5 Liraglutide Interactions and How to Manage Them
Key takeaways:
Liraglutide (Victoza) is a once-daily injection used to lower blood glucose. It’s also approved for weight loss under the brand name Saxenda. Liraglutide is in the glucagon-like peptide-1 (GLP-1) agonist medication class.
Liraglutide can interact with insulin or insulin-releasing medications like sulfonylureas or glinides. This interaction can cause blood glucose levels to drop too low (called hypoglycemia). Be sure you know how to manage hypoglycemia if it happens.
Liraglutide may affect how your body absorbs certain oral medications. You should keep an updated list of all your medications to share with each member of your healthcare team. They can watch for interactions ahead of time and make changes as needed.
Table of contents
Liraglutide (Victoza) is a once-daily injection used to treat Type 2 diabetes in people ages 10 and up. It’s also known to lower the risk of heart attack and stroke in certain adults. And a higher-dose version, called Saxenda, is approved to help adults and children ages 12 and older lose weight.
Liraglutide belongs to the glucagon-like peptide-1 (GLP-1) agonist class. It mimics the gut hormone GLP-1, causing insulin release, less glucose production, and slowed digestion. This can help control blood glucose levels and result in weight loss.
It’s common for people with Type 2 diabetes to need more than one medication to manage blood glucose levels, or to treat other health conditions. Interactions between these medications are possible, but can often be managed with extra monitoring or dosage adjustments. Below, we review 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 glucose 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 glucose. When liraglutide and insulin are taken together, there is a chance your blood glucose 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 glucose 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 healthcare provider may lower your insulin dose to reduce the risk of hypoglycemia. Track your blood glucose 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 provider know.
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 healthcare provider may lower your sulfonylurea dosage as you’re starting liraglutide — just to be safe. But it’s still important to monitor your blood glucose levels regularly with this combination. Let your healthcare provider 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 healthcare provider 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 in Type 2 diabetes because it prevents a spike in blood glucose. And it can also make you feel full, resulting in weight loss.
However, delayed gastric emptying may also affect how your body absorbs oral medications. This can be a concern for narrow therapeutic index drugs (NTIs). 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 provider 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 increase blood glucose
Certain medications can raise blood glucose levels. Examples include corticosteroids, like prednisone, and beta blockers, like metoprolol (Lopressor, Toprol XL). Antipsychotics such as olanzapine (Zyprexa) and clozapine (Clozaril) may also cause a bump in blood glucose
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 get your blood glucose under control.
If you start a new medication while on liraglutide, keep an eye on your blood glucose levels for any changes. If your levels are higher than usual, let your healthcare provider know.
When should you contact your healthcare provider about a liraglutide interaction?
If you’re worried about a liraglutide interaction, contact your healthcare provider or pharmacist. It’s also important to let them know if you start or stop a new medication while on liraglutide. This can help them identify potential interactions and manage them ahead of time.
Hypoglycemia is the most common risk associated with liraglutide interactions. If you experience shaking, sweating, or a fast heartbeat, check your blood glucose. If it’s less than 70 mg/dL, follow the instructions you’ve been given for managing hypoglycemia.
If you’re experiencing hypoglycemia with your diabetes medications, tell your healthcare provider. Tracking your blood glucose readings can help you identify potential patterns or triggers. If needed, they may adjust your medications or doses.
The bottom line
Liraglutide can interact with insulin, sulfonylureas, and glinides. It can also interact with medications that raise blood glucose levels, like prednisone and metoprolol, as well as oral medications. These interactions can usually be managed with dosage adjustments and blood glucose monitoring.
Make sure your healthcare provider and pharmacist have your current medication list to check for interactions before and during treatment with liraglutide.
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References
ElSayed, N. A., et al. (2023). 9. Pharmacologic approaches to glycemic treatment: Standards of care in diabetes—2023. Diabetes Care.
Jiang, W. (n.d.). FDA drug topics: Understanding generic narrow therapeutic index drugs. U.S. Food and Drug Administration.
Marathe, C. S., et al. (2013). Relationships between gastric emptying, postprandial glycemia, and incretin hormones. Diabetes Care.
Novo Nordisk A/S. (2022). Victoza [package insert].
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