Saxenda (liraglutide): Overview, how it works, and more

Such a simpler time, 2014. People were pouring ice buckets on their heads to raise money for charity. Selfies were the new party trick. Obesity was finally recognized as a chronic disease by the American Medical Association the year before. And liraglutide, an innovative medication known as a glucagon-like peptide 1 agonist (GLP-1), was given FDA approval for weight management…without much hullabaloo.

No one could have predicted that this single GLP-1 agonist would kickstart an entire new category of weight-management medications. But in a world of semaglutide and tirzepatide and the-next-thing-tides, does liraglutide still have a place? Here’s why the original still stands.

What is Saxenda (liraglutide)?

Liraglutide is one of several types of GLP-1 agonists, commonly referred to as weight-loss injections—and the original. “It was one of the first to hit the market for the treatment of diabetes, in 2010, and the first to also be approved for the treatment of obesity, in 2014,” says Dr. Robert Kushner, M.D., professor of medicine in endocrinology and medical education at Northwestern University Feinberg School of Medicine in Chicago. As such, it helped pave the way for a new direction in treating both diabetes and obesity, he says, by harnessing the power of gut hormones. At the time, this was a novel way to support weight loss.

How does Saxenda (liraglutide) work?

To understand how liraglutide works, you need to first understand GLP-1. A gut hormone that’s released by cells in your gastrointestinal system after you eat, GLP-1’s job is to increase the amount of insulin the body makes in order to balance your blood sugar. It also inhibits glucagon, a hormone that regulates your blood sugar levels. As a result, GLP-1 can prevent blood sugar from spiking after a meal and even lower blood sugar.

GLP-1 agonists, liraglutide included, can amplify and extend the timeline of this effect, ultimately helping to control blood sugar for longer periods of time. On top of this, “liraglutide has actions in the brain to control appetite and slow stomach emptying, making it easier for people with obesity to follow a reduced-calorie diet and lose weight,” says Kushner. “As some of my patients say, the drug ‘quiets the mind’ and makes it easier to eat healthier.” Over time with continued use, liraglutide helps lower the weight at which the body naturally wants to settle.

How to use Saxenda effectively

Saxenda is taken with a once-daily injection that you give yourself. It sounds intimidating, but the packaging is designed to make it as easy as possible. Here’s a quick run-through of how it goes:

1. Check that the pen label reads “Saxenda (liraglutide),” pull off the cap, and do a quick visual check of the liquid. It should be clear, colorless, and free of particles.
2. Attach the needle. (Needles are sold separately—which may require a prescription in some states.)
3. Dial your dose (each pen contains 18mg of medication and the dose can be adjusted from the lowest dose .6mg to the highest 3mg).
4. Press the pen into your abdomen, thigh, or upper arm. Rotating injection sites helps avoid soreness.
5. Press down on the dose button and count to six slowly.
6. Withdraw the pen and dispose of the needle properly.

“The medication is slowly escalated every week over the first month of treatment,” says Dr. Holly Lofton, M.D., professor of medicine and surgery at NYU Grossman School of Medicine and the director of the Medical Weight Management Program at NYU Langone Health in New York City. While dosing schedules depend upon the individual and their healthcare provider’s guidance, the starting dose for Saxenda is generally .6mg, while the maximum is typically 3.0mg, per the manufacturer.

If you miss a dose, take it as soon as you can unless it’s nearly time for the next dose. In that case, take only that dose. If you forget to take the medication for three or more days, call your provider as you may need to restart the medicine at a lower dose. Never take extra doses. If you do take too much medication, call Poison Control (800-222-1222) or go to your nearest emergency room.

How long does it take to lose weight on Saxenda (liraglutide)?

As with any weight-loss method, it can take some time to see significant results—especially since liraglutide has to be scaled up over several weeks. “Individuals usually feel some appetite reduction after initiating the medication, although the dose is very low at first,” says Kushner, who notes that clinical trials have shown weight loss can begin as soon as the first week of treatment.

Early studies published in the Journal of the American Medical Association and New England Journal of Medicine found that the average amount of weight loss was between 5% and 10% of one’s body weight after 36 months. However, a more recent study published in Obesity Facts found that liraglutide can help people lose nearly 10% of their body weight within four months. To lose the most weight and improve health, experts recommend that patients pair liraglutide—like any other weight-loss medication—with a healthy lifestyle.

A diet that prioritizes protein will help ensure you get the nutrition you need despite eating fewer calories. Moving your body, reducing stress, and getting high-quality sleep can help further minimize cravings—all habits that a behavior-change program like WeightWatchers® can help you build, in tandem with medication.

Other health benefits of liraglutide

Liraglutide’s ability to control blood sugar also gives it built-in heart-health benefits. The LEADER clinical trial, which ran from 2010 to 2012, assessed the cardiovascular benefits, glycemic control, safety, and cardiovascular risk factors—weight loss included—of liraglutide. “The LEADER trial determined liraglutide to have a benefit in reduction of cardiac risk in patients with diabetes,” says Lofton. A later analysis of that trial, published in Circulation, found that liraglutide also improved the outcomes of people with type 2 diabetes who had a history of heart attack and stroke, as well as those with heart disease.

Liraglutide versus other GLP-1 agonists

After liraglutide, other weight-loss drugs followed. The other medications in the overarching class of GLP-1 agonists work the same way, but they can vary in their results, dosage, and even frequency. Take semaglutide, which is better known by its brand names Wegovy and Ozempic. It is injected weekly instead of daily like liraglutide and studies have shown it can result in greater weight loss. But providers sometimes prefer to prescribe liraglutide over Wegovy because it has a lower risk of side effects.

How long do you need to take Saxenda?

Since obesity is a chronic condition, the medications to treat it, such as Saxenda, aren’t designed to be a one-and-done treatment. Rather, they’re meant to be used long-term for as long as someone wants to maintain the weight loss. “It is not a short-term use medication for temporary weight loss,” Lofton says. “It is intended to treat obesity, and does so by changing the physiology of one’s body while they are taking the medication.”

If someone stops taking it, they’ll likely regain the weight they lost. After all, if they’ve lost weight on liraglutide as a direct result of reduced appetite—fewer cravings, an increase in satiety, and a reduction in hunger—then “all of these benefits will disappear once the medication is stopped, making it harder for the patient to maintain the weight loss,” says Kushner. While studies haven’t tested liraglutide specifically, clinical trials of other GLP-1 agonists concluded that when people stop taking the medication, they regain weight.

Understanding the safety and side effects of Saxenda

Like other GLP-1 agonists, potential liraglutide side effects are mostly gastrointestinal in nature, and may include:

• Nausea
• Vomiting
• Diarrhea
• Constipation
• Heartburn
  
  

Side effects —whether they happen at all and their severity—vary from person to person. (*For a complete list of side effects visit the Saxenda website.) Factors such as your age, additional medications you take, and other conditions you have can impact how well you tolerate this drug. Serious allergic reactions (i.e., a rash, dizziness, itching, swelling of the face, tongue, or throat) are rare. Severe abdominal pain, mood disturbances, or signs of low blood sugar (such as shaking, blurred vision, rapid heartbeat, or sudden sweating) should be reported to your physician.

The best approach for managing side effects is to prevent them in the first place. “Side effects are mitigated by starting at a low dose and escalating slowly over the course of at least a month,” Kushner says. “You should also eat a diet that’s lower in fat, have smaller portion sizes, and avoid skipping meals.”

To resolve digestive distress after taking the medication, experts recommend eating bland, low-fat foods (such as plain toast or white rice) and staying hydrated. Upping your water intake or consuming broth and food with a high water content (like gelatin) can be helpful.

Saxenda and the other GLP-1 medications also come with a boxed warning (formerly known as the Black Box warning), which explain any safety concerns the Food and Drug Administration (FDA) may have. In the case of Saxenda, thyroid tumors were found in animal (rat and mice) studies, but human studies looking at the effects of GLP1 medications show no increased risk for thyroid cancer.

Who can benefit from Saxenda

Liraglutide is prescribed for people with a body mass index (BMI) of more than 27 who also have a weight-related medical problem (diabetes, high blood pressure, or high cholesterol, for example) or for people living with obesity with a BMI over 30. Youth between the ages of 12 and 17 who weigh at least 132 pounds and live with obesity are also approved by the FDA to use Saxenda.

For the best results, experts recommend using Saxenda (liraglutide) in conjunction with a healthy diet and regular physical activity. Eating nourishing food, drinking enough water, and exercising regularly (strength training especially) keep you feeling your best as you’re losing weight. Proper nutrition and hydration help mitigate side effects and activity protects against the loss of lean muscle mass. Experts recommend pairing medication with a proven behavior change program like WeightWatchers—for long-term, sustainable health outcomes.

Speak with your healthcare provider to determine if weight-management medication is right for you. Be sure to mention if you have a history of alcohol misuse, high cholesterol, digestive-related issues like gallbladder disease, pancreatitis, kidney disease, or if you’ve ever been treated for depression. Working with a provider who is trained in weight-management and weight stigma can be especially helpful as you consider your options.

Who shouldn't take Saxenda?

Saxenda is not indicated for people (or people with relatives) who have Medullary Thyroid Cancer (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), a rare, inherited endocrine system condition. On top of that, liraglutide’s side effects are a consideration. For that reason, “other concerns would be a patient with underlying GI diseases or chronic symptoms, such as diarrhea or nausea, since the medication may worsen these symptoms,” Kushner says.

Cost and accessibility of Saxenda

The price of Saxenda can be steep, with a list price over $1,000 for a 30-day supply without insurance. Some insurance plans may cover the medication, which can help reduce that cost—but not all plans cover weight-management medications, including Medicare and those purchased through the government marketplace. To find out what’s included in your plan, check with your insurance company.

Many pharmaceutical companies have patient assistance programs (PAPs), which are intended to provide access to brand-name medications at little or no cost. Visit the manufacturer’s website to learn more about the PAP for Saxenda.

Right now, filling prescriptions for many of the popular weight-loss medications (including Saxenda) is difficult due to high demand and manufacturer shortages. Unfortunately, these shortages are expected to last into 2024.

The FDA keeps track of these shortages and the estimated dates the medications will be back in stock on its drug shortages list. Fortunately, other medications can be prescribed for weight loss that aren’t in short supply, so talk to your provider if you’re concerned about supply for your medication.

The bottom line

The original GLP-1 agonist, Saxenda stands out because of a lower risk of side effects and years of research on its safety and efficacy. The daily injection, scaled up over the course of several weeks, has been shown in studies to translate to a 5% to 10% weight loss when paired with a healthy lifestyle. Research also shows it can improve heart health in people living with type 2 diabetes. Patients must continue taking liraglutide for life, however, to maintain results.