Liraglutide
Victoza, Saxenda
The daily GLP-1 that proved the class could treat obesity, now largely superseded by weekly drugs that work better and require a seventh of the injections.
FDA-approved
FDA-approved as Victoza in 2010 for type 2 diabetes and as Saxenda in 2014 for chronic weight management. Generic liraglutide became available in 2024.
What it is
Liraglutide is a GLP-1 receptor agonist with a fatty acid chain attached, which lets it bind albumin and survive in circulation for about thirteen hours instead of the couple of minutes native GLP-1 manages. That was a real achievement in 2010. It is also why the drug needs a daily injection rather than a weekly one.
It has two names because it has two approvals at two doses. Victoza, up to 1.8 mg, is for type 2 diabetes. Saxenda, up to 3 mg, is for weight management. Same molecule, different titration and a different price.
What the evidence shows
The SCALE programme is the reason Saxenda exists. In the 56 week obesity and prediabetes trial, liraglutide 3 mg produced about 8% mean weight loss against roughly 2.6% on placebo, with around 60 to 65% of participants losing at least 5% of body weight and about 30% losing at least 10%.
Those were impressive numbers in 2014. They are no longer impressive numbers. Semaglutide reached roughly 15% in STEP-1 and tirzepatide about 21% in SURMOUNT-1, both on weekly injections. Liraglutide asks for seven injections a week to deliver roughly half the result.
This is worth stating plainly because liraglutide is still prescribed, still marketed, and now available as a cheaper generic. Cheaper is a real argument. Equivalent is not.
Practical notes
- The titration schedule is not optional. Starting at 3 mg produces nausea severe enough that people quit. The four to five week ramp exists because the gut adapts, and rushing it is the most common self-inflicted failure.
- Generic availability changed the calculation. For someone paying cash, generic liraglutide at a fraction of semaglutide's price is a defensible trade even at lower efficacy. That is a budget decision, and it deserves to be made knowingly rather than by default.
- Daily dosing is the real adherence problem. Trial adherence is not real world adherence. A drug you inject every morning has more opportunities to be skipped than one you inject on Sundays.
- The thyroid contraindication is class-wide and rodent-derived. It comes from C-cell tumours in rats, and whether it translates to humans remains unsettled. It is still a contraindication, and family history is worth actually asking about rather than assuming.
Side effects and warning signs
Commonly reported
- Nausea, most pronounced during titration and usually settling
- Vomiting and diarrhoea
- Constipation
- Injection-site reactions
- Gallstones, more likely with rapid weight loss
Stop and get medical help
- Personal or family history of medullary thyroid carcinoma or MEN2. This is a boxed contraindication for the class
- Severe persistent abdominal pain radiating to the back, which is how pancreatitis presents
- Signs of gallbladder disease during rapid weight loss
Sources
From the community
Discussion for this compound concentrates in r/liraglutide and r/Semaglutide.
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