Makindo Medical Notes

💡 Missed dose advice: If a dose is delayed by more than 12 hours, the missed dose should be skipped and the next dose taken at the usual scheduled time. Do not double the dose.

📘 About

• Always check the BNF for latest prescribing advice.
• Liraglutide is a GLP-1 receptor agonist used in the management of type 2 diabetes mellitus (T2DM) when other therapies are insufficient, or metformin is unsuitable.
• In the UK, it is also licensed (under a different brand/dose, Saxenda®) for the management of obesity and weight reduction in certain patients.

⚙️ Mode of Action

• GLP-1 receptor agonist mimicking endogenous incretin hormone.
• Enhances glucose-dependent insulin secretion from pancreatic β-cells.
• Suppresses inappropriate glucagon release.
• Delays gastric emptying → promotes satiety and weight loss.

💊 Indications & Dosing (Diabetes)

• T2DM (monotherapy if metformin unsuitable, or in combination with other antidiabetic agents):
• Start: 0.6 mg SC once daily for ≥1 week.
• Increase to 1.2 mg SC once daily for ≥1 week.
• Can increase further to 1.8 mg SC once daily if additional glycaemic control required.
• Administered by subcutaneous injection in abdomen, thigh, or upper arm (rotation of sites advised).

🔄 Interactions

• See BNF.
• May delay absorption of concomitant oral medicines due to slower gastric emptying.

⚠️ Cautions

• Risk of pancreatitis – counsel patients to report severe abdominal pain radiating to back.
• Monitor renal function, particularly if GI side effects cause dehydration.
• Use with caution in patients with thyroid disease or history of thyroid nodules.

🚫 Contraindications

• Diabetic gastroparesis.
• Inflammatory bowel disease.
• Severe congestive heart failure (NYHA class IV).
• Personal/family history of medullary thyroid carcinoma (specific to GLP-1 class, more US than UK emphasis).

💥 Side Effects

• GI: Nausea, vomiting, abdominal pain, diarrhoea/constipation.
• Injection site reactions (pain, erythema, swelling).
• Hypoglycaemia (especially if combined with sulfonylurea or insulin).
• Headache, dizziness, fatigue.
• Rare: Pancreatitis, gallbladder disease.

📖 References

• BNF – Liraglutide
• NICE NG28: Type 2 Diabetes in adults: management

📝 Revisions

• September 2025 – Expanded with obesity licence, side effects, and UK guidance.