Victoza (liraglutide): What is it used for, How does it work, What are the side effects?

What is Victoza (liraglutide) used for?

• Victoza is used in combination with metformin, with metformin and a sulfonylurea, with metformin and a sodium glucose cotransporter 2 inhibitor (SGLT2i), or basal insulin to improve blood sugar levels in adults with type 2 diabetes.
• Victoza is used in combination with metformin with or without basal insulin to improve blood sugar levels in adolescents and children aged 10 years and above with type 2 diabetes.
• Victoza may be used on its own if your blood sugar is not properly controlled by diet and exercise alone and you cannot use metformin.
• If you have type 2 diabetes and have a history of heart disease (such as a past heart attack, heart failure, or stroke), Victoza can be used along with diet and exercise to lower your risk of dying from events related to your heart or blood vessels.
• Victoza should not be used in type 1 diabetes (formerly known as insulin-dependent diabetes mellitus or IDDM).

How does Victoza work?

Victoza belongs to a class of medicines called GLP-1 analogue. Victoza helps your body to make more insulin when your blood sugar is high.

What is type 2 diabetes?

Type 2 diabetes is a condition in which your body does not make enough insulin, and/or does not use the insulin that your body produces as well as it should. When this happens, sugar (glucose) builds up in the blood. This can lead to serious problems.

What are the ingredients in Victoza?

Medicinal ingredients: Liraglutide

Non-medicinal ingredients: Disodium phosphate dihydrate, propylene glycol, phenol and water for injections

What strengths is Victoza available in?

Pre-filled multidose pen that can deliver 30 doses of 0.6 mg, 15 doses of 1.2 mg or 10 doses of 1.8 mg.

Who should not use Victoza?

• You or a member of your family has ever had medullary thyroid cancer.
• You have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
• You are allergic to any of the ingredients in Victoza.
• You are pregnant or breastfeeding.

To help avoid side effects and ensure proper use, talk to your healthcare professional before you take Victoza. Talk about any health conditions or problems you may have, including if you:

• Or a member of your family has or has had medullary thyroid carcinoma, or if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
• Have type 1 diabetes.
• Have ever had diabetic ketoacidosis (increased ketones in the blood or urine).
• Have ever had an allergic reaction to Victoza.
• Have a high heart rate (fast pulse).
• Have a condition called heart block.
• Have any heart disease, such as angina, heart rhythm disturbances or congestive heart failure; or if you have ever had a myocardial infarction (heart attack).
• Have kidney problems.
• Have liver problems.
• Have gastrointestinal (digestive) problems.
• Have ever had pancreatitis.
• Are breastfeeding or plan to breastfeed.
• Are pregnant or plan to become pregnant.
• Have severe vomiting and/or diarrhea and/or dehydration.

When initiating treatment with Victoza, you may in some cases experience loss of fluids/dehydration, e.g. in case of vomiting, nausea and diarrhea. It is important to avoid dehydration by drinking plenty of fluids. Worsening of renal function may sometimes require hemodialysis. Contact your doctor if you have any questions or concerns.

Victoza may increase heart rate and could cause changes known as PR prolongation, which are detected by electrocardiogram (ECG) tracings. Increased heart rate is the same as a faster pulse. Rarely, drugs with these effects can cause changes in heart rhythm that could result in dizziness, palpitations (a feeling of rapid, pounding, or irregular heart beat), fainting or death. These heart rhythm changes are more likely if you have heart disease, or if you are taking certain other drugs. It is important to follow your doctor’s advice about the dose of Victoza or about any special tests that you may need. See ‘What are possible side effects from using Victoza?’

Victoza is not recommended for use in children under 10 years of age.

Tell your healthcare professional about all the medicines you take, including any drugs, vitamins, minerals, natural supplements or alternative medicines.

In particular, tell your doctor, Diabetes Nurse Educator or pharmacist if you are using any of the following medicines for diabetes:

• A sulfonylurea medicine (such as glibenclamide or glimepiride). This is because using Victoza at the same time may cause your blood sugar to get too low (hypoglycemia).
• When you first start using these medicines together, your doctor may tell you to lower the dose of the sulfonylurea medicine.
• Insulin. You may get hypoglycemia (low blood sugar) when using Victoza with insulin as insulin increases the risk of hypoglycemia. See ‘What are possible side effects from using Victoza?’
• If you are not sure if the medicines you are taking contain a sulfonylurea, ask your doctor, Diabetes Nurse Educator or pharmacist.

What medications may interact with Victoza?

The following list includes some, but not all, of the drugs that may increase the risk of heart rhythm problems while receiving Victoza. You should check with your doctor or pharmacist before taking any other medication with Victoza:

• Drugs to treat hypertension
• Drugs to treat heart failure
• Drugs to treat HIV infection
• Drugs to treat attention deficit-hyperactivity disorder
• Drugs to suppress appetite/cause weight loss
• Decongestants
• Drugs to treat asthma

How to take Victoza?

Take Victoza exactly as your doctor has prescribed.

Victoza is an injection which is given under the skin (subcutaneously). Do not inject it into a vein or muscle.

Before you use the pen for the first time, your doctor or Diabetes Nurse Educator will show you how to use it. The best places to give yourself the injection are the front of your thighs, the front of your waist (abdomen) or your upper arm. You can give yourself the injection at any time of the day. (see ‘Instructions for using the Victoza (liraglutide injection) pen’).

Do not share your Victoza pen with anyone else, even if the needle is changed. Do not reuse or share needles with another person including family members. You may give another person an infection or get an infection from them.

What is the usual dose of Victoza?

Victoza can be taken at any time of the day. It does not matter when you take it in relation to meals.

The usual starting dose is 0.6 mg once a day. Your doctor will tell you how long to keep taking this dose. It will be for at least one week. Your dose may be increased to 1.2 mg once a day if your blood glucose is not under control. If your blood glucose is not controlled with a dose of 1.2 mg, your doctor may tell you to increase the dose to 1.8 mg once a day. Do not change your dose unless your doctor has told you to.

You will not need to test your blood sugar levels each day in order to adjust your dose of Victoza. However, if you are taking a sulfonylurea medicine as well as Victoza, your doctor may advise you to test your blood sugar levels. This will help your doctor to decide if the dose of the sulfonylurea needs to be changed.

For children and adolescents starting Victoza, your doctor may advise you to test your blood sugar levels to monitor for hypoglycemia (low blood sugar).

What to do if you overdose on Victoza?

Warning: If you think you have taken too much Victoza, contact your healthcare professional, hospital emergency department or regional poison control centre immediately, even if there are no symptoms.

If you use more Victoza than you should, talk to your doctor straight away. You may need medical treatment. If you use too much Victoza you may feel sick (have nausea), become sick (vomit), or experience low blood sugar (hypoglycemia). Please refer to ‘Common (affects less than 1 in 10 people)’ for early warning signs of low blood sugar.

What to do if you miss a dose of Victoza?

If a dose of Victoza is missed take your dose on the next day as usual. Do not take an extra dose or increase the dose on the following day to make up for the missed dose.

Do not stop using Victoza without talking to your doctor. If you stop using it, your blood sugar levels may increase.

What are possible side effects from using Victoza?

These are not all the possible side affects you may feel when taking Victoza. If you experience any side effects not listed here, contact your healthcare professional.

Like all medicines, Victoza can cause side effects. The following side effects may happen with this medicine.

Very common (affects more than 1 in 10 people):

• Feeling sick (nausea). This usually goes away over time.
• Diarrhea

Common (affects less than 1 in 10 people):

• Low blood sugar (hypoglycemia). This is usually mild. It is more likely if you are also taking a medicine for diabetes called a sulfonylurea. The warning signs of low blood sugar may come on suddenly. They can include: cold sweat, cool pale skin, headache, fast heart beat, feeling sick, feeling very hungry, changes in vision, feeling sleepy, feeling weak, nervous, anxious, or confused, difficulty concentrating, shaking (tremor). Your doctor will tell you how to treat low blood sugar and what to do if you notice these warning signs. If you are already taking a sulfonylurea medicine when you start using Victoza, your doctor may tell you to reduce the dose of the sulfonylurea. While you are driving or using tools or machines, you should avoid getting low blood sugar (hypoglycemia), because this may reduce your ability to concentrate.
• Anorexia
• Decreased appetite
• Headache
• Being sick (vomiting)
• Burping
• Indigestion
• Inflamed stomach (gastritis). The signs include stomach pain, feeling sick (nausea) and being sick (vomiting)
• Gastro-esophageal reflux disease (GERD). The signs include heartburn.
• Painful or swollen tummy (abdomen)
• Constipation
• Wind (flatulence)
• Infection of the upper airways
• Injection site reactions (such as bruising, pain irritation, itching and rash)
• Increased heart rate
• Gallstones
• Inflamed gallbladder (upper abdominal pain after eating, nausea, bloating and indigestion, especially after consuming a fatty meal)

Uncommon (affects less than 1 in 100):

• Urticaria (a type of skin rash)

If any of the side effects do not go away or get worse, or if you notice any side effects not listed in the leaflet, please tell your doctor, Diabetes Nurse Educator or pharmacist.

If you have a troublesome symptom or side effect that is not listed here or becomes bad enough to interfere with your daily activities, talk to your healthcare professional.

How to store Victoza?

Keep out of reach and sight of children.

Do not use Victoza after the expiry date which is stated on the label and carton. The expiry date refers to the last day of that month.

• Before you start to use Victoza, store it in a refrigerator (2˚C-8˚C) away from the freezer compartment. Do not freeze it.
• When Victoza is being used, you can keep it for 1 month either at room temperature (not above 30˚C) or in a refrigerator (2˚C-8˚C).
• Do not use Victoza if it has been frozen.
• Do not use Victoza if it is not clear and colourless.
• Always remove the injection needle after each injection and store your Victoza pen without an injection needle attached. This prevents contamination, infection, and leakage. It also ensures that the dosing is accurate.
• When you are not using the pen, keep the cap on. This will protect the medicine from light.
• Protect Victoza from high temperatures and sunlight.
• Medicines should not be disposed of via waste water or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

Reference: FDA Monograph

Disclaimer: We have made every effort to ensure that all information is factually correct and up to date, however this article is not comprehensive and does not contain all relevant information about the topic. IT should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should consult your doctor or pharmacist before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.