Victoza side effects and how to avoid them

Common Victoza side effects | Weight loss | Nausea | Serious side effects | Thyroid cancer | How long do side effects last? | Warnings | Interactions | How to avoid side effects

Victoza (liraglutide) is one of the glucagon-like peptide-1 (GLP-1) agonists, a drug class with increasing use in recent years. The primary use of Victoza is in the control of blood glucose (sugar) for the treatment of Type 2 diabetes mellitus. Another indication for using Victoza is to reduce the risk of cardiovascular events like heart attacks among those with Type 2 diabetes. Accordingly, this drug is often a preferred choice in those with diabetes and heart disease.

Take Victoza as a daily injection under the skin, using a pen device. Doses escalate from the lead-in dose of 0.6 mg daily in the first week to a standard dose of 1.2 mg daily and a maximum dose of 1.8 mg daily if needed. Side effects of Victoza range from relatively common but mild to rare but potentially severe. This article will focus on these adverse effects.

RELATED: What is Victoza?

Common side effects of Victoza

Common Victoza side effects include:

• Hypoglycemia (low blood sugar)
• Nausea, vomiting, dyspepsia (indigestion), or appetite loss
• Diarrhea or constipation
• Headache
• Upper respiratory infection or nasopharyngitis
• Back pain
• Elevated bilirubin, lipase, or amylase levels (blood tests of liver or pancreatic function)

Weight loss

Interestingly, appetite loss but not weight loss was listed among the side effects after the initial clinical trials of Victoza. Studies have subsequently found that liraglutide is associated with dose-dependent weight loss significantly more than placebo, even at the doses of liraglutide used for diabetes. In fact, the manufacturer of Victoza, Novo Nordisk, also makes liraglutide under the brand name Saxenda. Based on its weight loss effect, Saxenda is indicated by the Food and Drug Administration (FDA) for chronic weight management, using a higher liraglutide dose of 3 mg injected daily. Weight loss is not dependent on liraglutide causing nausea, so a side effect of significant nausea should not be tolerated.

Nausea

The most common adverse reaction to Victoza is nausea. According to the drug’s medication guide, this symptom is reported by 18% of individuals taking the Victoza 1.2 mg daily dose and 20% taking the 1.8 mg dose. Nausea from the drug is thought to arise from a gastroparesis effect (slowing of stomach emptying). Fortunately, nausea from GLP-1 agonists can subside with continued use or with a lesser dose. 

If nausea is severe, persistent, or accompanied by vomiting or pain, seeking medical attention is advisable. These symptoms could indicate a more serious reaction to Victoza, such as cholelithiasis (gallstones), cholecystitis (inflammation of the gallbladder), pancreatitis (inflammation of the pancreas), or renal failure (kidney function impairment). These have all been mentioned in case reports, but causality from Victoza has not been established.

Serious side effects of Victoza

Serious side effects of Victoza are possible and may include:

• Thyroid C-cell cancer in animal studies
• Medullary thyroid carcinoma (MTC) risk or papillary thyroid carcinoma
• Hypersensitivity allergic reactions or anaphylaxis (a serious allergic reaction that can be life-threatening)
• Angioedema (sudden swelling of the face or body)
• Acute renal failure (sudden kidney failure) or chronic renal failure exacerbation (worsening of kidney function in one who has pre-existing kidney impairment)
• Pancreatitis
• Gallbladder problems including cholecystitis or cholelithiasis

Thyroid cancer

In studies of rodents, liraglutide was associated with higher rates of thyroid C-cell tumors. It is unknown whether liraglutide has the same effect in humans. Nonetheless, the FDA has a black box warning on Victoza regarding this concern and warning against the use of the drug by anyone with a personal or family history of thyroid cancer or a history of multiple endocrine neoplasia syndrome type 2 (MEN 2). These different circumstances are mentioned because they are associated with a higher risk of thyroid tumors. Signs of such a tumor could be a lump in the neck, dysphagia (difficulty swallowing), difficulty breathing, or hoarseness.

How long do Victoza side effects last?

Fortunately, nausea from GLP-1 agonists like Victoza may subside with continued use or with a lesser dose. Other common side effects typically resolve when the medication is stopped. The list of serious side effects, such as allergic reactions, renal failure, and pancreas or gallbladder problems, may require emergent treatment as well as drug discontinuation.

Victoza contraindications and warnings

Abuse and dependence

Victoza is not habit-forming, and a withdrawal syndrome does not occur if stopped. Discontinuing Victoza should be done upon the medical advice of a healthcare professional because elevated blood sugars could recur.

Overdose

An overdose of Victoza should prompt one to seek emergency medical attention and call the Poison Helpline at 1-800-222-1222.

Restrictions

Victoza can be used in adults, including seniors, with Type 2 diabetes mellitus. The drug can also be used by children 10 years of age and older with Type 2 diabetes. 

It is not intended for use in Type 1 diabetes mellitus. 

A history of medical conditions such as pancreatitis, medullary thyroid cancer (personally or in the family), hypersensitivity to this drug or drug class, or MEN 2 should also preclude the use of Victoza. 

Based on a lack of data to demonstrate safety, the use of alternatives to Victoza is generally suggested during pregnancy and breastfeeding.

Victoza interactions

Victoza and other medications for diabetes can interact with a substantial list of medications. The prescribing medical provider should review the entire medication list, including supplements and over-the-counter medications, before initiating Victoza. The following are some specific drug interactions.

• Cidofovir is contraindicated (should not be used) with Victoza, due to potential bone marrow and kidney side effects with concurrent use.
• Except for other GLP 1 agonist drugs, additional diabetic medications, including metformin and sulfonylureas, can be used cautiously in combination with Victoza. Blood sugar levels should be monitored to look for hypoglycemia.
• Loop diuretics, such as budesonide, and quinolone antibiotics, such as levofloxacin, can reduce the effectiveness of diabetic medications like Victoza.
• Aminoglycoside antibiotics, such as gentamicin, may need to be avoided due to a possible increased risk of kidney problems.

How to avoid Victoza side effects

1. Use Victoza at the same time every day. The particular time is not important, but your healthcare provider may have a particular recommendation for you.
2. Rotate body sites used for injections. Avoid using the same injection site every time. Victoza may be administered to the front of the thighs, abdomen, or upper arm.
3. Before starting Victoza, inform your healthcare provider if you have a personal or family history of thyroid tumors, MEN 2, or pancreatitis.
4. Drink plenty of water to promote more frequent urination, which is healthy for your kidneys.
5. Understand that hypoglycemia (low blood sugars) can cause an array of symptoms, including drowsiness, weakness, dizziness, tremor, sweating, fast heartbeat, palpitations, and anxiety. Monitor blood sugar levels to help avoid hypoglycemia.