5 Liraglutide (Victoza, Saxenda) Interactions and How to Manage Them

Liraglutide is a once-daily injection used to treat Type 2 diabetes (as Victoza) and support weight loss (as Saxenda). It works by mimicking the hormone glucagon-like peptide-1 (GLP-1), which affects blood glucose (sugar), digestion, and appetite.

If you’ve been prescribed liraglutide, chances are you’re also taking other medications — whether for diabetes, heart health, or other reasons. When you’re taking several medications, it's good to know that drug interactions can happen. These interactions can affect how well your treatment works or increase the chance of side effects. Here, we’ll discuss five potential liraglutide interactions and how to manage them.

1. Insulin

Insulin is a hormone that’s naturally made by the pancreas to regulate blood sugar levels. But certain people with Type 2 diabetes may need to take extra insulin. In this case, experts recommend combining insulin with a medication like liraglutide.

Even though liraglutide is injected, it’s not the same as insulin. Instead, it triggers insulin production after you’ve eaten to lower your blood sugar. When liraglutide and insulin are used together, there is a chance your blood sugar could drop too low. This is known as hypoglycemia.

If you feel hypoglycemia symptoms, such as shaking, sweating, or fast heart rate, check your blood sugar right away. If it has dropped too low, follow the instructions from your healthcare team to bring it back up to a safe level.

As a precaution, your prescriber may lower your insulin dose to reduce the risk of hypoglycemia. Track your blood sugar levels during treatment to ensure you’re taking the right dose of both medications. If your levels are lower than usual, or if you’re experiencing hypoglycemia episodes, let your prescriber know.

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2. Sulfonylureas

Sulfonylureas are a group of oral medications used to treat Type 2 diabetes. They include medications like glipizide (Glucotrol XL), glimepiride (Amaryl), and glyburide (DiaBeta, Glynase).

Like liraglutide, sulfonylureas stimulate the release of insulin from the pancreas. But they have this effect even if you haven’t eaten a meal. When a sulfonylurea is combined with liraglutide, this can increase the risk of hypoglycemia.

Similar to insulin, your prescriber may lower your sulfonylurea dosage as you’re starting liraglutide — just to be safe. But you should still monitor your blood sugar levels regularly with this combination. Let your prescriber know if you’re experiencing hypoglycemia episodes. If needed, they may make further adjustments.

3. Glinides

Glinides are a class of medications similar to sulfonylureas. They also trigger insulin release, but they work faster and for a shorter time. So, they’re typically taken only at mealtime. Nateglinide and repaglinide are two examples.

Like sulfonylureas, combining a glinide with liraglutide can raise the risk of hypoglycemia. So, your prescriber may adjust your glinide dosage when you start liraglutide. Let them know if you’re experiencing hypoglycemia, since additional adjustments may be needed.

4. Oral medications

One of the ways liraglutide works is by delaying gastric emptying. This means that food moves more slowly through your digestive tract. This is a beneficial effect for those living with Type 2 diabetes because it prevents a spike in blood sugar after you eat. And it can also make you feel full, resulting in weight loss.

EXPERT PICKS: WHAT TO READ NEXT

• How to save: Glucagon-like peptide-1 (GLP-1) medications like liraglutide (Victoza, Saxenda) don’t need to break the bank. Explore ways to save on your prescription with this GLP-1 savings guide.

• Compare options: Liraglutide is one of several medications that work like the hormone GLP-1. Read more about available GLP-1 agonists.

• Possible side effects: From diarrhea to appetite changes, find out about liraglutide’s potential side effects and how to manage them.

However, delayed gastric emptying may also affect how your body absorbs oral medications. This can be a concern for narrow therapeutic index drugs (NTIs), such as warfarin (Coumadin, Jantoven) and digoxin (Lanoxin). A small change in your dose or blood levels can affect the effectiveness and safety of NTIs.

Even so, studies have shown that dosage adjustments may not be needed in most cases. Your healthcare team can determine if this interaction may potentially affect you. Make sure they have your current medication list to review ahead of time.

5. Medications that raise blood sugar

Certain medications can raise blood sugar levels, which can make your liraglutide dose less effective for managing diabetes. Examples of these medications include:

• Corticosteroids, such as prednisone

• Beta blockers, such as metoprolol (Lopressor, Toprol XL)

• Antipsychotics, such as olanzapine (Zyprexa) and clozapine (Clozaril)

Some of these medications are only taken for a short period of time. In this case, the rise in blood glucose is usually temporary and resolves after stopping the medication. But many of them are taken long-term. This may require a higher liraglutide dosage to keep your blood sugar within your target range.

If you start a new medication while on liraglutide, keep an eye on your blood sugar levels for any changes. If your levels are higher than usual, let your prescriber know.

Good to know: Beta blockers can also mask certain symptoms of hypoglycemia, such as shakiness and irritability. One symptom you may still experience is sweating. So if you’re sweating more than usual, it’s a good idea to check your blood sugar levels. 

Does alcohol interact with liraglutide?

There’s no direct interaction between liraglutide and alcohol. But drinking alcohol while using liraglutide can increase the risk of certain side effects and may also counteract liraglutide’s benefits.

• Worse side effects: Alcohol can irritate the stomach, which may worsen liraglutide side effects such as nausea and upset stomach.

• Hypoglycemia risk: Alcohol can increase the risk of hypoglycemia for people living with diabetes. This risk goes up if you combine alcohol with medications that lower blood sugar, such as liraglutide.

• Cardiovascular effects: If you have Type 2 diabetes and heart disease, liraglutide has proven cardiovascular benefits. Alcohol, on the other hand, can have negative effects on your heart and blood vessels.

• Impact on body weight: Regular alcohol use may limit weight loss from liraglutide. It can add extra calories to your diet and slow down your metabolism.

If you choose to drink with liraglutide, it’s best to talk to your healthcare team for guidance. This may include:

• Limiting how much you drink

• Avoiding drinking alcohol on an empty stomach

• Monitoring for worsening side effects and blood sugar changes

• Choosing lower-calorie drink options when possible

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Written by:

Julie Adkison, PharmD, BCACP, CDCES

Julie Adkison, PharmD, BCACP, CDCES, is a clinical pharmacist specializing in ambulatory care practice and diabetes care and education. She has worked in a faculty position in family medicine for many years.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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