Liraglutide in clinical practice: dosing, safety and efficacy

Summary Aims:  This article reviews practical issues that healthcare providers need to consider when implementing therapy with the once-daily glucagon-like peptide-1 (GLP-1) receptor agonist liraglutide. Key points:  Liraglutide is administered once daily by subcutaneous injection, independent of meals and at any time of day. To improve gastro-intestinal tolerability, the starting dose is 0.6 mg liraglutide daily. After at least 1 week, the dose should be increased to 1.2 mg. Some patients may benefit from an additional increment to the maximum recommended daily dose of 1.8 mg. Daily blood glucose monitoring is not required, although may be necessary if liraglutide is used with a sulphonylurea (SU). Treatment is contraindicated in patients with known hypersensitivity to liraglutide or an excipient. Liraglutide slows gastric emptying, but does not interact with acetaminophen, oral contraceptives, atorvastatin, griseofulvin, lisinopril or digoxin in a way that necessitates dose adjustments of these agents. The efficacy and safety of liraglutide are not influenced by differences in gender, age or ethnicity and race. Overall, liraglutide is generally well tolerated. Patients can experience gastrointestinal side effects, such as nausea, which diminish over time. As liraglutide increases insulin production in a glucose-dependent manner, the incidence of hypoglycaemia largely depends on the hypoglycaemic risk profile of the selected oral antidiabetic with which it is used. The use of an SU may increase the risk of hypoglycaemia; this risk can be lowered by reducing the SU dose. Conclusions:  Liraglutide is a once-daily treatment option that can be used in adults with type 2 diabetes regardless of gender, age (although therapeutic experience in patients over 75 years of age is limited) and ethnicity or race.