours have passed since the scheduled administration time, the missed dose should be skipped and the next dose should be administered at the regularly scheduled time the following day. Patients should not administer two doses on the same day to make up for a missed dose. Consistency in daily administration time is recommended but not required, as the 24-hour dosing interval provides flexibility.
Overdose
Overdose with Victoza may result in severe nausea, vomiting, and hypoglycemia. In clinical trials, doses up to 15 mg daily (approximately 8 times the maximum recommended dose) have been administered and were associated with increased gastrointestinal adverse reactions. No fatal overdose cases have been reported. In the event of overdose, appropriate supportive treatment should be initiated according to the patient’s clinical signs and symptoms. Blood glucose should be monitored closely, and hypoglycemia should be treated with oral carbohydrates or intravenous glucose as appropriate. Because liraglutide has a long half-life (approximately 13 hours), effects may persist for extended periods. Hemodialysis is unlikely to be effective due to high protein binding.
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 refrigerated
- The pen in use may be kept at room temperature for 30 days
- Always remove the needle after each injection and store the pen without a needle attached
- Keep out of reach of children
- Do not use after the expiration date printed on the label
- Discard 30 days after first use, even if medication remains
Disclaimer
This information is provided for educational purposes only and is not intended as medical advice. Victoza is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual results may vary. Patients should consult with their healthcare provider for complete information about their condition and treatment options. The prescribing physician should be consulted regarding any questions about diagnosis or treatment. Never disregard professional medical advice or delay seeking it because of something you have read in this product information.
Reviews
Clinical trials demonstrate Victoza’s efficacy in glycemic control with sustained HbA1c reductions of 1.0% to 1.5%. The LEAD (Liraglutide Effect and Action in Diabetes) clinical trial program, involving over 4,000 patients, established its safety and efficacy profile. The cardiovascular outcomes trial (LEADER) showed a 13% reduction in major adverse cardiovascular events and a 22% reduction in cardiovascular mortality in high-risk patients with type 2 diabetes. Real-world evidence studies have confirmed these findings in diverse patient populations. Many endocrinologists report positive patient experiences with weight management and reduced hypoglycemia concerns compared to other antidiabetic regimens. Patient satisfaction surveys indicate improved quality of life measures related to convenient dosing and reduced disease management burden.