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What to know about Saxenda for weight loss

Liraglutide—known by the brand name Saxenda—was the first GLP-1 medication FDA-approved for weight loss in 2014. As newer GLP-1s have come on the market, has the original lost its luster? Here’s what the experts say.
Published May 31, 2023

Such a simpler time, 2014. People were pouring ice buckets on their heads to raise money for charity. Selfies were the new party trick. Obesity was finally recognized as a chronic disease by the American Medical Association the year before. And liraglutide, an innovative drug known as a glucagon-like peptide 1 agonist (GLP-1), was given FDA approval for weight management…without much hullabaloo.

No one could have predicted that this single GLP-1 agonist would kickstart an entire new category of weight-management medications. But in a world of semaglutide and tirzepatide and the-next-thing-tides, does liraglutide still have a place? Here’s why the original still stands.

What is Saxenda (liraglutide)?

Liraglutide is one of several types of GLP-1 agonists, commonly referred to as weight-loss injections—and the original. “It was one of the first to hit the market for the treatment of diabetes, in 2010, and the first to also be approved for the treatment of obesity, in 2014,” says Dr. Robert Kushner, M.D., professor of medicine in endocrinology and medical education at Northwestern University Feinberg School of Medicine in Chicago. As such, it helped pave the way for a new direction in treating both diabetes and obesity, he says, by harnessing the power of gut hormones. At the time, this was a novel way to support weight loss.

How does Saxenda (liraglutide) work?

To understand how liraglutide works, you need to first understand GLP-1. A gut hormone that’s released by cells in your gastrointestinal system after you eat, GLP-1’s job is to increase the amount of insulin the body makes in order to balance your blood sugar. It also inhibits glucagon, a hormone that regulates your blood sugar levels. As a result, GLP-1 can prevent blood sugar from spiking after a meal and even lower blood sugar.

GLP-1 agonists, liraglutide included, can amplify and extend the timeline of this effect, ultimately helping to control blood sugar for longer periods of time. On top of this, “liraglutide has actions in the brain to control appetite and slow stomach emptying, making it easier for people with obesity to follow a reduced-calorie diet and lose weight,” says Kushner. “As some of my patients say, the drug ‘quiets the mind’ and makes it easier to eat healthier.” Over time with continued use, liraglutide helps lower the weight at which the body naturally wants to settle.

How long does it take to lose weight on Saxenda (liraglutide)?

As with any weight-loss method, it can take some time to see significant results—especially since liraglutide has to be scaled up over the course of several weeks. “Individuals usually feel some appetite reduction after initiating the medication, although the dose is very low at first,” says Kushner, who notes that clinical trials have shown weight loss can begin as soon as the first week of treatment.

“The medication is slowly escalated every week over the first month of treatment,” says Dr. Holly Lofton, M.D., professor of medicine and surgery at NYU Grossman School of Medicine and the director of the Medical Weight Management Program at NYU Langone Health in New York City. While dosing schedules depend upon the individual and their healthcare provider’s guidance, the starting dose for Saxenda is generally .6mg, while the maximum is typically 3.0mg, per the manufacturer.

Early studies published in the Journal of the American Medical Association and New England Journal of Medicine found that the average amount of weight loss was between 5% and 10% of one’s body weight after 36 months. However, a more recent study published in Obesity Facts found that liraglutide can help people lose nearly 10% of their body weight within four months. To lose the most weight and improve health, experts recommend that patients pair liraglutide—like any other weight-loss medication—with a healthy lifestyle.

A balanced diet will help ensure you get nutritious food despite eating fewer calories, while moving your body, reducing stress, and getting high-quality sleep can help further minimize cravings—all habits that a behavior-change program like WeightWatchers can help you build, in tandem with medication.

Other health benefits of liraglutide

Liraglutide’s ability to control blood sugar also gives it built-in heart-health benefits. The LEADER clinical trial, which ran from 2010 to 2012, assessed the cardiovascular benefits, glycemic control, safety, and cardiovascular risk factors—weight loss included—of liraglutide. “The LEADER trial determined liraglutide to have a benefit in reduction of cardiac risk in patients with diabetes,” says Lofton. A later analysis of that trial, published in Circulation, found that liraglutide also improved the outcomes of people with type 2 diabetes who had a history of heart attack and stroke, as well as those with heart disease.

Liraglutide versus other GLP-1 agonists

After liraglutide, other weight-loss drugs followed. The other medications in the overarching class of GLP-1 agonists work the same way, but they can vary in their results, dosage, and even frequency. Take semaglutide, which is better known by its brand names Wegovy and Ozempic. It is injected weekly instead of daily like liraglutide and studies have shown it can result in greater weight loss. But providers sometimes prefer to prescribe liraglutide over Wegovy because it has a lower risk of side effects.

What’s the difference between Saxenda and Victoza?

Saxenda and Victoza both include the same active ingredient, liraglutide, and are a daily injectable GLP-1 agonist. But they are branded under different names, with different indications and different doses. Saxenda is FDA-approved for weight loss, while Victoza is FDA-approved for type 2 diabetes. According to their respective manufacturers, Saxenda has a maximum dosage of 3.0 mg, and Victoza has a maximum dosage of 1.8 mg. That said, dosage is dependent upon the individual, and should be part of a larger in-depth conversation between a patient and their healthcare provider. Although Victoza can have weight loss as a side effect, it’s less commonly prescribed off-label because research shows the FDA-approved maximum dosage for Saxenda delivers greater weight loss than the maximum dosage for Victoza.

How long do you need to take Saxenda?

Since obesity is a chronic condition, the medications to treat it, such as Saxenda, aren’t designed to be a one-and-done treatment. Rather, they’re meant to be used long-term for as long as someone wants to maintain the weight loss. “It is not a short-term use medication for temporary weight loss,” Lofton says. “It is intended to treat obesity, and does so by changing the physiology of one’s body while they are taking the medication.”

If someone stops taking it, they’ll likely regain the weight they lost. After all, if they’ve lost weight on liraglutide as a direct result of reduced appetite—fewer cravings, an increase in satiety, and a reduction in hunger—then “all of these benefits will disappear once the medication is stopped, making it harder for the patient to maintain the weight loss,” says Kushner. While studies haven’t tested liraglutide specifically, clinical trials of other GLP-1 agonists (namely, semaglutide) concluded that when people stop taking the medication, they regain weight.

What are the side effects of Saxenda (liraglutide)?

Like other GLP-1 agonists, potential liraglutide side effects are mostly gastrointestinal in nature, and may include:

(You can find a complete list of side effects on the Saxenda site.) Whether they happen at all, and their severity, will largely vary from person to person. The best approach for managing side effects focuses on prevention. “Side effects are mitigated by starting at a low dose and escalating slowly over the course of a month,” Kushner says. “You should also follow a diet that’s lower in fat, eat smaller portion sizes, and avoid skipping meals.”

Who shouldn't take Saxenda?

Saxenda is not recommended for people who are pregnant or breastfeeding. Plus, “it is not recommended in those with a history of pancreatitis or personal or family history of medullary thyroid cancer,” says Lofton. On top of that, liraglutide’s side effects are a consideration. For that reason, “other concerns would be a patient with underlying GI diseases or chronic symptoms, such as diarrhea or nausea, since the medication may worsen these symptoms,” Kushner says.

How much does Saxenda cost?

The price of Saxenda can be steep, with a list price over $1,000 for a 30-day supply without insurance. Some insurance plans may cover the drug, which can help reduce that cost—but not all plans cover weight-management medications, including Medicare.

So, for those paying out of pocket or with a commercial insurance plan that doesn’t offer full coverage, Novo Nordisk (the manufacturer of Saxenda) offers a savings card that can whittle down the 30-day cost to $30 or less for patients who meet the eligibility requirements. The manufacturer could stop the savings cards at any time, though, making them a short-term solution for a long-term treatment.

The bottom line

The original GLP-1 agonist, Saxenda stands out because of a lower risk of side effects and years of research on its safety and efficacy. The daily weight-loss injection, scaled up over the course of several weeks, has been shown in studies to translate to a 5% to 10% weight loss when paired with a healthy lifestyle. Research also shows it can improve heart health in people living with type 2 diabetes. Patients must continue taking liraglutide for life, however, to maintain results.