Saxenda: the newest recruit into the battle against obesity

Posted 4 April 2019 in Weight Loss

Feet on weighing scales. Source: medicalimages.comObesity is a growing problem in the UK. A quarter of UK adults are obese, and this proportion could rise further with our increasingly sedentary lifestyles and readily available cheap, unhealthy food. With many of us moving less due to sitting at desks at work, getting around by car and spending more time on the sofa instead of up and about, we burn fewer calories. Combined with a higher calorific intake thanks to the generally lower cost and greater accessibility of unbalanced ready meals and fast food compared with fresh produce, this equates to weight gain. (1)

Most of us know that on a basic level, the key to losing weight is simply eating less and moving more, so that on a daily basis, calories taken in amount to less than calories burnt. But in reality, many factors can stand in the way of this change in lifestyle, including time constraints and lack of motivation. In addition, several medical conditions such as type II diabetes mellitus, pre-diabetes, polycystic ovarian syndrome (PCOS) and hypothyroidism, as well as certain medications, can make weight loss harder to achieve. That’s why medical intervention may sometimes be needed. (1)

Until recently, there was only one medication – orlistat – licensed to treat obesity in this country. Orlistat stops around a third of the fat in your diet being absorbed, helping to prevent weight gain. However, unpleasant side effects directly related to this mode of action include oily, loose stools, flatulence, urgency to pass stools more frequently than is normal for you, and an oily rectal discharge. (1)

What is Saxenda and how does it work?

The newest addition to the obesity treatment market is Saxenda, a brand of the medication liraglutide. Liraglutide was originally developed as an anti-diabetic drug and is licensed for this purpose under the name Victoza, at a different strength to Saxenda. Saxenda is available as a pre-filled pen for subcutaneous (under the skin) injection containing 18mg of liraglutide in 3ml of solution. (2)

Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist, meaning it acts at the receptor for GLP-1, an appetite-regulating substance naturally produced in the body. The way in which liraglutide interacts with the receptor is currently unclear. (2)

Saxenda is different from weight management products that you may have taken in the past. Saxenda makes you feel full and less hungry, which can help you eat less and reduce your body weight.  It can help you to not only lose weight, but keep it off as well.

Use the Saxenda pen at home or on the go

You can inject your dose in your stomach area (abdomen), upper leg (thigh), or upper arm.

Saxenda - self-injectable pen can be used in the upper arm, abdomen or thigh

Who can use Saxenda?

Saxenda is licensed to treat obesity in people with a body mass index (BMI) of 30kg/m2 or higher, or those with a BMI of 27kg/m2 to 30kg/m2 who have one or more of a number of weight-linked health conditions including type II diabetes mellitus, hyperlipidaemia (raised fat or cholesterol levels in the blood), high blood pressure and obstructive sleep apnoea. It should be used in combination with a reduced-calorie diet and regular exercise. (2)

Children and young people under the age of 18 should not use Saxenda, as it is not yet known how the drug affects this age group. Furthermore, Saxenda should not be used by pregnant or breastfeeding women due to unknown effects on the foetus or baby. (3)

What is the dose for Saxenda?

When starting Saxenda, the initial dose is 0.6mg daily, injected into the abdomen, front of the thigh or upper arm, but not into a vein or muscle. The dose is increased at least on a weekly basis by a further 0.6mg until the daily dose is 3mg, the maximum recommended daily dose. The reason for this gradual increase in dose is that gastrointestinal side effects, such as nausea, vomiting, diarrhoea and constipation are very common, especially at the beginning of treatment, so lower doses to start improve tolerability and make it more likely that the patient will continue treatment. If Saxenda is still intolerable two weeks after stepping up to the next dose, treatment should be stopped. (2)

How long before Saxenda starts to work?

Patients using Saxenda can expect to have lost at least 5% of their starting weight once they have been on 3mg daily for twelve weeks, given they have also been consuming fewer calories and increasing exercise. If this hasn’t been achieved, treatment with Saxenda should no longer be continued. (2)

What results have been seen with Saxenda?

Medical studies with more than 3,000 people taking Saxenda were conducted to understand the benefits and risks of Saxenda. The results from the study showed significant weight loss.

Along with a low-calorie meal plan and increased physical activity, some people lost nearly 2.5 times more weight with Saxenda versus placebo (17.3 lb vs 7 lb). Study participants had an average starting weight of 234 lb and an average BMI of 38. (3)

In a different 1-year study, most people who stayed on Saxenda kept the weight off. (3)

Can I use Saxenda alongside other medication?

If you take a type of medication for diabetes known as a sulfonylurea (such as gliclazide or glimepiride), the dose may need to be adjusted while you use Saxenda to reduce the risk of hypoglycaemia (low blood sugar). (4)

If you use Victoza for diabetes you should not use Saxenda at the same time. This is because they both contain liraglutide, so using them together will lead to overdose.

Patients taking warfarin or other anticoagulants may need to have more frequent tests to monitor how long it takes their blood to clot. (4)

Where can I find Saxenda?

Saxenda is usually only prescribed privately as the manufacturer does not intend for it to be promoted within the NHS. It will be available to purchase from Webmed Pharmacy in the near future, so watch this space! (5)

References

  1. NHS. Obesity – Overview [cited 24 March 2019]. Available at: https://www.nhs.uk/conditions/obesity/
  2. NICE. Obese, overweight with risk factors: liraglutide (Saxenda) – Product overview [cited 24 March 2019]. Available at: https://www.nice.org.uk/advice/es14/chapter/Product-overview
  3. Novo Nordisk. Saxenda [cited March 2019] https://www.saxenda.com/learn-about-saxenda/what-results-have-been-seen-with-saxenda.html
  4. emc. Saxenda 6 mg/mL solution for injection in pre-filled pen [cited 24 March 2019]. Available at: https://www.medicines.org.uk/emc/product/2313/pil
  5. NICE. Obese, overweight with risk factors: liraglutide (Saxenda) – Estimated impact for the NHS [cited 24 March 2019]. Available at: https://www.nice.org.uk/advice/es14/chapter/Estimated-impact-for-the-NHS

Author
Gabby Gallaher MPharm

Medically reviewed by
Superintendent pharmacist Margaret Hudson BSc(Hons) MRPharmS
4 April 2019

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