Victoza (liraglutide)

How is Victoza Used?

This medication comes in a prefilled injection pen that is used once daily. The injection is administered subcutaneously in the upper arm, thigh, or abdomen, and the injection site should be rotated for each administered dose to avoid irritation or damage to the skin.

Patients will also be advised of the appropriate changes needing to be made to their dietary habits and exercise regimen while using this medication.

Storage

These prefilled injection pens should be stored in refrigeration and kept between the temperatures of 36°F(2°C) and 46°F (8°C) until being used for the first time. Once the pen has been opened and is ready for use, it may be stored at room temperature between 59°F (15°C) and 86°F (30°C) or stored back in the refrigerator for a maximum of 30 days, after which it will need to be disposed of properly.

Keep this medication out of the reach of children at all times.

Victoza pens should be stored with their caps on and needles removed. They should also be protected from both light and heat.

Uses

Victoza is prescribed for:

• the management of high blood glucose levels in adults and children above the age of 10 years with type 2 diabetes
• the prevention of cardiovascular events in adult patients with both type 2 diabetes and heart disease

How Does Victoza Work?

This medication works to manage blood glucose levels in three different ways. By decreasing the release of glucagon in the patient’s blood, this medication impairs the body’s ability to raise the patient’s blood glucose levels. It also activates the GLP-1 receptor located in the pancreas. When doing this, it increases the amount of insulin released by the pancreas to lower blood glucose levels in this manner as well. Additionally, it slows down the digestion process, allowing food to move more slowly through the stomach to the intestines, making patients feel fuller for longer.

Dosage

This medication is available as a liquid solution contained within a prefilled injection pen, holding a total of 3 mL of solution with 18 mg of liraglutide. The available dosage sizes for injection are 0.6 mg, 1.2 mg, or 1.8 mg.

The patient’s dosage of Victoza will be determined by their prescribing physician based on a variety of different health factors.

Most adult patients with type 2 diabetes will begin with a once-daily dose of 0.6 mg for the span of their first week of treatment. This dosage will typically be increased to a daily dose of 1.2 mg after the first week. By the third week of treatment, patients in need of further management of their blood glucose levels will be increased to the maximum daily dosage of 1.8 mg. This dosage plan is the same for adult patients using Victoza solely for their type 2 diabetes as well as those with type 2 diabetes that are using the medication to manage their risk of cardiovascular events.

Pediatric patients that are ten years of age or older and have type 2 diabetes will typically start with a low once-daily dose of 0.6 mg. Similar to the adult dosing schedule, this dosage may be increased to a once-daily dose of 1.2 mg after the span of a week. If a dosage increase is necessary after this point, the child may then be increased to the maximum once-daily dosage for pediatric patients of 1.8 mg once per day.

Overdose

If an overdose of this medication has occurred or is suspected, the patient’s physician or local Poison Control Center should be contacted as soon as possible. If serious side effects occur after using too much of this medication, emergency medical attention should be sought immediately.

Symptoms of an overdose of Victoza may include severe hypoglycemia (dangerously low blood glucose levels) and severe nausea or vomiting.

Side Effects

The most common side effects of taking Victoza are as follows:

• abdominal discomfort, swelling, or pain (mild)
• appetite loss
• burping
• constipation
• diarrhea
• feeling dizzy
• gassiness
• headaches
• heartburn
• injection site reactions (swelling, itchiness, or redness)
• nausea
• rash
• vomiting

Some of the following side effects may occur when using this medication and should be discussed with your doctor as soon as possible, as they may develop into more serious conditions over time:

• difficulties with swallowing
• hoarseness
• increased frequency of nasal congestion, colds, or sinus infections
• increase in heart rate
• itching
• lump in the neck
• symptoms of gallbladder inflammation
  • bloating
  • indigestion
  • nausea
  • upper abdominal pain after eating
• symptoms of hypoglycemia (low blood glucose levels)
  • anxiety
  • blurry vision
  • confusion
  • dizziness
  • feeling drowsy
  • feeling hungry
  • feeling jittery
  • feeling nervous
  • feeling tired
  • headaches
  • irritability
  • nausea
  • rapid heart rate
  • speech difficulties
  • sweating
  • tingling or numbness of the tongue or lips
  • trembling
  • trouble concentrating
  • weakness

Seek emergency medical attention and stop using this medication if you experience any of the following side effects after injecting Victoza:

• chest pain
• changes in heart rhythm (i.e., palpitations or fainting)
• loss of consciousness
• pancreatitis
  • abdominal pain (upper left side)
  • abdominal swelling
  • back pain
  • chills
  • fever
  • nausea
  • rapid heart rate
• seizures
• serious allergic reaction
  • breathing difficulties
  • itchy rash on the skin
  • swelling of the throat or face
  • wheezing
• severe hypoglycemia
  • feeling disoriented
  • seizures
  • unconsciousness

Warnings & Precautions

Children

It has not been determined if this medication is effective or safe for use in those below the age of 10 years old.

Heart-Related Issues

The way in which electrical impulses travel through a patient’s heart may be impacted by this medication. Additionally, the use of Victoza may trigger an increase in heart rate in some individuals. Patients with an abnormal heart rhythm or heart disease should discuss these aspects of their health with their prescribing physician, as these issues may impact the safety, efficacy, and dosage of the medication. Some individuals may require additional monitoring during treatment.

Hepatic Function

It has not been determined if this medication is safe or effective for those who have impaired liver function. If you have a history of liver disease or impaired hepatic function, you should be sure to discuss these aspects of your health history with your physician before beginning treatment with this medication. This medication may affect a patient’s liver function or have its safety or efficacy impacted by impaired liver function and require the patient to undergo additional monitoring during treatment.

Hypoglycemia

Patients using this medication that also use a sulfonylurea medication to manage their hyperglycemia are at an increased risk of experiencing low blood glucose levels. Those who are using both of these medications for treatment may require changes to their daily dosages to better manage their condition without adverse side effects, including issues such as hypoglycemia, occurring. Patients using these medications that experience symptoms of low blood glucose levels should inform their doctor as soon as possible. This may include symptoms such as tingling or numbness of the lips or tongue, weakness, confusion, feeling lightheaded, feeling hungry, getting a headache, feeling shaky or nervous, breaking out in a cold sweat, or experiencing a rapid heart rate.

Intestinal Conditions

Patients with health conditions that affect their digestion and intestinal tract should discuss these matters with their physician before using this medication. It has not been determined if this medication is safe or effective in those who have inflammatory bowel disease, including conditions such as ulcerative colitis and Crohn’s disease. Using a medication like Victoza may impact these conditions, have its efficacy impacted by these conditions, and may also require the patient to undergo additional monitoring during treatment.

Pancreatitis

This medication has been linked to the development of pancreatitis (inflammation of the pancreas). Patients with a medical history including pancreatitis should discuss this aspect of their health with their physician before beginning treatment with this medication, as this may impact the efficacy and dosage of the medication and may also require the patient to undergo additional monitoring during treatment. Patients that are using this medication and experience any symptoms of pancreatitis should report these symptoms to their physician as soon as possible. Persistent or severe abdominal pain, with or without vomiting, that may move to the patient’s backside is an indicator of this condition.

Thyroid Cancer Risks

This medication is associated with the development of thyroid cancer in some individuals that have used it. Those who have multiple endocrine neoplasia syndrome type 2 (MEN 2) or a family or personal history of thyroid cancer should not be prescribed Victoza for treatment due to this risk. Patients using this medication that experience difficulties with breathing or swallowing, develop hoarseness that doesn’t go away, or have a lump develop in their neck should inform their physician immediately.

Pregnancy and Breastfeeding

This medication should not be used during pregnancy, and patients that become pregnant while using Victoza should inform their prescribing physician immediately.

Additionally, it has not been determined if this medication passes into breast milk; therefore, there may be some risks associated with using this medication while breastfeeding an infant. Patients desiring to breastfeed while using this medication should discuss the potential risks with their physician before proceeding.

Renal Function

It has not been determined if this medication is safe or effective for those who have impaired renal function. If you have a history of kidney disease or impaired renal function, you should be sure to discuss these aspects of your health history with your physician before beginning treatment with this medication. This medication may affect a patient’s kidney function or have its safety or efficacy impacted by impaired kidney function and require the patient to undergo additional monitoring during treatment. Patients using this medication that experience vomiting or nausea during treatment should be sure to stay well-hydrated and drink plenty of water to avoid dehydration.

Senior Patients

Patients above the age of 65 years are at an increased risk of experiencing side effects when using this medication.

Drug Interactions

Speak to your doctor about any medications or herbal supplements you are currently taking before beginning treatment with this medication. Discuss any concerns you may have with your doctor or a trusted pharmacist.

The following medications are known to interact with Victoza:

• acetylsalicylic acid (ASA)
• alpha-lipoic acid
• androgens
• atazanavir
• atenolol
• atypical antipsychotics
• basiliximab
• beclomethasone
• beta-blockers
• budesonide
• buserelin
• chloroquine
• chlorpropamide
• ciprofloxacin
• citalopram
• clozapine
• conjugated estrogen
• corticosteroids
• diabetes medications
• dienogest
• digoxin
• disopyramide
• diuretics
• elbasvir

• epinephrine
• estradiol
• estrogens
• ethinyl estradiol
• everolimus
• fluoxetine
• fluticasone
• furosemide
• glecaprevir
• glucagon
• glyburide
• goserelin
• grazoprevir
• hepatitis C antivirals
• HIV protease inhibitors
• hydrochlorothiazide
• hydrocortisone
• hydroxychloroquine
• indapamide
• indinavir
• inhaled corticosteroids
• insulin
• lanreotide
• ledipasvir

• leuprolide
• levonorgestrel
• medroxyprogesterone
• metformin
• metoprolol
• mifepristone
• moclobemide
• monoamine oxidase inhibitors (MAOIs)
• niacin
• nilotinib
• norethindrone
• norfloxacin
• octreotide
• ofloxacin
• olanzapine
• paroxetine
• pasireotide
• pentamidine
• phenelzine
• pibrentasvir
• prednisone
• progestins
• propranolol
• pseudoephedrine

• quetiapine
• quinine
• quinolone antibiotics
• rasagiline
• risperidone
• ritonavir
• rosiglitazone
• saquinavir
• selective serotonin reuptake inhibitors (SSRIs)
• selegiline
• sertraline
• sirolimus
• sofosbuvir
• somatropin
• sulfamethoxazole
• sulfisoxazole
• sulfonamide antibiotics (“sulfas”)
• sunitinib
• tacrolimus
• testosterone
• tramadol
• tranylcypromine
• velpatasvir
• venetoclax
• vorinostat
• water pills

Alternative Medications

For patients who are unable to use this medication or are experiencing significant adverse side effects, alternative medications may be used to treat some of the associated conditions for which this medication is commonly prescribed:

• canagliflozin (Invokana)
• dapagliflozin (Farxiga)
• dulaglutide (Trulicity)
• empagliflozin (Jardiance)
• exenatide (Bydureon, Byetta)
• glipizide (Glucotrol, Glucotrol XL)
• glyburide (Diabeta, Glynase)
• insulin aspart (Novolog)
• insulin degludec (Tresiba)
• insulin detemir (Levemir)
• insulin glargine (Basaglar, Lantus, Toujeo)
• insulin glulisine (Apidra)
• insulin lispro (Humalog)
• linagliptin (Tradjenta)
• metformin (Glumetza, Riomet)
• pioglitazone (Actos)
• saxagliptin (Onglyza)
• semaglutide (Ozempic)
• sitagliptin (Januvia)