Liraglutide - Revision history

MDElliottMD: Strip Category:MedCategory marker per interface-claude 2026-05-20 hygiene order: this page is a medicine, narrative, wiki-meta page, or stylesheet rather than a class-overview category, so it should not carry the MedCategory tag. Class memberships and other tags preserved.

2026-05-19T18:00:11Z

Strip Category:MedCategory marker per interface-claude 2026-05-20 hygiene order: this page is a medicine, narrative, wiki-meta page, or stylesheet rather than a class-overview category, so it should not carry the MedCategory tag. Class memberships and other tags preserved.

← Older revision		Revision as of 18:00, 19 May 2026
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	}}		}}

	~~[[Category:MedCategory]]~~
	[[Category:GLP-1 receptor agonists]]		[[Category:GLP-1 receptor agonists]]
	[[Category:Antidiabetic medicines]]		[[Category:Antidiabetic medicines]]
	[[Category:Anti-obesity medicines]]		[[Category:Anti-obesity medicines]]
	[[Category:Novo Nordisk medicines]]		[[Category:Novo Nordisk medicines]]

MDElliottMD: Em-dash sweep: replace em-dash with comma per project rule; PendellsCorner verbatim quotes preserved.

2026-05-19T03:16:08Z

Em-dash sweep: replace em-dash with comma per project rule; PendellsCorner verbatim quotes preserved.

MDElliottMD: Migrate tags to (Phase 2 of indications-to-problems rebuild)

2026-05-17T00:11:51Z

Migrate <indication> tags to <problem> (Phase 2 of indications-to-problems rebuild)

← Older revision		Revision as of 00:11, 17 May 2026
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	* Modest SBP reduction (~2–3 mmHg)<ref name="victoza-label"/>		* Modest SBP reduction (~2–3 mmHg)<ref name="victoza-label"/>

	\| indications = <~~indication~~ ref="diabetes-type-2" author="MDElliottMD"/>		\| indications = <problem ref="diabetes-type-2" author="MDElliottMD"/>
	<~~indication~~ ref="obesity" author="MDElliottMD"/>		<problem ref="obesity" author="MDElliottMD"/>
	<~~indication~~ ref="cv-risk-t2dm" author="MDElliottMD"/>		<problem ref="cv-risk-t2dm" author="MDElliottMD"/>

	\| dosing = <titration slug="victoza-standard" author="MDElliottMD" title="Victoza — standard T2DM titration">		\| dosing = <titration slug="victoza-standard" author="MDElliottMD" title="Victoza — standard T2DM titration">

MDElliottMD: Fix Cargo VARCHAR(300) overflow: blank structure, shorten mechanism, move chemistry/mechanism prose to PK/PD

2026-05-16T23:33:09Z

Fix Cargo VARCHAR(300) overflow: blank structure, shorten mechanism, move chemistry/mechanism prose to PK/PD

← Older revision		Revision as of 23:33, 16 May 2026
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	\| generic = Liraglutide		\| generic = Liraglutide
	\| brand = Victoza (T2DM), Saxenda (obesity)		\| brand = Victoza (T2DM), Saxenda (obesity)
	\| structure = 31-amino-acid acylated peptide analog of human [[GLP-1]] (7–37), with Arg34 substitution and a C16 palmitic acid linked via γGlu spacer at Lys26 — drives albumin binding for a ~13-hour half-life supporting once-daily dosing.<ref name="knudsen2000">Knudsen LB, Nielsen PF, Huusfeldt PO et al. (2000). Potent derivatives of glucagon-like peptide-1 with pharmacokinetic properties suitable for once daily administration. ''J Med Chem'' 43(9):1664–9. doi:10.1021/jm9909645</ref>		\| structure =

	\| classes = [[GLP-1 receptor agonist]] · [[Antidiabetic medicines\|Antidiabetic]] · [[Anti-obesity medicines\|Anti-obesity]] · [[Cardiovascular risk reduction]] agent		\| classes = [[GLP-1 receptor agonist]] · [[Antidiabetic medicines\|Antidiabetic]] · [[Anti-obesity medicines\|Anti-obesity]] · [[Cardiovascular risk reduction]] agent
	\| mechanism = ~~Selective~~ agonist of the [[GLP-1 receptor]]. Produces glucose-dependent insulin secretion, glucagon suppression, delayed gastric emptying, hypothalamic appetite suppression, and cardiovascular benefits independent of glycemia.<ref name="drucker2022">Drucker DJ (2022). GLP-1 physiology informs the pharmacotherapy of obesity. ''Mol Metab'' 57:101351.</ref>		\| mechanism = Once-daily agonist of the [[GLP-1 receptor]].

	\| uses = [[Type 2 diabetes mellitus]] (incl. pediatric ≥10 y) · [[Obesity]] (incl. pediatric ≥12 y) · [[Cardiovascular risk reduction]] in T2DM		\| uses = [[Type 2 diabetes mellitus]] (incl. pediatric ≥10 y) · [[Obesity]] (incl. pediatric ≥12 y) · [[Cardiovascular risk reduction]] in T2DM
	\| starting_dose = Victoza: 0.6 mg SC daily × 1 wk<ref name="victoza-label">US FDA. ''Victoza (liraglutide) prescribing information.'' Novo Nordisk. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/022341s027lbl.pdf</ref> · Saxenda: 0.6 mg SC daily × 1 wk<ref name="saxenda-label">US FDA. ''Saxenda (liraglutide) prescribing information.'' Novo Nordisk. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/206321Orig1s000lbl.pdf</ref>		\| starting_dose = Victoza: 0.6 mg SC daily × 1 wk<ref name="victoza-label">US FDA. ''Victoza (liraglutide) prescribing information.'' Novo Nordisk. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/022341s027lbl.pdf</ref> · Saxenda: 0.6 mg SC daily × 1 wk<ref name="saxenda-label">US FDA. ''Saxenda (liraglutide) prescribing information.'' Novo Nordisk. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/206321Orig1s000lbl.pdf</ref>
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	Clinically, liraglutide is the first GLP-1 RA shown to reduce cardiovascular events in T2DM ([[LEADER trial\|LEADER]]) and remains the only GLP-1 RA with formal pediatric approval — Victoza for T2DM in children ≥10 y, Saxenda for obesity in adolescents ≥12 y.<ref name="leader2016">Marso SP et al. (2016). Liraglutide and cardiovascular outcomes in type 2 diabetes (LEADER). ''NEJM'' 375:311–22. doi:10.1056/NEJMoa1603827</ref><ref name="victoza-label"/><ref name="saxenda-label"/>		Clinically, liraglutide is the first GLP-1 RA shown to reduce cardiovascular events in T2DM ([[LEADER trial\|LEADER]]) and remains the only GLP-1 RA with formal pediatric approval — Victoza for T2DM in children ≥10 y, Saxenda for obesity in adolescents ≥12 y.<ref name="leader2016">Marso SP et al. (2016). Liraglutide and cardiovascular outcomes in type 2 diabetes (LEADER). ''NEJM'' 375:311–22. doi:10.1056/NEJMoa1603827</ref><ref name="victoza-label"/><ref name="saxenda-label"/>

	\| pharmacokinetics = The C16 fatty acid drives non-covalent albumin binding (~98%), protecting from DPP-4 cleavage and slowing renal clearance — terminal half-life ~13 hours, supporting once-daily dosing.<ref name="knudsen2000"/><ref name="victoza-label"/> Cleared by proteolytic catabolism; no CYP-mediated metabolism. No dose adjustment for renal or hepatic impairment.<ref name="victoza-label"/>		\| pharmacokinetics = '''Chemistry'''. 31-amino-acid acylated peptide analog of human [[GLP-1]] (7–37), with Arg34 substitution and a C16 palmitic acid linked via γGlu spacer at Lys26 — drives albumin binding for a ~13-hour half-life supporting once-daily dosing.<ref name="knudsen2000">Knudsen LB, Nielsen PF, Huusfeldt PO et al. (2000). Potent derivatives of glucagon-like peptide-1 with pharmacokinetic properties suitable for once daily administration. ''J Med Chem'' 43(9):1664–9. doi:10.1021/jm9909645</ref>

			The C16 fatty acid drives non-covalent albumin binding (~98%), protecting from DPP-4 cleavage and slowing renal clearance — terminal half-life ~13 hours, supporting once-daily dosing.<ref name="knudsen2000"/><ref name="victoza-label"/> Cleared by proteolytic catabolism; no CYP-mediated metabolism. No dose adjustment for renal or hepatic impairment.<ref name="victoza-label"/>

			\| pharmacodynamics = '''Receptor pharmacology'''. Selective agonist of the [[GLP-1 receptor]]. Produces glucose-dependent insulin secretion, glucagon suppression, delayed gastric emptying, hypothalamic appetite suppression, and cardiovascular benefits independent of glycemia.<ref name="drucker2022">Drucker DJ (2022). GLP-1 physiology informs the pharmacotherapy of obesity. ''Mol Metab'' 57:101351.</ref>

	~~\| pharmacodynamics =~~ At maintenance doses:		At maintenance doses:
	* HbA1c reduction of ~1.0–1.5 percentage points at 1.8 mg/day (T2DM)<ref name="victoza-label"/>		* HbA1c reduction of ~1.0–1.5 percentage points at 1.8 mg/day (T2DM)<ref name="victoza-label"/>
	* Weight loss of ~2–3 kg at 1.8 mg/day in T2DM; ~5–8 kg (~5–10% body weight) at 3.0 mg/day in obesity without T2DM (SCALE trials)<ref name="scale">Pi-Sunyer X, Astrup A, Fujioka K et al. (2015). A randomized, controlled trial of 3.0 mg of liraglutide in weight management (SCALE Obesity and Prediabetes). ''NEJM'' 373(1):11–22. doi:10.1056/NEJMoa1411892</ref>		* Weight loss of ~2–3 kg at 1.8 mg/day in T2DM; ~5–8 kg (~5–10% body weight) at 3.0 mg/day in obesity without T2DM (SCALE trials)<ref name="scale">Pi-Sunyer X, Astrup A, Fujioka K et al. (2015). A randomized, controlled trial of 3.0 mg of liraglutide in weight management (SCALE Obesity and Prediabetes). ''NEJM'' 373(1):11–22. doi:10.1056/NEJMoa1411892</ref>

MDElliottMD: Create Liraglutide page (initial draft, MedTemplate, full inline cites)

2026-05-16T23:11:35Z

Create Liraglutide page (initial draft, MedTemplate, full inline cites)

New page

{{MedTemplate
| generic = Liraglutide
| brand = Victoza (T2DM), Saxenda (obesity)
| structure = 31-amino-acid acylated peptide analog of human [[GLP-1]] (7–37), with Arg34 substitution and a C16 palmitic acid linked via γGlu spacer at Lys26 — drives albumin binding for a ~13-hour half-life supporting once-daily dosing.<ref name="knudsen2000">Knudsen LB, Nielsen PF, Huusfeldt PO et al. (2000). Potent derivatives of glucagon-like peptide-1 with pharmacokinetic properties suitable for once daily administration. ''J Med Chem'' 43(9):1664–9. doi:10.1021/jm9909645</ref>
| classes = [[GLP-1 receptor agonist]] · [[Antidiabetic medicines|Antidiabetic]] · [[Anti-obesity medicines|Anti-obesity]] · [[Cardiovascular risk reduction]] agent
| mechanism = Selective agonist of the [[GLP-1 receptor]]. Produces glucose-dependent insulin secretion, glucagon suppression, delayed gastric emptying, hypothalamic appetite suppression, and cardiovascular benefits independent of glycemia.<ref name="drucker2022">Drucker DJ (2022). GLP-1 physiology informs the pharmacotherapy of obesity. ''Mol Metab'' 57:101351.</ref>
| uses = [[Type 2 diabetes mellitus]] (incl. pediatric ≥10 y) · [[Obesity]] (incl. pediatric ≥12 y) · [[Cardiovascular risk reduction]] in T2DM
| starting_dose = Victoza: 0.6 mg SC daily × 1 wk<ref name="victoza-label">US FDA. ''Victoza (liraglutide) prescribing information.'' Novo Nordisk. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/022341s027lbl.pdf</ref> · Saxenda: 0.6 mg SC daily × 1 wk<ref name="saxenda-label">US FDA. ''Saxenda (liraglutide) prescribing information.'' Novo Nordisk. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/206321Orig1s000lbl.pdf</ref>
| preparations = Pre-filled multi-dose pen (3 mL): Victoza 6 mg/mL (0.6 / 1.2 / 1.8 mg per day);<ref name="victoza-label"/> Saxenda 6 mg/mL (0.6 / 1.2 / 1.8 / 2.4 / 3.0 mg per day)<ref name="saxenda-label"/>
| fda_max = 1.8 mg/day SC (Victoza, T2DM)<ref name="victoza-label"/> · 3.0 mg/day SC (Saxenda, obesity)<ref name="saxenda-label"/>
| routes = Subcutaneous (abdomen, thigh, upper arm); same time each day, with or without food<ref name="victoza-label"/>
| onset = Glycemic effect within days; weight effect over weeks to months<ref name="saxenda-label"/>
| duration = ~24 h (daily dosing)<ref name="victoza-label"/>
| halflife = ~13 hours<ref name="victoza-label"/>
| bioavailability = SC ~55%<ref name="victoza-label"/>
| pregnancy = Avoid. Discontinue before planned pregnancy.<ref name="victoza-label"/>
| legal = Rx-only;<ref name="victoza-label"/> not a controlled substance
| intro = Liraglutide is a once-daily subcutaneous [[GLP-1 receptor agonist]] developed by Novo Nordisk and marketed as '''[[Victoza]]''' for [[type 2 diabetes mellitus]] (FDA-approved January 2010)<ref name="victoza-label"/> and as '''[[Saxenda]]''' at the higher 3.0 mg daily dose for [[obesity]] (December 2014).<ref name="saxenda-label"/>

Liraglutide was the first daily GLP-1 RA to reach market — preceded only by twice-daily exenatide (Byetta, 2005).<ref name="knudsen2000"/> It is the molecular predecessor and pharmacological template for [[semaglutide]], differing principally in the fatty-acid tail (C16 palmitic vs C18 fatty diacid) and the spacer architecture — semaglutide's modifications extending the half-life from ~13 h to ~165 h, enabling weekly rather than daily dosing.<ref name="lau2015">Lau J, Bloch P, Schäffer L et al. (2015). Discovery of the once-weekly glucagon-like peptide-1 (GLP-1) analogue semaglutide. ''J Med Chem'' 58(18):7370–80. doi:10.1021/acs.jmedchem.5b00726</ref>

Clinically, liraglutide is the first GLP-1 RA shown to reduce cardiovascular events in T2DM ([[LEADER trial|LEADER]]) and remains the only GLP-1 RA with formal pediatric approval — Victoza for T2DM in children ≥10 y, Saxenda for obesity in adolescents ≥12 y.<ref name="leader2016">Marso SP et al. (2016). Liraglutide and cardiovascular outcomes in type 2 diabetes (LEADER). ''NEJM'' 375:311–22. doi:10.1056/NEJMoa1603827</ref><ref name="victoza-label"/><ref name="saxenda-label"/>

| pharmacokinetics = The C16 fatty acid drives non-covalent albumin binding (~98%), protecting from DPP-4 cleavage and slowing renal clearance — terminal half-life ~13 hours, supporting once-daily dosing.<ref name="knudsen2000"/><ref name="victoza-label"/> Cleared by proteolytic catabolism; no CYP-mediated metabolism. No dose adjustment for renal or hepatic impairment.<ref name="victoza-label"/>

| pharmacodynamics = At maintenance doses:
* HbA1c reduction of ~1.0–1.5 percentage points at 1.8 mg/day (T2DM)<ref name="victoza-label"/>
* Weight loss of ~2–3 kg at 1.8 mg/day in T2DM; ~5–8 kg (~5–10% body weight) at 3.0 mg/day in obesity without T2DM (SCALE trials)<ref name="scale">Pi-Sunyer X, Astrup A, Fujioka K et al. (2015). A randomized, controlled trial of 3.0 mg of liraglutide in weight management (SCALE Obesity and Prediabetes). ''NEJM'' 373(1):11–22. doi:10.1056/NEJMoa1411892</ref>
* 13% relative risk reduction in MACE in T2DM with high CV risk (LEADER)<ref name="leader2016"/>
* Modest SBP reduction (~2–3 mmHg)<ref name="victoza-label"/>

| indications = <indication ref="diabetes-type-2" author="MDElliottMD"/>
<indication ref="obesity" author="MDElliottMD"/>
<indication ref="cv-risk-t2dm" author="MDElliottMD"/>

| dosing = <titration slug="victoza-standard" author="MDElliottMD" title="Victoza — standard T2DM titration">
0.6 mg SC daily × 1 week (tolerability ramp; not therapeutic)
→ 1.2 mg SC daily (typical maintenance)
→ 1.8 mg SC daily (max) if further glycemic control needed<ref name="victoza-label"/>

A pediatric protocol is identical, but with closer attention to tolerability and growth.<ref name="victoza-label"/>
</titration>

<titration slug="saxenda-standard" author="MDElliottMD" title="Saxenda — standard obesity titration">
0.6 mg SC daily × 1 week
→ 1.2 mg × 1 week
→ 1.8 mg × 1 week
→ 2.4 mg × 1 week
→ 3.0 mg daily (maintenance)<ref name="saxenda-label"/>

If a step is not tolerated, hold at the prior dose for an extra week before advancing. Discontinue if the patient cannot tolerate 3.0 mg after extended titration, or if they have not achieved ≥4% body-weight loss at 16 weeks on the maximum dose.<ref name="saxenda-label"/>
</titration>

| effects = * '''Nausea''' — dose-dependent, worst in the first 1–2 weeks of any new dose level<ref name="victoza-label"/>
* '''Diarrhea / constipation''' (variable)<ref name="victoza-label"/>
* '''Decreased appetite''' (the desired effect)<ref name="victoza-label"/>
* '''Early satiety'''<ref name="saxenda-label"/>
* '''Injection-site reactions''' — uncommon, generally mild<ref name="victoza-label"/>
* '''Headache''' (more common than with the weekly agents){{Citation needed}}

GI tolerability is generally somewhat better than twice-daily exenatide but worse than the long-acting weekly agents (dulaglutide, semaglutide, tirzepatide) at equivalent glycemic effect.{{Citation needed}}

| interactions = <pharmaInteractions/>

| pregnancy_details = Avoid. Animal embryofetal toxicity is documented.<ref name="victoza-label"/> Discontinue before planned conception (the 13-hour half-life means washout is rapid — days, not weeks).

| monitoring = * Baseline: HbA1c, weight, BP, renal function, lipid panel
* Personal or family history of MTC or [[MEN2]] — '''contraindicated''', do not start<ref name="victoza-label"/>
* Every 3 months for first year: HbA1c, weight, GI tolerability, signs of [[pancreatitis]] or [[gallbladder disease]]
* '''Pre-procedure''': skip the morning dose on the day of a planned procedure (per [[American Society of Anesthesiologists|ASA]] 2024 guidance for daily-dosed GLP-1 RAs)<ref name="kindel2024">Kindel TL et al. (2024). Perioperative GLP-1 receptor agonist safety guidance. ''Surg Obes Relat Dis'' 20(12):1183–8.</ref>

| counseling = * Daily injection same time each day — pick a time you can stick with.<ref name="victoza-label"/>
* GI side effects peak in first 1–2 weeks of each new dose level, then attenuate.
* If a daily dose is missed and remembered within ~12 h, take it; otherwise skip and resume the next day. Do not double-dose.<ref name="victoza-label"/>
* '''Surgery''': skip the morning dose on procedure day.<ref name="kindel2024"/>
* '''Pregnancy planning''': discontinue before trying to conceive.<ref name="victoza-label"/>

| anecdotes = <vote slug="liraglutide-headache"/>

| seealso = [[GLP-1 receptor agonist]] · [[Semaglutide]] · [[Dulaglutide]] · [[Tirzepatide]] · [[Exenatide]] · [[Type 2 diabetes mellitus]] · [[Obesity]]

| references = <references/>
}}

[[Category:MedCategory]]
[[Category:GLP-1 receptor agonists]]
[[Category:Antidiabetic medicines]]
[[Category:Anti-obesity medicines]]
[[Category:Novo Nordisk medicines]]

← Older revision		Revision as of 03:16, 19 May 2026
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	\| intro = Liraglutide is a once-daily subcutaneous [[GLP-1 receptor agonist]] developed by Novo Nordisk and marketed as '''[[Victoza]]''' for [[type 2 diabetes mellitus]] (FDA-approved January 2010)<ref name="victoza-label"/> and as '''[[Saxenda]]''' at the higher 3.0 mg daily dose for [[obesity]] (December 2014).<ref name="saxenda-label"/>		\| intro = Liraglutide is a once-daily subcutaneous [[GLP-1 receptor agonist]] developed by Novo Nordisk and marketed as '''[[Victoza]]''' for [[type 2 diabetes mellitus]] (FDA-approved January 2010)<ref name="victoza-label"/> and as '''[[Saxenda]]''' at the higher 3.0 mg daily dose for [[obesity]] (December 2014).<ref name="saxenda-label"/>

	Liraglutide was the first daily GLP-1 RA to reach market — preceded only by twice-daily exenatide (Byetta, 2005).<ref name="knudsen2000"/> It is the molecular predecessor and pharmacological template for [[semaglutide]], differing principally in the fatty-acid tail (C16 palmitic vs C18 fatty diacid) and the spacer architecture — semaglutide's modifications extending the half-life from ~13 h to ~165 h, enabling weekly rather than daily dosing.<ref name="lau2015">Lau J, Bloch P, Schäffer L et al. (2015). Discovery of the once-weekly glucagon-like peptide-1 (GLP-1) analogue semaglutide. ''J Med Chem'' 58(18):7370–80. doi:10.1021/acs.jmedchem.5b00726</ref>		Liraglutide was the first daily GLP-1 RA to reach market, preceded only by twice-daily exenatide (Byetta, 2005).<ref name="knudsen2000"/> It is the molecular predecessor and pharmacological template for [[semaglutide]], differing principally in the fatty-acid tail (C16 palmitic vs C18 fatty diacid) and the spacer architecture, semaglutide's modifications extending the half-life from ~13 h to ~165 h, enabling weekly rather than daily dosing.<ref name="lau2015">Lau J, Bloch P, Schäffer L et al. (2015). Discovery of the once-weekly glucagon-like peptide-1 (GLP-1) analogue semaglutide. ''J Med Chem'' 58(18):7370–80. doi:10.1021/acs.jmedchem.5b00726</ref>

	Clinically, liraglutide is the first GLP-1 RA shown to reduce cardiovascular events in T2DM ([[LEADER trial\|LEADER]]) and remains the only GLP-1 RA with formal pediatric approval — Victoza for T2DM in children ≥10 y, Saxenda for obesity in adolescents ≥12 y.<ref name="leader2016">Marso SP et al. (2016). Liraglutide and cardiovascular outcomes in type 2 diabetes (LEADER). ''NEJM'' 375:311–22. doi:10.1056/NEJMoa1603827</ref><ref name="victoza-label"/><ref name="saxenda-label"/>		Clinically, liraglutide is the first GLP-1 RA shown to reduce cardiovascular events in T2DM ([[LEADER trial\|LEADER]]) and remains the only GLP-1 RA with formal pediatric approval, Victoza for T2DM in children ≥10 y, Saxenda for obesity in adolescents ≥12 y.<ref name="leader2016">Marso SP et al. (2016). Liraglutide and cardiovascular outcomes in type 2 diabetes (LEADER). ''NEJM'' 375:311–22. doi:10.1056/NEJMoa1603827</ref><ref name="victoza-label"/><ref name="saxenda-label"/>

	\| pharmacokinetics = '''Chemistry'''. 31-amino-acid acylated peptide analog of human [[GLP-1]] (7–37), with Arg34 substitution and a C16 palmitic acid linked via γGlu spacer at Lys26 — drives albumin binding for a ~13-hour half-life supporting once-daily dosing.<ref name="knudsen2000">Knudsen LB, Nielsen PF, Huusfeldt PO et al. (2000). Potent derivatives of glucagon-like peptide-1 with pharmacokinetic properties suitable for once daily administration. ''J Med Chem'' 43(9):1664–9. doi:10.1021/jm9909645</ref>		\| pharmacokinetics = '''Chemistry'''. 31-amino-acid acylated peptide analog of human [[GLP-1]] (7–37), with Arg34 substitution and a C16 palmitic acid linked via γGlu spacer at Lys26, drives albumin binding for a ~13-hour half-life supporting once-daily dosing.<ref name="knudsen2000">Knudsen LB, Nielsen PF, Huusfeldt PO et al. (2000). Potent derivatives of glucagon-like peptide-1 with pharmacokinetic properties suitable for once daily administration. ''J Med Chem'' 43(9):1664–9. doi:10.1021/jm9909645</ref>

	The C16 fatty acid drives non-covalent albumin binding (~98%), protecting from DPP-4 cleavage and slowing renal clearance — terminal half-life ~13 hours, supporting once-daily dosing.<ref name="knudsen2000"/><ref name="victoza-label"/> Cleared by proteolytic catabolism; no CYP-mediated metabolism. No dose adjustment for renal or hepatic impairment.<ref name="victoza-label"/>		The C16 fatty acid drives non-covalent albumin binding (~98%), protecting from DPP-4 cleavage and slowing renal clearance, terminal half-life ~13 hours, supporting once-daily dosing.<ref name="knudsen2000"/><ref name="victoza-label"/> Cleared by proteolytic catabolism; no CYP-mediated metabolism. No dose adjustment for renal or hepatic impairment.<ref name="victoza-label"/>

	\| pharmacodynamics = '''Receptor pharmacology'''. Selective agonist of the [[GLP-1 receptor]]. Produces glucose-dependent insulin secretion, glucagon suppression, delayed gastric emptying, hypothalamic appetite suppression, and cardiovascular benefits independent of glycemia.<ref name="drucker2022">Drucker DJ (2022). GLP-1 physiology informs the pharmacotherapy of obesity. ''Mol Metab'' 57:101351.</ref>		\| pharmacodynamics = '''Receptor pharmacology'''. Selective agonist of the [[GLP-1 receptor]]. Produces glucose-dependent insulin secretion, glucagon suppression, delayed gastric emptying, hypothalamic appetite suppression, and cardiovascular benefits independent of glycemia.<ref name="drucker2022">Drucker DJ (2022). GLP-1 physiology informs the pharmacotherapy of obesity. ''Mol Metab'' 57:101351.</ref>
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	<problem ref="cv-risk-t2dm" author="MDElliottMD"/>		<problem ref="cv-risk-t2dm" author="MDElliottMD"/>

	\| dosing = <titration slug="victoza-standard" author="MDElliottMD" title="Victoza — standard T2DM titration">		\| dosing = <titration slug="victoza-standard" author="MDElliottMD" title="Victoza, standard T2DM titration">
	0.6 mg SC daily × 1 week (tolerability ramp; not therapeutic)		0.6 mg SC daily × 1 week (tolerability ramp; not therapeutic)
	→ 1.2 mg SC daily (typical maintenance)		→ 1.2 mg SC daily (typical maintenance)
Line 48:		Line 48:
	</titration>		</titration>

	<titration slug="saxenda-standard" author="MDElliottMD" title="Saxenda — standard obesity titration">		<titration slug="saxenda-standard" author="MDElliottMD" title="Saxenda, standard obesity titration">
	0.6 mg SC daily × 1 week		0.6 mg SC daily × 1 week
	→ 1.2 mg × 1 week		→ 1.2 mg × 1 week
Line 58:		Line 58:
	</titration>		</titration>

	\| effects = * '''Nausea''' — dose-dependent, worst in the first 1–2 weeks of any new dose level<ref name="victoza-label"/>		\| effects = * '''Nausea''', dose-dependent, worst in the first 1–2 weeks of any new dose level<ref name="victoza-label"/>
	* '''Diarrhea / constipation''' (variable)<ref name="victoza-label"/>		* '''Diarrhea / constipation''' (variable)<ref name="victoza-label"/>
	* '''Decreased appetite''' (the desired effect)<ref name="victoza-label"/>		* '''Decreased appetite''' (the desired effect)<ref name="victoza-label"/>
	* '''Early satiety'''<ref name="saxenda-label"/>		* '''Early satiety'''<ref name="saxenda-label"/>
	* '''Injection-site reactions''' — uncommon, generally mild<ref name="victoza-label"/>		* '''Injection-site reactions''', uncommon, generally mild<ref name="victoza-label"/>
	* '''Headache''' (more common than with the weekly agents){{Citation needed}}		* '''Headache''' (more common than with the weekly agents){{Citation needed}}

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	\| interactions = <pharmaInteractions/>		\| interactions = <pharmaInteractions/>

	\| pregnancy_details = Avoid. Animal embryofetal toxicity is documented.<ref name="victoza-label"/> Discontinue before planned conception (the 13-hour half-life means washout is rapid — days, not weeks).		\| pregnancy_details = Avoid. Animal embryofetal toxicity is documented.<ref name="victoza-label"/> Discontinue before planned conception (the 13-hour half-life means washout is rapid, days, not weeks).

	\| monitoring = * Baseline: HbA1c, weight, BP, renal function, lipid panel		\| monitoring = * Baseline: HbA1c, weight, BP, renal function, lipid panel
	* Personal or family history of MTC or [[MEN2]] — '''contraindicated''', do not start<ref name="victoza-label"/>		* Personal or family history of MTC or [[MEN2]], '''contraindicated''', do not start<ref name="victoza-label"/>
	* Every 3 months for first year: HbA1c, weight, GI tolerability, signs of [[pancreatitis]] or [[gallbladder disease]]		* Every 3 months for first year: HbA1c, weight, GI tolerability, signs of [[pancreatitis]] or [[gallbladder disease]]
	* '''Pre-procedure''': skip the morning dose on the day of a planned procedure (per [[American Society of Anesthesiologists\|ASA]] 2024 guidance for daily-dosed GLP-1 RAs)<ref name="kindel2024">Kindel TL et al. (2024). Perioperative GLP-1 receptor agonist safety guidance. ''Surg Obes Relat Dis'' 20(12):1183–8.</ref>		* '''Pre-procedure''': skip the morning dose on the day of a planned procedure (per [[American Society of Anesthesiologists\|ASA]] 2024 guidance for daily-dosed GLP-1 RAs)<ref name="kindel2024">Kindel TL et al. (2024). Perioperative GLP-1 receptor agonist safety guidance. ''Surg Obes Relat Dis'' 20(12):1183–8.</ref>

	\| counseling = * Daily injection same time each day — pick a time you can stick with.<ref name="victoza-label"/>		\| counseling = * Daily injection same time each day, pick a time you can stick with.<ref name="victoza-label"/>
	* GI side effects peak in first 1–2 weeks of each new dose level, then attenuate.		* GI side effects peak in first 1–2 weeks of each new dose level, then attenuate.
	* If a daily dose is missed and remembered within ~12 h, take it; otherwise skip and resume the next day. Do not double-dose.<ref name="victoza-label"/>		* If a daily dose is missed and remembered within ~12 h, take it; otherwise skip and resume the next day. Do not double-dose.<ref name="victoza-label"/>