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GLP-1 Receptor Agonist Pregnancy: Contraindicated (Saxenda) — limited data; switch to insulin for T2DM in pregnancy

Liraglutide

Brand names: Victoza (T2DM), Saxenda (obesity)

Adult dose

Dose: T2DM (Victoza): starting 0.6 mg OD SC × 1 week, then 1.2 mg OD, up to 1.8 mg OD. Obesity (Saxenda): starting 0.6 mg OD SC, increase by 0.6 mg weekly to 3 mg OD.
Route: Subcutaneous injection
Frequency: Once daily (any time, without regard to meals)
Max: 1.8 mg OD (Victoza); 3 mg OD (Saxenda)
LEADER trial: CV mortality benefit in T2DM with high CV risk. Saxenda (3 mg) licensed for weight management in obesity.

Paediatric dose

Route: Subcutaneous
Frequency: OD
Max: Not licensed in children for T2DM
Concentration: 6 mg/mL pen mg/ml
Saxenda licensed ≥12 years for obesity management with BMI ≥30 (or ≥27 in presence of comorbidities) — step up same as adults

Dose adjustments

Renal

No dose adjustment required. Limited experience in severe renal impairment — use with caution.

Hepatic

No dose adjustment required. Avoid in severe hepatic impairment.

Clinical pearls

  • LEADER trial: 13% RRR in 3-point MACE in T2DM with established CV disease
  • Dose escalation reduces GI side effects — slow titration essential
  • Medullary thyroid cancer screening: personal/family history of MTC or MEN-2 is absolute contraindication
  • Saxenda (3 mg) + lifestyle intervention: 5–8% additional weight loss vs placebo (SCALE trial)

Contraindications

  • Personal or family history of medullary thyroid cancer
  • MEN-2 syndrome
  • Diabetic ketoacidosis
  • Pregnancy (Saxenda)

Side effects

  • Nausea (very common — usually transient)
  • Vomiting
  • Diarrhoea
  • Constipation
  • Decreased appetite
  • Pancreatitis (rare)
  • Tachycardia
  • Thyroid C-cell tumours (animal data — black box warning)

Interactions

  • Oral medications — slowed gastric emptying may reduce absorption; particularly warfarin/INR, oral contraceptives
  • Insulin/sulfonylureas — increased hypoglycaemia risk

Monitoring

  • HbA1c (3-monthly)
  • Body weight
  • Pancreatic enzymes if abdominal pain
  • Thyroid evaluation if neck lump or symptoms
  • Heart rate

Reference: BNFc; LEADER Trial (Marso et al, NEJM 2016); SCALE Trial; BNF; NICE TA664. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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