Nevolat (Liraglutide)

Liraglutide is generic Saxenda. Since the patent for Saxenda, by Novo Nordisk, expired in 2024 other pharmaceutical manufacturers have been able to produce Liraglutide. Zentiva have named their product "Nevolat" but other manufacturers will be producing Liraglutide and calling it by different generic branded names.

Certain brands will only be licenced for controlling type 2 diabetes but Nevolat has been licenced for weight loss.

GLP-1 is a hormone that is released within the body in response to food intake and acts as a physiological regulator of appetite.

Liraglutide is 97% similar to GLP-1 and works in the brain to decrease appetite and thereby reduce food intake resulting in weight loss. It also delays the time it takes for your stomach to empty so that you feel fuller for longer.

Liraglutide should be used alongside a reduced-calorie diet and increased physical activity for chronic weight management in adult patients with an initial body mass index, BMI of 30 (obese) or 27 or greater (overweight) in the presence of at least one other chronic health condition (eg, high blood pressure, diabetes, or high cholesterol).

Liraglutide is a self-injected prefilled pen used once daily.

Inject your dose of Liraglutide under the skin (subcutaneous injection) in your stomach area (abdomen), upper leg (thigh), or back of the upper arm. It is also recommended that you alternate the site at which the injection is made.

Do not inject into a vein or muscle.

Push the needle all the way into the skin at a 90º angle.

Once you have injected the Liraglutide, leave the syringe in place while you count slowly to 6 to make sure the full dose is delivered.

If the disposable needle found at the tip of one of your Saxenda pens bends out of shape whilst you are trying to use the pen, you should discard the needle and use a new one.

Never share your Saxenda pen or needles with another person. You may give an infection to them, or get an infection from them.

You can order an individual pen or a pack of 3 or 5 pens.

You use a gradually increasing dose over the first 5 weeks.

If you are just starting to use Liraglutide then a single pen should last 17 days and a pack of 5 pens should last 44 days.

Once you are on the full 3mg daily dose, a pack of 5 pens should last 30 days

You should follow a 4-week dose escalation to reach the fully effective 3-mg dose. The 4-week dose-escalation period can reduce the likelihood of gastrointestinal symptoms.

The Liraglutide starting dose is 0.6 mg subcutaneously, SC, per day for 1 week.

You should increase the dose by 0.6 mg each week until the full maintenance dose of 3 mg is reached.

By the start of the fifth week you should be on the maximum maintenance dose.

• Week 1 - 0.6 mg SC once daily x 7 days
• Week 2 - 1.2 mg SC once daily x 7 days
• Week 3 - 1.8 mg SC once daily x 7 days
• Week 4 - 2.4 mg SC once daily x 7 days
• Week 5 onwards ı 3.0 mg SC once daily

You should have lost at least 5% of your starting body weight by week 12 if you want to continue with Liraglutide.

Liraglutide can be taken at any time of the day, with or without food and drink, but you must stick to taking it at the same time each day such as at breakfast or bedtime. Choose a time of the day that works best for you.

If you forget to take a dose, but remember within 12 hours of when you would usually take it, take the missed dose as soon as you remember.

If more than 12 hours have passed since you would usually take it, skip the dose and continue like normal the next day.

Do not take a double dose or increase the dose the following day to make up for the missed dose.

If you use more Liraglutide than you should, talk to your doctor or go to a hospital straight away. Take the medicine pack with you. You may need medical treatment. The following effects may happen: • feeling sick (nausea) • being sick (vomiting).

Before first use Saxenda must be stored in a refrigerator (2°C to 8°C). That is why we deliver it in temperature controlled packaging.

However, once you start using the pen you can keep it out of the fridge for 1 month when stored at a temperature below 30°Cin a refrigerator (2°C to 8°C). When you are not using the pen, keep the pen cap on in order to protect it from light. Do not use this medicine if the solution is not clear and colourless or almost colourless

Do not freeze. Keep away from the freezer compartment.

We will supply the Liraglutide pen with the needles and a yellow sharps box to dispose of used needles.

When the sharps bin is full, it should be returned to your nearest local Household Waste Recycling Centre where it will be disposed of properly.

Only fill the bin up to where it says "Do not fill above this line". You can find your local council here https://www.gov.uk/request-clinical-waste-collection

You must not put used needles or other sharps in any of your household waste bins.

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Serious side-effects

• Some severe allergic reactions (anaphylaxis) have been reported rarely in patients using Liraglutide. You should see your doctor straight away if you get symptoms such as breathing problems, swelling of face and throat and a fast heartbeat.

• Cases of inflammation of the pancreas (pancreatitis) have been reported uncommonly in patients using Liraglutide. Pancreatitis is a serious, potentially life-threatening medical condition. Stop taking Liraglutide and contact a doctor immediately if you notice any of the following serious side effects:- Severe and persistent pain in the abdomen (stomach area) which might reach through to your back, as well as nausea and vomiting, as it could be a sign of an inflamed pancreas (pancreatitis).

Other side effects :-

Very common: may affect more than 1 in 10 people

• Feeling sick (nausea), being sick (vomiting), diarrhoea, constipation – these usually go away after a few days or weeks.

Common: may affect up to 1 in 10 people

• Problems affecting the stomach and intestines, such as indigestion (dyspepsia), inflammation in the lining of the stomach (gastritis), stomach discomfort, upper stomach pain, heartburn, feeling bloated, wind (flatulence), belching and dry mouth
• Feeling weak or tired
• Changed sense of taste
• Dizziness
• Difficulty sleeping (insomnia). This usually occurs the first 3 months of treatment
• Gallstones
• Injection site reactions (such as bruising, pain, irritation, itching and rash)
• Low blood sugar (hypoglycaemia).

The warning signs of low blood sugar may come on suddenly and can include: cold sweat, cool pale skin, headache, fast heartbeat, feeling sick, feeling very hungry, changes in vision, feeling sleepy, feeling weak, being nervous, being anxious, confusion, difficulty concentrating and shaking (tremor).

Your doctor will tell you how to treat low blood sugar and what to do if you notice these warning signs.

• increase of pancreatic enzymes, such as lipase and amylase which may lead to pancreatitis

Uncommon: may affect up to 1 in 100 people

• Loss of fluids (dehydration). This is more likely to occur at the start of treatment and may be due to being sick (vomiting), feeling sick (nausea) and diarrhoea
• Inflamed gall bladder • Allergic reactions including skin rash • Feeling generally unwell
• Faster pulse
• Rare: may affect up to 1 in 1,000 people
• Reduced kidney function
• Acute kidney failure. Signs may include reduction in urine volume, metallic taste in mouth and easily bruising

The most common side effect that you may experience when you first start Saxenda is nausea.

This usually improves as your body adjusts to treatment.

If you do experience nausea, there are some general recommendations that you can follow :-

1. Eat bland, low-fat foods, like crackers, toast, and rice

2. Try drinking ginger or peppermint tea.

3. Avoid lying down after you eat

4. Eat small regular meals and eat mindfully so that you notice a feeling of satiety and don't push past it.

If you experience sickness (vomiting) or diarrhoea it is important to avoid dehydration by drinking plenty of fluids.

As there is limited therapeutic experience in patients 75 years of age or over, use in these patients is not recommended.

Anyone with liver or kidney disease should not take Liraglutide.

Hypersensitivity to liraglutide or to any of the excipients listed in the patient information leaflet.

This medicine is not recommended if you have a severe stomach or gut problem which results in delayed stomach emptying (called gastroparesis), or if you have an inflammatory bowel disease.

Liraglutide should be used with caution in patients with thyroid disease.

Upon initiation of liraglutide treatment in patients on warfarin or other coumarin derivatives more frequent monitoring of International Normalised Ratio (INR) is recommended.

The use of Liraglutide is not recommended if you have severe heart failure or disease of the pancreas.

If you know that you are due to have surgery where you will be under anesthesia (sleeping), please tell your doctor that you are taking Liraglutide.

Do not use Saxenda if you are pregnant, think that you might be pregnant or are planning to have a baby. This is because it is not known if Saxenda may affect the baby. Do not breast-feed if you are using Saxenda. This is because it is not known if Saxenda passes into breast milk.

Special warnings and precautions for use

In patients with diabetes mellitus Saxenda must not be used as a substitute for insulin.

Saxenda should not be mixed with other injectables (e.g. insulins).

If you are diabetic then we will only supply Saxenda if your diabetes is controlled by diet alone and you are not on any medication for it. This is because it will affect your diabetes control and adjustments to your usual medicines may be needed.

No, Liraglutide is a prescription-only medication and requires a simple, discreet consultation.

In order to buy Saxenda weight loss pens from WebMed Pharmacy you will need to complete an online consultation with us to ensure this medication is safe and suitable for you. Our GMC registered doctor will then supply the prescription you need to have Liraglutide. Our pharmacy will make sure that it is delivered to you the next working day if ordered before 3.30pm Monday to Thursday. You can always upgrade to Saturday delivery at checkout if you order after3.30pm on Thursday.

Do not use Liraglutide after the expiry date which is stated on the pen label and carton after ‘EXP’. The expiry date refers to the last day of that month.

The temperature controlled packaging that your Liraglutide is delivered in has a limited life span and therefore, if you select having it delivered to a pickup shop then you must collect it on the day that it’s delivered there and refrigerate it as soon as possible. Or be aware that you can only use it for 1 month when stored out of the fridge at a temperature below 30°C

Also, because Liraglutide is temperature sensitive, if you order after 3.30pm on Thursday it will be sent out on Monday for free tracked delivery on Tuesday. You can upgrade to a Saturday delivery for only £4.

Patient Information Leaflet for Nevolat