Xultophy
Xultophy is used to manage blood sugar levels in adults with Type 2 diabetes. It's a premixed injection that combines two medications: insulin degludec (a long-acting insulin) and liraglutide (a glucagon-like peptide-1 (GLP-1) agonist). It works best when used along with a healthy diet and regular exercise. Xultophy (insulin degludec / liraglutide) comes as a prefilled pen that's given as an once-daily injection under the skin. Side effects include low blood sugar, common cold symptoms, and headache.
What is Xultophy (insulin degludec / liraglutide)?
What is Xultophy (insulin degludec / liraglutide) used for?
Type 2 diabetes in adults
How Xultophy (insulin degludec / liraglutide) works
Xultophy (insulin degludec / liraglutide) is a combination of two medications that work together to lower blood sugar:
Insulin degludec is a long-acting insulin. It helps control blood sugar levels throughout the day by helping your body absorb and store sugar from the bloodstream after a meal.
Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist. It activates GLP-1, a hormone that tells your pancreas to release more insulin, your liver to make less sugar, and makes you feel full longer by slowing down how quickly food leaves the stomach.
Drug Facts
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What are the side effects of Xultophy (insulin degludec / liraglutide)?
Common Side Effects
- Low blood sugar (up to 37%)
- Common cold or flu (up to 10%)
- Headache (9%)
- Nausea (8%)
- Diarrhea (8%)
- Rise in a pancreas enzyme (lipase) (7%)
Other Side Effects
- Vomiting
- Constipation
- Upset stomach
- Stomach pain
- Heartburn
- Low appetite
- Low blood sugar
- Weight gain
- Swelling
- Injection-site reactions (e.g., redness, pain, bleeding, itching)
Serious Side Effects
- Thyroid cancer: mass in the neck, trouble breathing or swallowing, hoarseness
- Inflammation of the pancreas (pancreatitis): severe stomach pain that spreads to your back, nausea, vomiting
- Severely low blood sugar: dizziness, shakiness, feeling confused, feeling irritable or anxious, feeling faint, sweating, extreme hunger, can't think clearly
- Kidney damage: tiredness, dry and itchy skin, urinating more often, bloody or foamy urine, swelling in your feet or ankles, muscle cramping
- Dangerously low potassium levels: weakness, muscle cramps or twitches, constipation, abnormal heartbeat, tiredness, trouble breathing
- Gallbladder problems: severe upper stomach and back pain, yellowing of your skin or eyes (jaundice), fever, nausea, vomiting
- Heart failure: shortness of breath, tiredness, swelling in your legs, ankles, or feet, sudden weight gain
- Severe allergic reaction: rash; hives; swelling of face, tongue, and throat; trouble breathing
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions or angioedema—skin rash, itching or hives, swelling of the face, eyes, lips, tongue, arms, or legs, trouble swallowing or breathing
- Gallbladder problems—severe stomach pain, nausea, vomiting, fever
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Low blood sugar (hypoglycemia)—tremors or shaking, anxiety, sweating, cold or clammy skin, confusion, dizziness, rapid heartbeat
- Low potassium level—muscle pain or cramps, unusual weakness or fatigue, fast or irregular heartbeat, constipation
- Pancreatitis—severe stomach pain that spreads to your back or gets worse after eating or when touched, fever, nausea, vomiting
- Thoughts of suicide or self-harm, worsening mood, feelings of depression
- Thyroid cancer—new mass or lump in the neck, pain or trouble swallowing, trouble breathing, hoarseness
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Diarrhea
- Headache
- Loss of appetite
- Nausea
- Runny or stuffy nose
- Sore throat
- Upset stomach
Pros and cons of Xultophy (insulin degludec / liraglutide)
Pros
Injected once per day at any time of day
Comes as an easy-to-use injection pen
Pens can be stored at room temperature for up to 3 weeks
Cons
Can't customize the dose of each individual active ingredient
Contains insulin, which can cause low blood sugar and weight gain
Given as injection under the skin
Pharmacist tips for Xultophy (insulin degludec / liraglutide)
Ask your prescriber how often you should check your blood sugar during the day as you take Xultophy (insulin degludec / liraglutide). Keep a log of your blood sugar readings and show it to your prescriber at your office visits. This helps you and your prescriber keep track of how well Xultophy (insulin degludec / liraglutide) is working for you and whether you need dose adjustments.
Using Xultophy (insulin degludec / liraglutide) can raise your risk of dangerously low blood sugar levels. It's important that you and your caregiver know how to recognize symptoms of low blood sugar level, such as sweating, shakiness, anxiety, and hunger.
When you're using Xultophy (insulin degludec / liraglutide), make sure to always carry fast-acting sugars with you so that you can bring your blood sugar levels up when it drops too low.
Xultophy (insulin degludec / liraglutide) can cause nausea and diarrhea. You're more likely to experience these side effects when you first start this medication. Typically, these side effects should ease or go away after a few days or weeks of treatment. Let your healthcare team know if you continue to experience nausea and diarrhea after this time.
Store unopened Xultophy (insulin degludec / liraglutide) pens and in the refrigerator until the expiration date. Keep opened pens at room temperature or in the refrigerator for up to 21 days.
Never share Xultophy (insulin degludec / liraglutide) pens or needles with anyone else. Sharing Xultophy (insulin degludec / liraglutide) with someone puts you at risk of getting dangerous infections.
Before you inject Xultophy (insulin degludec / liraglutide), check that the solution in the pen is clear and colorless without any particles (solid chunks). If it isn't, don't use the pen and ask your pharmacist for a replacement.
How to prime a new pen: by selecting the priming symbol, holding the pen with the needle pointing up, tapping the pen to allow air bubbles to rise to the top, and press and hold the dose button until the dose counter shows "0" lined up with the dose pointer. You should see a drop of medication at the needle tip; if you don't, you'll need to repeat the priming steps for up to 6 more times.
How to select a dose: Turn the dose selector on the Xultophy (insulin degludec / liraglutide) pen to select the dose you need. Even numbers are printed on the dial, while odd numbers are shown as lines. Keep in mind that the dose is based on the number of units of insulin degludec. But with every unit of insulin degludec you're using, 0.036 mg of liraglutide is also being delivered.
Inject Xultophy (insulin degludec / liraglutide) under the skin (subcutaneously). You can inject the medication into the skin of your stomach area (2 inches away from your belly button), thighs, or back of your upper arms.
Be sure to rotate injection sites with each dose of Xultophy (insulin degludec / liraglutide) to prevent hard lumps from forming in your skin. Don't inject the medication into any area that has lumps, pits, bruises, scars, or tenderness.
Always use a new needle for each Xultophy (insulin degludec / liraglutide) injection to help prevent infections and blocked needles. Don't reuse or share your needles with other people to avoid spreading infections.
Throw away all used needles and empty Xultophy (insulin degludec / liraglutide) pens in a sharps container or something made of heavy-duty plastic, such as an empty milk carton or laundry detergent bottle. This helps lower the risk of needle-stick injuries. Don't throw away needles and pens in your trash can.
Frequently asked questions about Xultophy (insulin degludec / liraglutide)
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What are the risks and warnings for Xultophy (insulin degludec / liraglutide)?
Xultophy (insulin degludec / liraglutide) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of thyroid cancer
Animal studies suggest liraglutide, an ingredient in Xultophy, can cause thyroid cancer. It's not known whether Xultophy (insulin degludec / liraglutide) can cause thyroid cancer in people. Let your prescriber know if you or a family member has ever had thyroid cancer called medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN 2). Because of this possible risk, you won't be able to take Xultophy (insulin degludec / liraglutide). Call your prescriber right away if you have a lump in the neck or throat, trouble breathing or swallowing, or hoarseness that won't go away, because these can be symptoms of thyroid cancer.
Inflammation of the pancreas (pancreatitis)
Risk factors: History of pancreatitis | History of gallstones | History of alcohol use disorder
Although rare, people who've used Xultophy (insulin degludec / liraglutide) have experienced inflammation in their pancreas (pancreatitis). Seek medical help right away if you have severe stomach pain that spreads to your back with or without vomiting. If you experience pancreatitis with Xultophy (insulin degludec / liraglutide), talk to your prescriber about alternative medications. It's not recommended to restart Xultophy (insulin degludec / liraglutide) even after your symptoms go away.
Risk of high and low blood sugar levels
Changing your insulin or insulin routine, such as where you inject Xultophy (insulin degludec / liraglutide), can affect how your body responds to insulin. This can lead to either high or low blood sugar levels. In addition, injecting Xultophy (insulin degludec / liraglutide) repeatedly into skin areas that shows signs of lipodystrophy, such as pitting or thickened skin, can also result in high blood sugar levels.
Don't make changes to your Xultophy (insulin degludec / liraglutide) dose or routine without first checking in with your diabetes care team. Make sure to avoid injecting into skin areas that show signs of lipodystrophy. If your care team instructs you to make any changes to your insulin routine, they'll also ask you to check your blood sugar levels more often to see how the changes affect your blood sugar levels.
Dangerously low blood sugar levels (hypoglycemia)
Risk factors: Changes in diet and exercise | Drinking alcohol | Taking other medications for diabetes together with Xultophy (insulin degludec / liraglutide) | Liver or kidney problems | Not using Xultophy (insulin degludec / liraglutide) as directed
Using Xultophy (insulin degludec / liraglutide) alone or together with other medications that lower blood sugar can lead to hypoglycemia, which is dangerously low blood sugar levels. If not treated in time, it can be life-threatening.
Check your blood sugar level regularly to make sure it's within a safe range. Never mix Xultophy (insulin degludec / liraglutide) with other insulins nor use it with an insulin pump. If you make any changes to your diet or meal patterns, other medications, or how much you exercise, let your care team know because they might need to adjust your dose of Xultophy (insulin degludec / liraglutide).
Make sure you're familiar with symptoms of hypoglycemia, such as feeling shaky, being nervous or anxious, sweating or body chills, and excessive hunger. Keep fast-acting sugars, such as glucose tablets, with you at all times so you can treat an episode of hypoglycemia. If your blood sugar levels don't improve even after you take fast-acting sugars, get medical help right away.
Kidney damage
Risk factors: History of kidney problems | Dehydration | Taking certain medications like diuretics (water pills), ACE inhibitors, or NSAIDs
Some people who took Xultophy (insulin degludec / liraglutide) had new or worsening kidney problems (called acute kidney injury). Kidney problems from Xultophy (insulin degludec / liraglutide) typically improve after receiving treatment or after stopping the medication. To be safe, let your care team know if you have a history of kidney problems or take medications that cause kidney damage before you start Xultophy (insulin degludec / liraglutide). Also, make sure to drink plenty of fluids during treatment to stay hydrated and prevent kidney damage. Tell your prescriber if you're having trouble urinating or if you're not urinating as much as usual while you're taking this medication.
Gallbladder problems
In clinical studies for Xultophy (insulin degludec / liraglutide), some people who took the medication developed gallbladder problems like gallstones. Contact your prescriber right away if you have severe upper stomach or back pain that appears suddenly, fever, or jaundice (yellowing of the skin or eyes). These can be signs of gallbladder problems. You'll probably need to get lab tests done so your prescriber can check to see whether your gallbladder is okay.
Low blood potassium levels
Risk factors: Taking other medications with Xultophy (insulin degludec / liraglutide) that lower potassium
Xultophy (insulin degludec / liraglutide) can lower the levels of potassium in your blood, which can be dangerous. You're more at risk if you're already taking medications that lower your potassium, such as certain diuretics or water pills. If needed, your prescriber might check your potassium levels regularly and give you medications to keep your potassium normal.
Symptoms of low potassium levels include weakness, muscle cramps or twitches, digestive problems, or abnormal heartbeats. Call a healthcare professional if you have these symptoms while you're taking this medication.
Swelling and heart failure when used with certain diabetes medications
Risk factors: Taking glitazones together with Xultophy (insulin degludec / liraglutide) | History of heart failure
Taking Xultophy (insulin degludec / liraglutide) with glitazones (also known as thiazolidinediones), like pioglitazone (Actos), can cause your body to hold onto fluid. This can lead to or worsen heart failure because the additional fluid can put stress on your heart and cause symptoms such as trouble breathing or the inability to exercise.
Make sure to tell your prescriber if you have heart failure or if you're taking a glitazone before you start Xultophy (insulin degludec / liraglutide). And contact your care team if you have unusual sudden weight gain, swelling, or trouble breathing because these can be signs of fluid buildup and heart failure.
Xultophy (insulin degludec / liraglutide) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| five 3ml pens of 100 units/ml | 1 package | $1264.91 | $1264.91 |
Typical dosing for Xultophy (insulin degludec / liraglutide)
Your prescriber will determine your dose based on different factors, such as your blood sugar levels, and whether you're already using a form of long-acting insulin or another GLP-1 agonist medication.
Each Xultophy 100/3.6 pen contains 100 units/mL of insulin degludec and 3.6 mg/mL of liraglutide. The dose is based on the number of units of insulin degludec.
If you're not taking insulin or a GLP-1 agonist: The typical starting dose is 10 units injected under the skin into the thigh, upper arm, or stomach once a day.
If you're taking insulin or a GLP-1 agonist: The typical starting dose is 16 units injected under the skin into the thigh, upper arm, or stomach once a day.
How much does Xultophy (insulin degludec / liraglutide) cost?
Xultophy (insulin degludec / liraglutide) contraindications
Have a personal or family history of medullary thyroid carcinoma (MTC)
Rare disorder of the endocrine system called multiple endocrine neoplasia syndrome type 2 (MEN 2)
Symptoms of low blood sugar (hypoglycemia)
What are alternatives to Xultophy (insulin degludec / liraglutide)?
Type 2 diabetes in adults
What is the latest news about Xultophy (insulin degludec / liraglutide)?
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References
Best studies we foundLewis, J. L., III. (2023). Hypokalemia (low level of potassium in the blood). Merck Manual Consumer Version.
MedlinePlus. (2024). Multiple endocrine neoplasia (MEN) II.
Nasrallah, S. N., et al. (2012). Table 1. Comparison of insulin degludec and other insulin analogs. Clinical Medicine Insights: Endocrinology and Diabetes.
National Cancer Institute. (2019). Medullary thyroid cancer (MTC).
National Kidney Foundation. (2024). Acute kidney injury (AKI).
Novo Nordisk. (2024). Xultophy® 100/3.6 insulin degludec & liraglutide injection [package insert].
Novo Nordisk. (2024). Xultophy 100/3.6- insulin degludec and liraglutide injection, solution [package insert]. DailyMed.
You and Your Hormones. (2021). Insulin.
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