1. Saxenda (Liraglutide) SAMUEL GYAWU-AMOATENG

2. Indication & Approval  Saxenda, is FDA approved as a treatment option for chronic weight management in addition to a reduced-calorie diet and physical activity  Drug was approved in December 23 rd 2014  It is approved in adults with BMI of 30 or greater (obesity) or adults with BMI of 27 or greater (overweight) with at least one weight-related condition such as HTN, T2DM, or Dyslipidemia.

3. Drug Class  Saxenda is a glucagon-like peptide-1 (GLP-1) receptor agonist also known as incretin mimitic. Therefore is should not be used with other drugs belonging to the same class such as Victoza, for T2DM.

4. MOA  A long acting analog of human glucagon-like peptide- (GLP-1) (an incretin hormone) which  increases glucose-dependent insulin secretion,  decreases inappropriate glucagon secretion,  increase's B-cell growth/replication,  slows gastric emptying, and decreases food intake.  It’s administration results in decreases in hemoglobin A1c by ~1%

5. Dosage & Formulation  Initial 0.6mg SubQ once daily for 1 week, increase by 0.6mg daily at weekly intervals to target the dose of 3mg once daily.  If 3mg dose is not tolerated, d/c therapy since efficacy has not been established at lower doses.  Evaluate changes in body weight 16 weeks after starting of therapy. d/c if at least 4% of baseline body weight loss has not been achieved.  No dosage adjustments for renal or mild-to-severe hepatic impairment patient.

6. Administration & Storage  Drug is administered SuBQ in the upper arm, thigh or abdomen.  Should not be injected IV, or IM.  Can be administered w/o food at any time of the day  Store at 36 to 46 degree F, prior to initial use, and same temp after initial use  Do not freeze, discard if freezing occurs  Discard pen 30 days after initial use

7. PK, PD  It is highly protein bound. Approximately 98%  Vd SubQ is ~ 13- 25 L  Endogenously metabolized by dipeptidyl peptidase IV (DPP-IV) and endogenous endopeptidases  Metabolism is slower than native GLP-1  T1/2 ~ 13 hours  Peak plasma ~ 8-12 hours

8. Side Effects and Adverse Effects  Nausea, vomiting, diarrhea, tiredness, decrease appetite, headache  Renal impairment  Hypoglycemia,  Gall bladder problems  BBW : Thyroid Tumors: Dose dependent and treatment duration-dependent thyroid C-cell tumors.

9. Contraindications  Saxenda is contraindicated in patients with:  1. Hypersensitive to liraglutide or an component of the product [2]  2. Personal or family history of medullary thyroid carcinoma [1, 2]  3. Personal or family history of multiple endocrine neoplasia syndrome type 2 (MEN2) [1, 2]  Pregnancy [1]

10. Usage

11. CO$T! CO$T!! CO$T!!!  6 mg/mL (3 mL) : $256.39 [1]

12. Counseling Pearls & Monitoring  Saxenda approved with a Risk Evaluation and Mitigation Strategy (REMS) program.  Pregnancy Category X : Do not use if pregnant or plan on getting pregnant soon.  If dose is missed for 3 days or more, contact doctor on how to restart  Alternate injection site  Monitor for signs & symptoms of hypoglycemia  Monitor for signs and symptoms of pancreatitis,  Monitor for mood changes or behavioral changes.

13. Credits  [1.] Lexicomp http://0- online.lexi.com.wildpac.wne.edu/lco/action/doc/retrieve/docid/patch_f/2144379http://0- online.lexi.com.wildpac.wne.edu/lco/action/doc/retrieve/docid/patch_f/2144379  [2.] Micromedex http://0- www.micromedexsolutions.com.wildpac.wne.edu/micromedex2/librarian/ND_T/evidenc expert/ND_PR/evidencexpert/CS/984F15/ND_AppProduct/evidencexpert/DUPLICATIONS HIELDSYNC/CFB70A/ND_PG/evidencexpert/ND_B/evidencexpert/ND_P/evidencexpert/PF ActionId/evidencexpert.IntermediateToDocumentLink?docId=2814&contentSetId=31&titl e=LIRAGLUTIDE&servicesTitle=LIRAGLUTIDE#  [3.] Liraglutide med guide