Saxenda side effects and how to avoid them

Saxenda side effects | Nausea/vomiting | Hypoglycemia | Serious side effects | Thyroid cancer | Pancreatitis | Suicidal ideation | How long do side effects last? | Warnings | Interactions | How to avoid side effects

Effective and safe medications to assist with weight loss have long been sought after. In recent years, the search has turned up some new options. The glucagon-like peptide-1 (GLP-1) receptor agonist class of medications has seen increasing use not only for Type 2 diabetes mellitus management but also long-term obesity treatment, thanks to their ability to reduce appetite. 

Saxenda (liraglutide) is a GLP-1 receptor agonist that is taken as a 3 mg once daily subcutaneous injection. It was approved by the Food and Drug Administration (FDA) for chronic weight management based on studies showing effectiveness and safety when used along with a reduced-calorie diet and increased physical activity. The safety profile of Saxenda is imperfect, however, and this article will review what you need to know about potential Saxenda side effects and drug interactions.

RELATED: What is Saxenda?

Common side effects of Saxenda

The following are commonly reported reactions to Saxenda: 

• Nausea, vomiting, dyspepsia (indigestion), or appetite loss
• Diarrhea, constipation, or gastroenteritis (bowel infection)
• Injection site reaction
• Headache or dizziness
• Hypoglycemia (low blood sugar)
• Fever, cough, or rash
• Tiredness, insomnia, or asthenia (lack of strength or energy)
• Abdominal pain or distention
• Elevated lipase (pancreatic enzyme) or creatinine kinase (muscle enzyme)
• Eructation (belching) or flatulence
• Dyslipidemia (abnormal cholesterol levels)
• Gastroesophageal reflux disease (GERD)
• Urinary tract infection (UTI)
• Depression or anxiety
• Pain in extremities
• Xerostomia (dry mouth)
• Cholelithiasis (gallstones)
• Tachycardia (fast heartbeat)

Nausea/vomiting

In aggregate, gastrointestinal (GI) side effects are by far the most common adverse effects of Saxenda. Approximately 68% of users reported some type of gastrointestinal side effect, compared to 39% of placebo users in clinical trials, according to the product monograph. The most prevalent GI side effect was nausea, affecting 39% of Saxenda users. The drug delays gastric (stomach) emptying. Nausea progressed to vomiting in 15% of those taking Saxenda. When fatigue or a lack of strength are experienced, it is usually in connection with gastrointestinal symptoms like nausea. 

While strikingly common, these GI problems only led 6% of individuals to discontinue Saxenda, and these adverse effects tend to improve with extended GLP-1 agonist use and can be avoided by gradually increasing the dose. The dose of Saxenda can be increased by 0.6 mg every week, starting with 0.6 mg and ending at 3 mg once daily. The dose escalation can be even slower if needed.

Hypoglycemia

Victoza is another brand name of liraglutide manufactured by Novo Nordisk, used at lower doses than Saxenda and for Type 2 diabetes mellitus. Saxenda has a dual purpose in those with Type 2 diabetes and obesity, by assisting with blood glucose (sugar) control and weight loss. In this setting, the incidence rate of hypoglycemia was 23% in a clinical study, but the risk depends largely on what other diabetic medications are being taken concurrently. When diabetes was not present, less than 2% of Saxenda users reported hypoglycemia. 

Serious side effects of Saxenda

• Thyroid C-cell cancer in animal studies
• Medullary thyroid carcinoma (MTC) risk or papillary thyroid carcinoma
• Colorectal neoplasm (tumor)
• Hypersensitivity 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)
• Acute pancreatitis (inflammation of the pancreas)
• Gallbladder disease including cholecystitis or cholelithiasis
• Suicidal ideation

Thyroid cancer

Liraglutide was associated with higher rates of thyroid C-cell tumors in studies of rodents. The applicability of this finding to humans is unknown as it has not been demonstrated in humans. Compared to rodents, humans also have fewer C-cells and a low level of GLP-1 on C-cells. Despite these mitigating facts, more research is needed, and until then, the FDA has a black box warning on Saxenda regarding this concern. The warning states that anyone with a personal or family history of thyroid cancer or a history of Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) should not use GLP-1 agonists. These historical circumstances are mentioned because of their association with thyroid tumors.

Pancreatitis

Non-severe abdominal or stomach pain is listed as one of Saxenda’s common side effects, approaching a 5% incidence rate among users. Pain in the abdomen should be brought to medical attention to determine a cause, as it may be a symptom of pancreatitis. Less commonly, severe causes, such as acute pancreatitis, could be present. Since GLP-1 agonists have been in use, sporadic cases of pancreatitis have been noted during treatment, although a causal effect has not been defined.

Suicidal ideation

Uncommonly, in less than 1% of users, suicidal thoughts have occurred during Saxenda therapy. Confusing the matter is the fact that some placebo (inactive pill for comparison) users in the studies also experienced suicidal ideation. Consequently, no causal association between Saxenda and suicidal thoughts has been confirmed.

How long do side effects last?

Adverse events with Saxenda range from self-limited symptoms to severe events. Nausea may subside despite continued use or could resolve with lowering the dose. Otherwise, mild, common side effects usually resolve with the discontinuation of the drug. Serious side effects, such as allergic reactions, renal failure, and pancreas or gallbladder problems, may require emergent treatment and drug stoppage.

Saxenda contraindications & warnings

Abuse and dependence

Saxenda is not habit-forming and does not induce withdrawal symptoms when stopped.

Overdose

The maximum dosage of Saxenda is the recommended dose, that is 3 mg injected subcutaneously daily. Considering potential effects on the gastrointestinal tract and blood sugar level, an overdose of Saxenda necessitates emergency medical attention and a call to the Poison Helpline at 1-800-222-1222.

Restrictions

Adults of all ages and children as young as 12 years with a bodyweight of more than 60 kg (132 pounds) can use Saxenda for weight loss if they meet need-based criteria and do not have a contraindication. Criteria for use in adults is defined as being obese, having a body mass index (BMI) of at least 30 kg/m2, or a BMI of at least 27 kg/m2 with associated comorbidity such as hypertension (high blood pressure). Saxenda should not be used in pregnancy or while breastfeeding. Other contraindications include a personal history of hypersensitivity allergic reaction to this drug or other GLP-1 agonists; a personal history of MEN 2 syndrome, suicidality, or pancreatitis; or a personal or family history of medullary thyroid cancer. 

Saxenda interactions

Saxenda can interact with a substantial list of medications. For example, any drug whose action is altered by delayed gastric emptying can be affected by Saxenda. Review your entire list of prescription drugs and over-the-counter medications, as well as supplements, with the healthcare provider before starting on treatment. The following are some specific drug interactions.

• The antiviral cidofovir is contraindicated with Saxenda, due to potential bone marrow and kidney side effects with concurrent use.
• Other types of diabetic medications, including sulfonylureas, can be used cautiously in combination with Saxenda. In these situations, blood sugar levels should be monitored to look for hypoglycemia, and dosing may need to be adjusted.
• Aminoglycoside antibiotics, such as gentamicin, may need to be avoided due to a possible increased risk of kidney problems.

How to avoid Saxenda side effects

1. Saxenda can be taken at different times of day, but the prescriber may recommend a specific time. Whatever time that is, you should be consistent with it.
2. Rotate body sites used for injections. Options include the abdomen, upper arm, or thigh. Avoid using the same injection site every time. Refer to the prescribing information or medication guide for instructions on how to use Saxenda.
3. New Saxenda pens should be stored in the refrigerator at 36 to 46 degrees Fahrenheit. After using a Saxenda pen once, it can be stored in the refrigerator or at room temperature between 59 and 86 degrees Fahrenheit. Do not freeze Saxenda or use Saxenda that has been frozen.
4. Before starting Saxenda, review your medical condition with your healthcare provider and point out if you have a personal or family history of thyroid tumors, MEN 2, or pancreatitis.
5. Drink plenty of water to promote more frequent urination, which is healthy for your kidneys.
6. Recognize signs of hypoglycemia (low blood sugars) and report them. Symptoms can include drowsiness, weakness, dizziness, tremor, sweating, fast heart rate, palpitations, and anxiety. Those with diabetes mellitus should monitor blood sugar levels to help avoid hypoglycemia. 
7. Understand that signs of a thyroid tumor could be a lump in the neck, dysphagia (difficulty swallowing), difficulty breathing, or hoarseness. If noted, these should be reported to a healthcare professional for further medical advice.