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Liraglutide

GLP-1 receptor agonist · Saxenda, Victoza

UK status

MHRA licensed

Availability

Prescription only

Evidence base

Human RCT, phase 3

Controlled drug

No

Liraglutide is the older generation. It works on the same receptor as semaglutide, but it is cleared faster, so it needs injecting daily rather than weekly. That difference alone explains most of why it has fallen out of favour.

01What it is

Liraglutide is a GLP-1 analogue that stays closer to the natural hormone than semaglutide does. One amino acid is substituted and a fatty acid chain is attached, which extends its life in the body from minutes to around a day.

It matters historically because it established that the GLP-1 approach worked, both for blood glucose and for weight. Everything since has essentially been an attempt to improve on it.

02How it came about

Liraglutide was the second GLP-1 drug to market and the first to be practical as a once-daily injection. It established that the approach worked, both for blood glucose and for weight, and the LEADER trial went further by showing cardiovascular benefit, which changed how the class was viewed: not just a glucose drug, but one that affected hard outcomes.

Everything since has been an attempt to improve on it, mostly by lasting longer.

03UK legal and licensing status

Two brands, two indications. Victoza is licensed for type 2 diabetes. Saxenda is licensed for weight management. As with semaglutide, the same active drug under different brands with different licences is a common source of confusion.

NICE has issued guidance covering liraglutide for weight management within specialist services. In practice, availability has shifted towards the weekly drugs.

04How it works

Identical mechanism to semaglutide at the GLP-1 receptor: glucose-dependent insulin release, slower gastric emptying, reduced appetite signalling. The practical differences come from how long it lasts, not from what it does.

• Daily injection. A shorter half-life means daily administration, which most people find less convenient.
• Smaller average effect. Trial results for weight change are generally lower than those reported for semaglutide and tirzepatide, though the trials differ in design and population.

05What it is not

Claims that attach themselves to this compound and do not hold up.

• Not the first choice any more. Weekly drugs have largely displaced it for new prescriptions, mostly on convenience.
• Not two interchangeable products. Victoza is licensed for type 2 diabetes, Saxenda for weight management. Different licences and different doses.
• Not a weaker version of semaglutide. Same receptor, but a genuinely different pharmacokinetic profile, and daily dosing suits some people better.

06What the evidence shows

The main programmes are LEAD for type 2 diabetes and SCALE for weight management, alongside the LEADER cardiovascular outcomes trial. All were funded by Novo Nordisk.

Liraglutide has a longer real-world track record than the newer drugs simply because it has been in use longer, which is worth something when judging safety.

07Reported harms

The side effect profile is the class profile: gastrointestinal effects most commonly, with rarer signals set out in the Summary of Product Characteristics. The surgery and contraception advice for GLP-1 medicines applies.

08Interactions and cautions

The class cautions apply: additional contraception alongside the pill, telling the anaesthetist before surgery, and raised low blood sugar risk in combination with insulin or sulfonylureas.

09Stopping

The same pattern as the rest of the class. The SCALE trial extension data on weight regain after stopping was among the earliest evidence for what is now a well-recognised effect across all GLP-1 drugs.

10Monitoring

Weight, HbA1c where relevant, kidney function, tolerability, and periodic review of continued benefit.

11Questions worth asking

Take these to a doctor or pharmacist. A good clinician will not mind being asked, and the answers are specific to you in a way nothing on this page can be.

1. Is there a reason for daily rather than weekly in my case?
2. Which licence am I being prescribed under?
3. What is the plan when I stop?
4. Does this affect my contraception?

12Common questions

13Sources

Links go to the authoritative source. Where a document sits behind a paywall or moves around, the full citation is given so you can find it yourself.

1. Summary of Product Characteristicselectronic medicines compendium
2. Liraglutide monographBNF
3. Technology appraisal guidanceNICE
4. SCALE trialNew England Journal of Medicine, 2015
5. LEADER trialNew England Journal of Medicine, 2016