Victoza and Saxenda
What is Liraglutide?
Liraglutide is the generic name for two diabetes drugs, brand-named Victoza and Saxenda. The two drugs both contain this same ingredient, although they are FDA approved for different things. That is a dosage difference only.
- Indications for Victoza 1—FDA indicated to help lower blood sugar levels in conjunction with diet, exercise, and other diabetes medicines. As such, it is not a first choice for diabetes II, but only for patients that need supplemental treatment to other diabetic medications. Although the higher dose Saxenda (see below) is the same medicine, but for weight loss, the lower-dosed Victoza has also been known to have weight loss as a side effect.
- Indications for Saxenda2—FDA approved for weight loss. It also can be used for diabetes II, but since the dose for weight loss is higher than that of Victoza, it also helps with sugar control. It is approved for people with a body mass index (BMI) in the obese range (30 and over) or those who have a 27 BMI + weigh-related conditions, such as hypertension.
A tale of two diabetes
There are two types of diabetes:
- Diabetes mellitus –diabetes I (“type 1”) is a deficiency or total loss in the amount of insulin produced by cells in the pancreas.
- Insulin-resistant diabetes3—in diabetes II (“type 2”) there is insulin, but the cells don’t use it efficiently (are resistant to the insulin). This is similar if not the same as the temporary diabetes seen in pregnancy—gestational diabetes. In fact, a woman who develops gestational diabetes (insulin resistance) is at a higher risk for developing diabetes II in the future, so it should be a wake-up call to make healthy food choices and being physically active during the pregnancy and thereafter.
What does insulin actually do?
Insulin stimulates different organs (liver, muscle, fat) to take in glucose (sugar) from the blood after which it is converted into energy. Of course, the source of the glucose is what is ingested with food and drink. If the process overshoots toward excess energy, insulin also signals the body to store glucose as a molecule called glycogen, which can be released later if needed.4
What do Victoza and Saxenda actually do?
Liraglutide, which is the ingredient for both, mimics an intestinal hormone, called GLP-1 (glucagon-like peptide), which it the body’s “fed” signal.2 GLP-1 causes the incretin effect5 (an effect that causes glucose to stimulate insulin production). It also reduces stomach emptying, which impacts the amount of calories taken in. All of the GLP-1-like actions of liraglutide contribute to more efficient handling of sugar (for diabetes II) and less food intake (for obesity).
What are side effects to Victoza and Saxenda?
Side effects are diarrhea, headache, and nausea.
Adverse effects can be pancreatitis and abdominal pain, which are also contraindications to starting liraglutide. Kidney problems, gallbladder problems and gallstones, mood swings, low blood sugar, and allergy to liraglutide can occur.
Other conditions being investigated in humans because they were seen in some animal testing include thyroid cancer and heart disease. Even a family member with a history of thyroid cancer should prompt avoidance of the drug.6
How long will therapy take with Victoza and Saxenda?
It would be easy—and correct—to say that using these will last as long as there is obesity or type II diabetes. However, the go-to lab result that shows whether diabetes is adequately controlled is the Hemogobin A1c. This is a certain type of hemoglobin molecule that has sugar attached, and it undergoes change very slowly, meaning that a normal or abnormal HbA1c documents the success or failure of sugar control over months. It has become the gold standard for management of diabetes, long term, just as insulin has been the gold standard for daily control.
Who shouldn’t take Victoza and Saxenda?
As mentioned above, people with thyroid disorders or a family history of thyroid cancer. Also:
- People with a history of pancreatitis, alcoholism, or gallbladder disease
- Pregnant or breastfeeding patients
- People allergic to liraglutide
How sugar is taken in, stored, and burned for energy is a very complex sequence of interactions among the liver, pancreas, kidneys, muscles, and even the brain. Trying to simplify the process, especially for therapeutic purposes, is a daunting challenge to the pharmaceutical industry. So far, all that’s been accomplished is a piecemeal knee-jerk cause-and-effect of using certain components of that sequence. The liraglutide drug of Victoza and Saxenda are such isolated partners in managing this delicate balance among many body systems.
- Koliaki C, Doupis J. Incretin-based therapy: a powerful and promising weapon in the treatment of type 2 diabetes mellitus. Diabetes Ther 2011; 2:101.
- Shyangdan DS, Royle P, Clar C, et al. Glucagon-like peptide analogues for type 2 diabetes mellitus. Cochrane Database Syst Rev 2011; :CD006423.
- Lee YS, Jun HS. Anti-diabetic actions of glucagon-like peptide-1 on pancreatic beta-cells. Metabolism 2014; 63:9.
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