Saxenda Side Effects

In 2023, the CDC reported that 40.3% of US adults face obesity, with similar rates for both men and women. This long-term condition is associated with significant health risks, including type 2 diabetes, high blood pressure, heart disease, stroke, and cancer. Excess weight also often leads to higher cholesterol levels, worsening these conditions.

Medications like Saxenda (liraglutide) have been developed to help manage and prevent obesity-related diseases. Approved by the FDA in 2014, Saxenda is and injectable indicated for chronic weight management in adults and adolescents from 12 to 17 years with a BMI of 30 kg/m² or higher or a BMI of 27 kg/m² with at least one weight-related condition. It is used alongside a reduced-calorie diet and increased physical activity.

Like any medication, Saxenda has its share of side effects. In this article, we’ll take a closer look at the common and more serious Saxenda side effects, along with practical tips for managing them.

Common Side Effects of Saxenda

Here are the common Saxenda side effects:

1. Nausea and Vomiting

Nause is the most common side effect when starting Saxenda. Research found that 17–38% of participants taking Saxenda at doses of 1.2–3.0 mg experienced at least one episode of nausea or vomiting, compared to only 4% of those on placebo or orlistat.

These symptoms were primarily mild or moderate and occurred mainly during the first six weeks as the dose was increased. For those on the 3.0 mg dose, 48% reported nausea, and 13% reported vomiting, though only 4% withdrew due to these effects.

Participants who experienced nausea and vomiting lost an average of 9.2 kg (20.3 lbs), compared to 6.3 kg (13.9 lbs) in those who did not. Both groups on Saxenda lost more weight than those on placebo or orlistat, with similar quality-of-life improvements, showing that the benefits of Saxenda outweighed the side effects.

Managing nausea and vomiting involves eating bland, low-fat foods (like crackers or toast), choosing hydrating foods (like soup or gelatin), avoiding lying down after meals, and getting fresh air.

2. Diarrhea

Diarrhea was one of the most frequently reported Saxenda side effects among participants taking it in a controlled study. It usually ranged in severity from mild to moderate and occurred alongside other gastrointestinal symptoms like nausea.

Saxenda influences gut hormones that can affect digestion and intestinal motility, leading to increased stool frequency. In the trial, the incidence of diarrhea was notable enough to warrant attention. Severe cases were reported at 6.2%.

To manage diarrhea, stay hydrated with drinks like water, fruit juices, or broth. Eat fiber-rich foods like bananas, brown rice, or oatmeal to help slow digestion. Take over-the-counter remedies for relief and electrolyte replacement. If the diarrhea persists for more than a few days, contact a healthcare provider.

3. Constipation

During an 11-month study, 18.4% of Saxenda patients experienced constipation, slightly higher than the 15.3% of those on DPP-4 inhibitors. Three months into the therapy, the incidence of constipation remained similar, with 13.3% for Saxenda users and 15.7% for those on DPP-4 inhibitors.

By the six-month mark, constipation rates decreased for both groups, with Saxenda patients showing a 10.5% incidence. While constipation was a notable side effect of Saxenda, it improved over time for most patients.

Keep the body well-hydrated and include enough fiber in the diet to avoid constipation. A doctor might also recommend a stool softener or a laxative for relief.

4. Headache

Saxenda can cause headaches, but the incidence appears to be lower compared to DPP-4 inhibitors. In the study, headaches were reported in 13.3% of patients during the hospitalization period, 6.0% after three months, and 6.6% after six months of Saxenda therapy. While Saxenda can cause headaches, they tend to be less common and decrease over time.

Getting enough sleep, drinking enough water, and avoiding foods such as caffeine and chocolate can help relieve headaches.

5. Dyspepsia (Indigestion)

Dyspepsia associated with Saxenda typically begins around seven days after starting the drug, although the time-to-onset varies widely, with an interquartile range (IQR) from 0 to 54.5 days. This variability suggests that while some patients may experience dyspepsia shortly after starting Saxenda, others may develop symptoms later in the treatment. A clinical study reported 39 cases of dyspepsia, emphasizing that indigestion is a notable adverse effect of this therapy.

Patients experiencing severe dyspepsia may benefit from maintaining a lower, more tolerable dose rather than escalating further. Also, avoiding rich or spicy foods, eating smaller meals, and practicing mindful eating, may reduce the intensity of symptoms. Over-the-counter antacids or acid-reducing medications could also provide relief but should be discussed with a healthcare provider to avoid potential interactions.

6. Fatigue

Fatigue is another reported side effect of Saxenda. Clinical studies show that 14% of users experienced fatigue while taking the drug at a 3.0 mg dose over two years, with 8% reporting tiredness by the fourth month. It is important to maintain a balanced diet, get enough sleep, and take regular daily breaks to rest and ease tiredness.

7. Dizziness

Research indicates that 14.3% of patients experienced dizziness during the initial hospitalization period after starting Saxenda therapy. However, this incidence decreased over time, dropping to 9.6% at the three-month mark and further to 5.3% after six months.

8. Abdominal Pain

Abdominal pain is particularly common during the initial titration period, which usually lasts about four weeks as the body adjusts to the increasing doses. This may be due to the drug’s effects on gastric emptying and increased gastrointestinal activity.

There are a few strategies that may help manage it:

• • Follow the prescribed titration schedule carefully. Slower adjustments can help reduce side effects, so discuss with a healthcare provider if there is ongoing discomfort.

• • Eating small, frequent meals and avoiding rich, fatty, or spicy foods can help reduce gastrointestinal symptoms.

• • Drink enough liquid, as dehydration can worsen gastrointestinal discomfort. Aim for water and electrolyte-rich beverages rather than caffeinated or sugary drinks, which might intensify symptoms.

9. Increased Lipase (Pancreatic enzyme)

High lipase levels might indicate a problem with the pancreas. During a 56-week study, treatment with Saxenda at 3.0 mg led to an average increase of 31% in lipase levels compared to placebo. Enzyme levels returned to baseline after stopping Saxenda, and acute pancreatitis (AP) was rare, occurring in 0.3% of patients on Saxenda, with about half of these cases linked to gallstones.

If lipase levels increase during Saxenda treatment with severe abdominal pain, nausea, or vomiting, stop Saxenda immediately and consult a healthcare provider.

Warning!

The FDA is investigating hair loss, specifically alopecia, as a potential side effect of Saxenda, possibly linked to hormonal imbalances from weight loss.

Serious Side Effects of Saxenda

Serious side effects of Saxenda include:

1. Thyroid C-cell Tumors

Saxenda has been linked to the development of thyroid C-cell tumors, including adenomas and carcinomas, in a dose- and duration-dependent manner in both male and female rodents.

Although animal studies have observed malignant C-cell carcinomas, it remains unclear whether Saxenda poses a similar risk to humans, such as the development of medullary thyroid carcinoma (MTC). These rodent findings may not fully apply to humans, and case reports of MTC in Saxenda patients haven’t confirmed or ruled out a causal link.

Due to this potential risk, the FDA has contraindicated Saxenda for individuals with a personal or family history of MTC or multiple endocrine neoplasia type 2 (MEN 2). Elevated serum calcitonin levels, typically above 50 ng/L, may suggest MTC. If calcitonin is elevated, further evaluation is necessary. Patients with thyroid nodules detected during physical exams or neck imaging should also undergo further evaluation.

2. Acute Pancreatitis

Saxenda can cause acute pancreatitis, often presenting with epigastric pain, nausea, and vomiting. Studies show that it typically starts within 0 to 10 months of starting treatment. Elevated lipase levels, usually three times above average, and findings on CT scans are common indicators.

Most cases are managed by discontinuing Saxenda, providing IV fluids, and managing pain, with most patients recovering without complications. However, some patients had recurrent pancreatitis or developed more complications, such as acute respiratory distress syndrome and kidney injury.

Pancreatitis risk increases if a patient has gallstones and ongoing use of metformin, emphasizing the importance of early detection and Saxenda withdrawal. To prevent pancreatitis using Saxenda:

• • Monitor for early signs like abdominal pain and elevated lipase levels.

• • Avoid combining Saxenda with other pancreatitis risk factors like metformin or taking it when a patient has gallstones.

• • Discontinue Saxenda immediately if pancreatitis symptoms occur.

3. Acute Gallbladder Disease

Study results showed an increased risk of acute gallbladder with people using Saxenda, with 141 events in 4,668 patients versus 88 events in 4,672 patients on placebo. Saxenda was also associated with a higher frequency of cholecystectomy.

Additional analyses showed that weight loss, a known effect of Saxenda, was associated with a higher risk of gallbladder-related events. To help reduce the risk of acute gallbladder disease while using Saxenda, consider the following steps:

• • Focus on a balanced, low-fat diet to reduce the strain on the gallbladder.

• • Drink plenty of water throughout the day to help maintain overall health and support normal digestion.

• • Get regular check-ups with a doctor to monitor for any signs of gallbladder issues, particularly if there’s a history of gallstones or other related conditions.

• • For any symptoms such as persistent abdominal pain, nausea, or vomiting, especially after eating, contact a doctor. They may recommend further tests or suggest adjustments to the treatment plan.

4. Hypoglycemia (Low blood sugar)

Hypoglycemia is a common side effect of Saxenda, especially when combined with other anti-diabetic medications. In a clinical trial, 9.2% of patients on Saxenda (1.2 mg/day) plus glimepiride experienced hypoglycemia, compared to 2.6% in the placebo group.

Low blood sugar levels usually occur within 17 days of starting treatment, and 62.5% of cases required hospitalization, which is much higher than with albiglutide (16.67%). The fatality rate for hypoglycemia with Saxenda was 8.33%, the highest among GLP-1RAs. These results show that while Saxenda helps control blood sugar, it also carries a serious risk of hypoglycemia.

Here are the symptoms of hypoglycemia:

• • Looking pale
  • Shaking
  • Sweating
  • Headache
  • Hunger
  • Irregular heartbeat
  • Confusion
  • Loss of coordination
  • Slurred speech
  • Loss of consciousness

Seek medical help immediately if these symptoms are present. The doctor may adjust the medication dosage. Quick treatment involves consuming high-sugar foods or drinks, such as juice or candy, to raise blood sugar levels.

5. Increase in Heart Rate

Research indicates Saxenda’s impact on heart rate (HR) and heart rate variability (HRV) in patients with type 2 diabetes and coronary artery disease. After 12 weeks of treatment, Saxenda increased HR and reduced HRV, particularly overnight, when parasympathetic activity was strongest.

This disruption could affect the autonomic nervous system, which controls involuntary functions like heart rate and breathing. As a result, the body’s parasympathetic function, which is responsible for relaxation and recovery, may weaken.

While Saxenda offers benefits for weight loss and metabolic health, the increase in HR and reduced HRV could raise concerns regarding heart health. To help avoid an increase in heart rate while using Saxenda, consider the following steps:

• • Gradually increase the dosage of Saxenda as prescribed by a doctor. This helps the body adjust to the medication and may minimize side effects like an increased heart rate.

• • Regularly check the heart rate, especially if there are pre-existing heart conditions. This will help the healthcare provider track any changes.

• • Dehydration can increase heart rate, so drink plenty of water throughout the day, especially while on Saxenda.

• • Limit or avoid caffeine, nicotine, and other stimulants, as they can elevate heart rate, especially when combined with Saxenda.

• • While regular exercise is beneficial, excessive or intense physical activity can elevate the heart rate. Aim for moderate activity and consult a healthcare provider for guidance.

6. Renal Impairment

Renal impairment is a serious side effect of Saxenda, often linked to symptoms like nausea, vomiting, diarrhea, or dehydration. In some cases, it can be severe enough to require hemodialysis.

A case report describes the first documented instance of acute kidney injury potentially linked to Saxenda. A 53-year-old woman developed acute tubular necrosis, a form of kidney damage, after starting Saxenda 1.8 mg/day.

The patient’s symptoms included severe gastrointestinal issues, dehydration, and significant weight loss, which led to elevated serum creatinine and blood urea nitrogen levels. Discontinuation of Saxenda, volume repletion, and hemodialysis successfully treated the condition.

Following these guidelines may help minimize the risk of renal impairment while using Saxenda:

• • Take Saxenda as the healthcare provider prescribes, following the recommended dosage guidelines. Increasing the dose must be taken with caution.

• • Drink plenty of fluids, especially if there are gastrointestinal issues like nausea, vomiting, or diarrhea.

• • Be aware of symptoms like nausea, vomiting, diarrhea, or dehydration. Contact a physician immediately if these symptoms occur, as they can lead to more complications, including kidney impairment.

• • Get regular consultations with a doctor to monitor kidney function, especially if the patient has a history of renal issues or other health conditions that may affect the kidneys.

• • Report persistent or unusual gastrointestinal symptoms to a doctor immediately. Early intervention can help prevent complications like renal impairment.

7. Hypersensitivity Reactions

Patients may experience hypersensitivity reactions with Saxenda. In a report, a 44-year-old woman with obesity developed a localized allergic reaction to Saxenda after 18 days of treatment. The allergic reaction included red, raised patches of skin and itching at the injection site. It persisted for a week but resolved on its own after discontinuing the medication.

Patients should discontinue Saxenda if allergic reactions occur and seek medical advice promptly.

8. Suicidal Behavior and Ideation

Suicidal ideation or depression can also be a serious effect of using Saxenda. In a pooled analysis of 5,325 individuals, there were nine reports (0.3%) of suicidal ideation or behavior in those using Saxenda, compared to two reports (0.1%) in the placebo group. In phase 3a trials, depression scores improved in both groups by the end of treatment. Patients should be monitored for any concerning symptoms.

The FDA advises patients taking Saxenda not to stop taking the medication without consulting their healthcare professional, as discontinuing them may worsen the condition. If a patient experiences new or worsening depression, suicidal thoughts, or any unusual changes in mood or behavior, they should immediately inform their healthcare provider.

Takeaway

Saxenda can be helpful for weight loss and other weight-related conditions, but it may come with common side effects like nausea and diarrhea. Most studies suggest these Saxenda side effects can improve over time as the body adjusts to the medication. However, it’s essential to be aware of more serious risks, such as pancreatitis, thyroid tumors, and suicidal thoughts, which require immediate medical attention.

Like any drug, Saxenda should be taken under the supervision of a healthcare provider, who can monitor for any complications. While Saxenda can be a valuable part of a weight loss plan, it should be combined with a healthy diet, regular exercise, and routine medical check-ups.

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