Saxenda (liraglutide) in the Treatment of Obesity

What is Saxenda and how does it act in the body?

Saxenda contains the active substance liraglutide, which belongs to the group of GLP-1 receptor agonists. The medication works by mimicking the effect of the body's own intestinal hormone GLP-1 (glucagon-like peptide-1), which contributes to regulating appetite and satiety.

GLP-1 is naturally released from the small intestine in connection with meals and signals to the brain that energy has been supplied to the body. However, the hormone has a short half-life and is quickly broken down in the body. Liraglutide is a synthetic analog that is modified to have a longer duration of action, which enables an effect that lasts throughout the day and administration once daily.

Liraglutide acts, among other ways, centrally by activating GLP-1 receptors in areas such as the hypothalamus, which can lead to reduced hunger and an increased feeling of fullness. The treatment can thereby contribute to a reduced energy intake.

Who can get Saxenda prescribed for overweight?

Medications for weight treatment, such as Saxenda, can be considered for adults with a Body Mass Index (BMI) ≥30, or at a BMI ≥27 in combination with at least one weight-related complication, such as prediabetes or type 2 diabetes, hypertension, dyslipidemia, or obstructive sleep apnea.

Saxenda is approved for use in adults and can also be used for weight control in adolescents from 12 years of age, following an individual medical assessment.

Pharmacological treatment aims to treat obesity as a chronic disease and reduce the risk of secondary diseases. It is used as a supplement to lifestyle measures.

Prescription is always preceded by an individual medical assessment. The doctor takes into account your medical history, previous weight loss attempts, and relevant test results to determine if the treatment is appropriate.

How liraglutide is administered – solution in a pre-filled injection pen

Saxenda is administered as a subcutaneous injection once daily with a pre-filled injection pen, allowing for self-administration at home after instruction from a healthcare provider.

The medication is given in the subcutaneous fat and should not be injected into muscle or blood vessels. Recommended injection sites are the abdomen (at a distance from the navel), the front of the thighs, or the back of the upper arm. It is important to vary the injection site between doses to reduce the risk of local skin irritation.

The injection can be given independently of meals and at any time of the day, but should be taken at approximately the same time every day to maintain a steady drug effect.

You will receive instructions from a doctor or nurse on how the injection pen is used and how the dose is set.

Other medications in the same treatment category, such as semaglutide (Wegovy) and tirzepatide (Mounjaro), are usually administered once a week, which differs from liraglutide's daily dosing.

Dosage and principles for titration

Treatment with Saxenda begins at a low starting dose which is then increased stepwise over several weeks to allow the body's gastrointestinal tract to get used to the medication. The starting dose is usually 0.6 mg per day for at least one week, after which the dose is increased by 0.6 mg at intervals of at least one week up to 3.0 mg per day.

The gradual titration builds up tolerance over time. Throughout the titration phase, your healthcare provider monitors your symptoms and adjusts the dose as needed.

For children and adolescents under 18 years of age, a similar dose titration schedule is used with a maximum recommended dose of 3.0 mg per day.

Expected results when using Saxenda

In clinical studies, treatment with liraglutide has shown an average weight loss of approximately 4–6 percent of body weight after one year of treatment, when the medication is combined with lifestyle measures such as dietary changes and physical activity.

Even moderate weight loss has been shown to provide clinically relevant health effects. A weight reduction of around 5–10 percent can contribute to improved blood sugar control, lowered blood pressure, and beneficial effects on blood lipids, which together reduce cardiometabolic risk.

The treatment result varies between individuals, and some patients achieve greater weight loss than average. To achieve the best possible effect, it is recommended that the treatment be combined with long-term changes in diet and physical activity.

Common side effects and how to relieve them

The most common side effects of treatment with Saxenda are nausea, diarrhea, constipation, and headache. These most often appear at the start of treatment or in connection with a dose increase and are usually mild to moderate. The complaints tend to subside over time as the body adapts to the treatment.

Liraglutide affects the gastrointestinal tract, partly by delaying gastric emptying, which can contribute to nausea and an early feeling of fullness. Larger meals can in some cases worsen the symptoms.

Serious side effects are uncommon but can occur. These include pancreatitis (inflammation of the pancreas) and rare allergic reactions. Hypoglycemia may occur, primarily in people with diabetes who are simultaneously treated with other blood sugar-lowering medications.

To reduce the risk of discomfort, the following measures may be helpful:

• Eat smaller portions and stop the meal at early signals of fullness
• Avoid very fatty or hard-to-digest food if you experience nausea
• Ensure sufficient fluid intake to counteract constipation

In case of persistent or pronounced side effects, you should contact healthcare staff for assessment and possible dose adjustment. If you experience serious side effects or suspect an overdose, contact a medical facility immediately for help and advice.

Why strength training and protein are crucial

To promote a healthy body composition during weight loss, it is important to combine the treatment with sufficient protein intake and regular strength training. The goal is to preserve muscle mass to the greatest extent possible while fat mass decreases.

Medication treatment can contribute to a reduced energy intake. During an energy deficit, the body uses both fat and muscle tissue as an energy source. Without sufficient protein intake and muscle-stimulating activity, part of the weight loss may therefore consist of the loss of muscle mass.

Since muscle mass contributes to the body's energy expenditure, a loss of muscle will lower the basal metabolic rate. This means your body burns fewer calories at rest, making it harder to keep the new weight stable in the long term. Strength training acts as a signal to the body to preserve musculature, while protein provides the building blocks required to maintain and repair muscle tissue.

Common questions about Saxenda

What is the difference between Saxenda and Ozempic/Wegovy?

Saxenda (liraglutide) and Ozempic/Wegovy (semaglutide) are both GLP-1 receptor agonists from the same pharmaceutical company (Novo Nordisk A/S), but they contain different active substances and have different approved areas of use.

Saxenda is approved for the treatment of obesity and overweight and is administered as a daily injection. Ozempic is primarily approved for the treatment of type 2 diabetes, while Wegovy contains the same active substance (semaglutide) but at a higher dose specifically approved for the treatment of obesity. Semaglutide is given as an injection once a week.

The differences in substance and dosage also mean the medications have different effect profiles. In clinical studies, semaglutide has shown a greater average weight loss compared to liraglutide in the treatment of obesity.

In the direct comparative STEP 8 study, which included people with obesity without diabetes, an average weight loss of approximately 15.8% was achieved after 68 weeks of treatment with semaglutide (2.4 mg/week) compared to 6.4% with liraglutide (3.0 mg/day). Treatment with semaglutide was also associated with a greater reduction in energy intake, and a lower proportion of patients discontinued treatment.

Do I have to take the shot at exactly the same time every day?

It is recommended to take the medication at approximately the same time each day, as this can contribute to a steady drug effect and make it easier to remember the dose.

Does Saxenda work without exercising and changing the diet?

Saxenda can contribute to weight loss by affecting appetite and satiety, but it is used as a supplement to lifestyle measures such as dietary changes and physical activity. For the best and most sustainable results, it is recommended that the treatment be combined with changed eating habits and increased physical activity. Without such measures, the effect is generally more limited.

Will I gain weight if I stop taking Saxenda?

When treatment with Saxenda is discontinued, the medication's effect on appetite and satiety ceases, which can lead to increased hunger. This means the risk of weight gain increases, especially if no long-term lifestyle changes have been established.

Obesity is a chronic disease, and many people need a long-term treatment strategy to maintain their weight loss. This may involve continued medication treatment, sometimes at a lower dose, in combination with sustainable lifestyle habits. Any tapering or termination of treatment should always occur in consultation with the treating healthcare provider.

How long does it take before side effects disappear?

Gastrointestinal-related complaints, such as nausea, are most common at the beginning of treatment and in connection with dose increases. For most people, symptoms decrease gradually within a few weeks as the body adapts to the medication. However, how quickly the complaints resolve can vary between individuals.

Sources

European Medicines Agency (EMA). Saxenda https://www.ema.europa.eu/en/medicines/human/EPAR/saxenda

Mehta, A., Marso, S.P. & Neeland, I.J. Liraglutide for weight management: a critical review of the evidence. https://pmc.ncbi.nlm.nih.gov/articles/PMC5358074/

World Health Organization (WHO). Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

Koskinas KC et al. Obesity and cardiovascular disease: an ESC clinical consensus statement. European Heart Journal. https://pubmed.ncbi.nlm.nih.gov/39210706/

Rubino DM et al. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8 Randomized Clinical Trial. Journal of the American Medical Association. DOI: 10.1001/jama.2021.23619