Liraglutide (Victoza®)

The most common side effects are nausea and diarrhea. Some patients may also experience a decrease in appetite, stomach pain, vomiting, constipation. These side effects often get better in a few days or weeks, hence you are advised to continue taking the medicine. However, please speak to your doctor or pharmacist if the side effects continue or are very serious.

Another common side effect is low blood sugar, especially if Liraglutide is used together with other diabetes medicines like sulfonylureas (e.g. Glipizide, Gliclazide).

Symptoms of low blood sugar are weakness, dizziness, hunger, sweating, trembling, blurred vision, unsteady walk or fast heartbeat.
If you experience any of these low blood sugar symptoms, do the following immediately:
Step 1: Check your blood sugar level with a home blood sugar meter (glucometer) if available. If your blood sugar level is less than 4 mmol/L, take 15 grams of sugar such as:
- 3 glucose tablets or
- Half a glass of fruit juice or
- 3 teaspoons of sugar, honey or syrup
Step 2: You should feel better in about 15 minutes. If you have a home blood sugar meter, you should check your blood sugar level again.
Step 3: If your blood sugar level is still less than 4 mmol/L or you still have symptoms of low blood sugar, you should take another 15 grams of sugar.
If your symptoms still do not get better, see a doctor or go to the hospital immediately.

You may also experience some mild bruising, pain, irritation, itching and rash at the injection site.

Pancreatitis (inflammation of the pancreas) is a rare and serious side effect of this medication.
You should stop taking your medicine and check with your doctor immediately if you have these symptoms:
- Very bad pain in the stomach, abdomen or back area
- Nausea or vomiting that does not go away
- Fever

• This medication should not be used if you have type 1 diabetes (your body does not produce any insulin) or a condition called diabetic ketoacidosis (increase in ketones in blood or urine).
• This medication does not replace insulin.
• Inform your doctor if:
• you are allergic to this medication or any of the other ingredients of this medication.
• you are pregnant, planning to get pregnant
• you are breastfeeding
• you have a heart condition, kidney or liver problem
• you have stomach or intestinal problems, gastroparesis (a condition where there is delayed stomach emptying) or inflammatory bowel disease
• you have thyroid problems

​Avoid taking alcohol with this medicine

Liraglutide should be injected into the fat layer of the skin on your upper arms, thigh, or tummy (abdomen). It is not to be injected into the veins or into the muscles. Inject the dose told by your doctor, nurse or pharmacist. Read the product information leaflet on how to inject this medication.​

Preparing your dose

​	​ 1. Pull off pen cap 2. Check liraglutide in the cartridge. Liquid should be clear, (almost) colourless and free of particles. If not, you must use another pen.
​	​ 3. Pull paper tab from new disposable needle NovoFine® or NovoTwist® disposable injection needles up to a length of 8 mm and as thin as 32G (0.25/0.23 mm) and screw needle tightly onto pen.
​​	​ 4. Pull off outer and inner needle caps- discard inner cap, but save outer cap for needle disposal. Use a new needle each time you inject. Be careful not to bend or damage the needle.
​​​	​ 5. Always check flow of liraglutide before first injecting with a new pen. a) Turn dose selector until the flow-check symbol aligns with the pointer. b) ​Hold the pen with the needle pointing up. Tap the cartridge gently with your finger a few times, so any air bubble will rise to the top of the cartridge.
​	​ Keeping the needle pointing up, press dose button until 0mg aligns with the pointer and a drop of liraglutide should appear at the needle tip. If not, repeat steps 5a)-b) up to four times. If there is still no drop of liraglutide, change the needle and repeat steps 5a)-b) once. If a drop of liraglutide still does not appear, do not use the pen as this indicates it is defective and you must use a new one.  NOTE: If you drop your pen against a hard surface or suspect something is wrong with it, you have to put on a new disposable needle and check the flow before you ​inject.

​Dialing your dose​

​​

​ ​​1. Before selecting your dose, always check 0mg aligns with pointer. 2. Turn dose selector until dose is exactly aligned with pointer- depending on your healthcare provider’s recommendations, select 0.6mg, 1.2mg or 1.8mg. If the dose selector stops before you reach your dose, there is not enough liraglutide left for a full dose. Turn the dose selector backwards until an available dose lines up with the pointer and be careful not to press the dose button, as liraglutide may come out. Inject the available dose and then prepare a new pen to inject the remaining amount required to complete your dose. Otherwise, you can choose to inject the full dose with a new pen. Note: Do not use the cartridge scale to measure how much liraglutide to inject as it is not accurate enough. ​​

​ Injecting your dose

​	​ 1. Insert needle either into your abdomen, thigh or upper arm.
​​​	​2. Press the dose button until 0mg aligns with the pointer- be careful not to touch the display or press the dose selector sideways when you inject. 3. Keep dose button pressed down and leave the needle under the skin for at least 6 seconds to ensure you get your full dose.
​	​4. ​Withdraw the needle. You may see a drop of Liraglutide at the needle tip – this is normal and has no effect on your dose.
​	​5. Place the outer nee​dle cap on table and carefully guide the needle into the cap. Do not try to put the inner needle cap back on the needle
​​	​6. Once the needle is covered, carefully push the outer needle cap completely over the needle. Then unscrew the needle and dispose of it in a sharps container. Put the pen cap back on after every use. Store your pen without a needle attached.
​	​NOTE: When the pen is empty, remove the needle and throw away the pen in accordance with local requirements.

​If you forget a dose, use the injection as soon as you remember. However, if it is more than 12 hours since you should have injected this medication, skip the missed dose. Then inject the next dose as usual the following day. Do not inject an extra dose or increase the dose on the following day to make up for the missed dose.

​Make sure that your liraglutide injection appears clear and colourless/almost colourless before use. Do not use if it has been frozen accidentally. Ensure the needles are suitable for use with the injection.

Keep all new, unopened injections in a refrigerator between 2 to 8 degrees Celsius. Do not freeze.

Once you have started using the injection, you can choose to continue storing them in the fridge, or at room temperature (below 30 degrees Celsius). Keep the cap on the injection to protect the medicine from light. Keep this medication out of reach of children. Throw away the injection 4 weeks after opening.

​Throw away this injection, along with the needle, into a metal tin or glass jar to so that you won’t get any injuries from getting pricked by the needle accidentally. If used at the hospital, your healthcare provider will dispose the injection and needle in an appropriate sharps container.

Reference: Victoza®. [package insert]. Bagsvaerd, Denmark: Novo Nordisk A/S; 26 July 2016