title: Alternative dosing strategies for liraglutide in patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  Alternative dosing strategies for liraglutide in patients with type 2 diabetes mellitus are described.
  
  
  CONCLUSIONS
  Nausea is the most common adverse effect of liraglutide, affecting upward of 40% of patients depending on the dose of liraglutide and concomitant medications. The frequency of nausea is dose dependent, with a lower rate of nausea reported with 0.6 mg (5.2-10.7%) compared with 1.2 mg (10.5-29.2%) or 1.8 mg (6.8-40%). Due to dose-related adverse effects, it is reasonable to assume that smaller or slower dosage adjustments may improve tolerability and increase the likelihood that the patient will be able to continue therapy long term. Depending on the degree of nausea and the necessary reduction in blood glucose levels, it is reasonable to consider a smaller or slower increase in liraglutide dosage than what is currently recommended by the manufacturer. For instance, increasing the dose of liraglutide by 0.3 mg weekly instead of 0.6 mg weekly may help prevent or decrease the severity of nausea. Alternative dosing strategies may also include increasing the dosage every two weeks or even monthly rather than weekly. Depending on the degree of nausea and glycemic control, providers may recommend patients stop increasing the dosage. It is important to proactively assess each patient's ability to comply with special instructions to ensure safe use of the product.
  
  
  CONCLUSIONS
  Alternative dosing strategies that allow for slower dosage adjustments or smaller dosages may offer improved tolerability and increase the likelihood that patients will be able to continue long-term therapy with liraglutide.
authors.affiliation: Adriane B. Marino, Pharm.D., is Ambulatory Care Pharmacy Practice Resident; Sabrina W. Cole, Pharm.D., BCPS, is Assistant Professor of Pharmacy; and Donald S. Nuzum, Pharm.D., BCACP, BC-ADM, CDE, CPP, is Associate Professor of Pharmacy, Wingate University School of Pharmacy, Wingate, NC.
authors.forename: Adriane B
authors.initials: AB
authors.lastname: Marino
authors.forename: Sabrina W
authors.initials: SW
authors.lastname: Cole
authors.forename: Donald S
authors.initials: DS
authors.lastname: Nuzum
mesh_terms: D001786:Blood Glucose / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D052216:Glucagon-Like Peptide 1 / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000069450:Liraglutide; D009325:Nausea / Q000139:chemically induced / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D000069450:Liraglutide; D052216:Glucagon-Like Peptide 1