Saxenda®

Saxenda is a prescription-only medication for the treatment of obesity and overweight. It contains the active ingredient liraglutide – the same active ingredient as the diabetes medication Victoza, but at a higher dose.

Saxenda was the first GLP-1 medication approved specifically for weight reduction (2015) and paved the way for newer medications such as Wegovy and Mounjaro.

The difference from Wegovy:

• Saxenda: Daily injection, active ingredient liraglutide
• Wegovy: Weekly injection, active ingredient semaglutide

In studies, Saxenda led to an average weight loss of 5-10% – somewhat less than Wegovy, but still clinically significant.

Liraglutide is a GLP-1 receptor agonist that mimics the body's own satiety hormone GLP-1:

Appetite regulation: Activation of GLP-1 receptors in the brain leads to an increased feeling of fullness and reduced hunger.

Slowed gastric emptying: The stomach empties more slowly, which leads to a longer-lasting feeling of fullness.

Blood sugar regulation: When blood sugar is elevated, liraglutide promotes insulin release (relevant for people with diabetes).

The result:

• Less hunger and appetite
• Feeling full sooner
• Reduced calorie intake
• Stable blood sugar

Study results:

• Average weight loss: 5-10%
• About half of the participants lost more than 5%
• Improvement in blood pressure and metabolic values

Approved indication: Adults with:

• BMI ≥ 30 (obesity) OR
• BMI ≥ 27 with a weight-related comorbidity

Also approved for:

• Adolescents aged 12 and older with a BMI corresponding to obesity and a body weight above 60 kg

Requirements:

• Diet and exercise alone are not sufficient
• Motivation to change lifestyle

Not suitable in cases of:

• Pregnancy

Less suitable in cases of:

• History of pancreatitis
• Severe renal insufficiency
• Medullary thyroid cancer (including in the family)

Titration schedule (daily):

• Week 1: 0.6 mg
• Week 2: 1.2 mg
• Week 3: 1.8 mg
• Week 4: 2.4 mg
• From week 5: 3.0 mg (maintenance dose)

Important:

• Keep each dose level for at least one week
• If poorly tolerated: delay the dose increase
• Maximum dose: 3.0 mg daily

Available pen: Prefilled multi-dose pen containing 18 mg (lasts several days, depending on the dose).

Use:

• Once daily, at the same time
• Subcutaneous injection
• Abdomen, thigh, or upper arm
• Independent of meals

Tip on the time of day: Some people tolerate Saxenda better in the evening (sleeping through nausea at night). Others prefer the morning. Try out what works better for you.

Missed dose:

• Less than 12 hours have passed: Take the missed dose
• More than 12 hours: Skip it, take the next regular dose

Storage:

• Unopened: Refrigerator
• In use: Up to 30 days at room temperature or in the refrigerator

Absolute contraindications:

• Hypersensitivity to liraglutide
• Pregnancy and breastfeeding

Use with caution in:

• History of pancreatitis
• Severe renal insufficiency
• Heart failure
• Inflammatory bowel diseases
• Gallstone disease

Very common (>10%):

• Nausea
• Vomiting
• Diarrhea
• Constipation
• Headache

Common (1-10%):

• Dizziness
• Abdominal pain
• Flatulence
• Heartburn
• Fatigue
• Hypoglycemia (in people with diabetes)
• Gallstones
• Injection site reactions

Uncommon:

• Increased heart rate

Uncommon but serious:

• Pancreatitis

Rare but serious:

• Allergic reactions

Note: Gastrointestinal side effects are most common at the beginning and usually improve.

Insulin and sulfonylureas:

• Increased risk of hypoglycemia
• Dose adjustment often necessary

Oral medications:

• Absorption may be delayed

Warfarin:

• INR monitoring at the start of treatment

Paracetamol:

• Delayed absorption, usually clinically irrelevant