Names and pronunciation
(lir′a-gloo′tide) Saxenda, Victoza
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Drug reference
(lir′a-gloo′tide) Saxenda, Victoza
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Func. class.: Antidiabetic agent
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Chem. class.: Incretin mimetics
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ACTION: Improved glycemic control and potential weight loss via activation of the glucagon-like peptide-1 (GLP-1) receptor
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USES: Type 2 diabetes mellitus in combination with diet/exercise (Vic- toza), obesity (Saxenda)
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CONTRAINDICATIONS: Hyper- sensitivity, medullary thyroid carcinoma (MTC), multiple endocrine neoplasia syndrome type 2 (MEN 2), thyroid can- cer, pregnancy Precautions: Breastfeeding, children, geriatric patients, alcoholism, choleli- thiasis, ketoacidosis, diarrhea, fever, gastroparesis, hepatic/renal disease, hypoglycemia, infection, surgery, thy- roid disease, trauma, vomiting, pancreatitis
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Black Box Warning: Thyroid C-cell tumors DOSAGES AND ROUTES • Adult: SUBCUT (Victoza) 0.6 mg/day × 1 wk, then increase to 1.2 mg/day, max 1.8 mg/day; Saxenda (Initial BMI >27 kg/m2): 0.6 mg/day × 1 wk, then 1.2 mg/ day × 1 wk then 1.8 mg × 1 wk, then 2.4 mg/day × 1 wk, then 3 mg/day Black Box Warning: Thyroid C-cell tumors; monitor during treatment; if calci- tonin is elevated or if nodules can be felt, referral is needed; do not use in those with a family history of MTC or in those with multiple endocrine neoplasia syndrome type 2 • Diabetes: that may occur soon after meals: hunger, sweating, weakness, dizzi- ness, tremors, restlessness, tachycardia; serum glucose, A1c, CBC during treatment • Hypersensitivity to this product • Insulin use with Victoza: monitor for hypoglycemic reactions often • Stress: those diabetic patients exposed to stress, surgery, fever, infections may require insulin administration temporar- ily • Serious skin reactions: angioedema, hypersensitivity responses • Pancreatitis: monitor for nausea, vomiting, severe abdominal pain; product should be discontinued; give supportive care; monitor amylase, lipase, electrolytes
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SIDE EFFECTS CNS: Dizziness, headache CV: Hypertension ENDO: Hypoglycemia EENT: Sinusitis GI: Abdominal pain, anorexia, constipa- tion, diarrhea, dyspepsia, nausea, vomit- ing, pancreatitis INTEG: erythema, injection site reaction, urticaria MS: Back pain SYST: Antibody formation, infection, influenza, secondary thyroid malignancy, anaphylaxis, angioedema
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INTERACTIONS Increase: hypoglycemic reactions— angiotensin II receptor antagonists, ACE inhibitors, other antidiabetics, β-blockers, L dexfenfluramine, fenfluramine, disopyra- mide, FLUoxetine, fibric acid derivatives, mecasermin, MAOIs, octreotide, pegviso- mant, salicylates Decrease: liraglutide effect—protease inhibitors, phenothiazines, baclofen, atyp- ical antipsychotics, corticosteroids, cyclo- SPORINE, tacrolimus, carbonic anhydrase inhibitors, dextrothyroxine, diazoxide, phenytoin, fosphenytoin, ethotoin, isonia- zid, INH, niacin, nicotine, estrogens, pro- gestins, oral contraceptives, growth hor- mones, sympathomimetics Increase or decrease: hypoglycemic reactions—androgens, bortezomib, qui- nolones, cloNIDine, alcohol, lithium, pentamidine Increase or decrease: effects of—atorva statin, acetaminophen, griseofulvin Decrease: levels of digoxin Drug/Lab Test Increase: calcitonin, lipase Decrease: glucose
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Available forms: Solution for injection 0.6, 1.2, 1.8, 2.4, 3 mg prefilled pen (Saxenda); solution for injection 0.6, 1.2, 1.8 mg prefilled pen (Victoza)
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Administer: SUBCUT route • Give subcut only, inspect for particu- late matter, discoloration; do not use if unusually viscous, cloudy, discolored, or if particles present; give daily anytime, without regard to meals; pen needles must be purchased separately, use Novo Nordisk needle; before first use, prime, see manual for directions; give in thigh, abdomen, or upper arm; lightly pinch fold of skin, insert needle at 90-degree angle (45-degree angle if thin), release skin; aspiration is not needed, give over 6 sec, rotate injection sites • If dose is missed, resume once-daily dosing at next scheduled dose; if >3 days have elapsed since last dose, reinitiate at 0.6 mg, titrate • Storage: do not store pen with needle attached; avoid direct heat and sunlight; discard 30 days after first use; after first use may be stored at room temperature or refrigerated; do not freeze
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Assess:
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Evaluate: • Therapeutic response: stable and im- proved serum glucose, A1c, weight loss
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Hypersensitivity: to report any allergic symptoms • About symptoms of hypoglycemia/hy- perglycemia and what to do for each; to have glucagon emergency kit available; to carry a carbohydrate source at all times • About adverse reactions associated with therapy, such as nausea and vomit- ing; that upward dose titration can be delayed or ignored, depending on toler- ance • That diabetes is a lifelong illness; that product does not cure disease and must be continued on a daily basis • To carry emergency ID with prescrib- er’s phone number and medications taken • To continue with other recommenda- tions: diet, exercise • To test blood glucose using a blood glucose meter • To avoid other medications, herbs, sup- plements unless approved by prescriber • To report serious skin effects, abdominal pain with nausea/vomiting immediately • To consult written instructions if self- administration is ordered; to discard pen after 30 days • That continuing follow-up exams will be needed • That secondary malignancy is possible; that routine monitoring may be needed; to report trouble breathing, continuous hoarse ness, lump in neck region immediately • Not to share product with others; infec tions such as hepatitis may occur • Pregnancy/breastfeeding: that prod uct is not to be used in pregnancy or breastfeeding, that insulin is usually used in pregnancy, to notify health care profes sional if pregnancy is planned or sus pected or if breastfeeding
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PHARMACOKINETICS Protein binding (98%); half-life 12-13 hr; binds to albumin, then released into circulation; peak 8-12 hr; body weight significantly affects pharmacokinetics
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