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Endocrine Disorders, Contraception, and Hormone Therapy during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Several cases have been reported of normal infants born following exposure to liraglutide, but no epidemiological studies of large numbers of pregnancies exposed to Liraglutide during the first trimester are published. Based on rodent reproductive studies, the manufacturer states that Liraglutide is contraindicated for use during pregnancy. The recommendation is to switch patients to insulin as soon as pregnancy is recognized.
Selected topics
Published in Henry J. Woodford, Essential Geriatrics, 2022
Glucagon-like peptide-1(GLP-1) agonists (e.g. liraglutide, exenatide and semaglutide) increase insulin secretion, suppress glucagon secretion and slow gastric emptying. They reduce HbA1C by around 11–14 mmol/mol (1%) in clinical trials.93,111 Lower adherence in ‘real-world' settings is likely to lead to smaller reductions (around 6 mmol/mol). They need to be administered as subcutaneous injections (between twice daily and once weekly, depending on formulation) but have a lower hypoglycaemia risk than insulin. Possible adverse effects include nausea/vomiting, reduced appetite, weight loss and pancreatitis.
Neuropeptide Regulation of Ion Channels and Food Intake
Published in Tian-Le Xu, Long-Jun Wu, Nonclassical Ion Channels in the Nervous System, 2021
GLP-1R is another important target for anti-obesity treatment. Liraglutide is a GLP-1R agonist that has been approved by the FDA for obesity treatment (Mehta, Marso, and Neeland 2017). In adults with obesity or overweight who had either hypertension or dyslipidemia, treatment with liraglutide resulted in body weight loss and improved metabolic control (Pi-Sunyer et al. 2015). In adolescents with obesity, the use of liraglutide plus lifestyle therapy led to a significantly greater reduction in body-mass index (BMI) than placebo plus lifestyle therapy (Kelly et al. 2020). Both peripheral and central GLP-1Rs contribute to the liraglutide-mediated reduction in food intake and body weight (Adams et al. 2018; Burmeister et al. 2017; Beiroa et al. 2014; Sisley et al. 2014; He et al. 2019). In the arcuate nucleus of the hypothalamus, both TRPC5 and KATP channels contribute to liraglutide activation of POMC neurons and inhibition of NPY/AgRP neurons (He et al. 2019), suggesting these two channels play a role in liraglutide reduction of food intake and body weight of obese patients.
Type 2 diabetes and cardiovascular disease: risk reduction and early intervention
Published in Postgraduate Medicine, 2023
Debbie Hinnen, Davida Kruger, Melissa Magwire
Management strategies can be employed to help mitigate potential GI AEs such as nausea, vomiting, and diarrhea [46]. These strategies include slow dose escalation, especially when initiating a GLP-1RA [46] (Table 3). For semaglutide and dulaglutide, which are administered once weekly, dose escalation is recommended in at least 4-week increments to help alleviate potential GI AEs [7,8] (Figure 1). Dose escalation in 1-week increments is recommended for liraglutide, a once-daily GLP-1RA [9] (Figure 1). But again, slower dose escalation may be indicated. The administration guidance for liraglutide also recommends starting at the lowest dose in the case of a missed dose for more than 3 days to mitigate possible GI effects as a result of re-initiation [9] (Figure 1). In the authors’ clinical experience, people who have had GI issues with metformin may benefit from a slower dose escalation of GLP-1RA and/or reduction of metformin at the time of GLP-1RA initiation. Signs of constipation should be monitored due to decreased gastric emptying and there may be a need to increase fiber and fluids.
Efficacy and safety of liraglutide for obesity and people who are overweight: a systematic review and meta-analysis of randomized controlled trials
Published in Expert Review of Clinical Pharmacology, 2022
Qiucen Lin, Yan Xue, Huimin Zou, Zhen Ruan, Carolina Oi Lam Ung, Hao Hu
In the 3-year assessment of the SCALE Obesity and Prediabetes trial, participants with prediabetes were subject to receive liraglutide 3.0 mg or placebo extending from 56 weeks to 160 weeks. The intervention with liraglutide 3.0 mg for 160 weeks was associated with more significant weight loss, decreased risk of type 2 diabetes, and improvements in glycemic control compared with placebo. Liraglutide 3.0 mg was well-tolerated, and no new safety issues were observed compared with the previous assessment after 56 weeks of intervention [32]. The remarkable improvement in glycemic control compared with other AOMs made it an attractive option for patients, particularly with comorbid type 2 diabetes or cardiovascular disease [33]. The identification of serious, long-term adverse events such as cancers and other risk factors may take longer to appear. Moreover, most patients will regain weight after the drug discontinuation, reinforcing the need for more long-term data [34,35].
Adding liraglutide to diet and exercise to maintain weight loss – is it worth it?
Published in Expert Opinion on Pharmacotherapy, 2022
This S-LITE trial is the second time that liraglutide has been introduced after weight loss with diet and without drug treatment. The first time was in the SCALE Maintenance randomized study, where liraglutide was introduced after weight loss with a low-calorie diet, and diet and exercise counseling were provided to all 422 participants throughout. Over 56 weeks, there was a further 6.2% weight loss with liraglutide, compared to 0.2% in the placebo group, and 81.4% of participants in the liraglutide maintained their ≥ 5% weight loss, compared to 48.9% in the placebo group [20]. To my knowledge, the only other weight-reducing drug to be tested after weight loss without drug treatment was sibutramine. Although sibutramine did reduce weight regain, it was subsequently withdrawn due to increased cardiovascular risk [21]. As the only presently available drug to have been shown to be effective against weight regain, liraglutide should probably be preferred to other weight-loss medicines in this circumstance.