Obesity Pharmacotherapy
1. Liraglutide( mean change in BMI: 4-5 %)
a. Patient Selection: i. FDA-approval:
1. Obesity indication( Saxenda): a. Youth ≥12 years with body weight above 60 kg( 132 lbs) and an initial BMI corresponding to ≥30 kg / m 2 b. Adults ≥18 years with BMI ≥30 kg / m 2 or BMI ≥27 kg / m 2 with weight related comorbidity
2. Type 2 diabetes( Victoza): a. Pediatric: ≥10 years old b. Adults: ≥18 years old ii.
Other Considerations a. insulin resistance: acanthosis nigricans, elevated fasting blood glucose levels between 100 and 125 mg / dL, or hemoglobin A1c between 5.7 and 6.4 % b. poor satiety, food cravings c. Fatty liver disease d. Study in 6-11 year-olds with obesity demonstrated efficacy and safety. iii. CONTRAINDICATIONS 1. personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 2. pregnancy and breastfeeding iv. USE CAUTION 1. thyroid c-cell tumors 2. acute gall bladder disease 3. renal impairment 4. suicidal ideation
b. |
To Start Liraglutide: |
i. |
Check baseline basic metabolic panel to assess kidney function |
ii. |
Review warnings with patient and family: nausea, diarrhea, constipation, vomiting, abdominal |
pain, dyspepsia, headache, dizziness, fatigue |
iii. Start liraglutide: 0.6 mg daily subcutaneously for 1 week, then increase by 0.6 mg each week to max dose of 3 mg daily iv. Renown’ s 340b pharmacy offers Victoza at a discounted price( currently about $ 50 / month).
c. |
Follow-up: |
i. |
See patient every 1-3 months, initially to review side effects, efficacy |
ii. |
Expect BMI stabilization at a minimum |
d. |
Discontinue: |
i. |
If BMI continues to increase at full dose after 3-4 months or with side effects |
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