liraglutide

Victoza

Indications

Action

Pharmacokinetics

Time/action profile (↓ in HbA1c)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• headache

Dermatologic

• pruritis
• rash

Endocrinologic

• thyroid C-cell tumors (life-threatening)

Gastrointestinal

• pancreatitis (life-threatening)
• diarrhea (most frequent)
• nausea (most frequent)
• vomiting (most frequent)
• constipation

Genitourinary

• acute renal failure

Local

• hypersensitivity reactions including anaphylaxis and angioedema (life-threatening)
• injection site reactions

Interactions

Drug-Drug interaction

Route/Dosage

Availability

Nursing implications

Nursing assessment

• Observe patient taking concurrent insulin for signs and symptoms of hypoglycemic reactions (sweating, hunger, weakness, dizziness, tremor, tachycardia, anxiety).
• If thyroid nodules or elevated serum calcitonin are noted, patient should be referred to an endocrinologist.
• Monitor for pancreatitis (persistent severe abdominal pain, sometimes radiating to the back, with or without vomiting). If pancreatitis is suspected, discontinue liraglutide; if confirmed, do not restart liraglutide.
• Lab Test Considerations: Monitor serum HbA_1c periodically during therapy to evaluate effectiveness.

Potential Nursing Diagnoses

Implementation

• Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma, infection, or surgery may require administration of insulin.
• Subcutaneous: Administer once daily at any time of the day, without regard to food. Inject into abdomen, thigh, or upper arm. Solution should be clear and colorless; do not administer solutions that are discolored or contain particulate matter.
  • Initial dose of 0.6 mg/day is increased after 1 wk to 1.2 mg/day. If glycemic control is not acceptable, increase to 1.8 mg/day. Available in a prefilled pen without needle; patient may require Rx for needles.
  • First Time Use for Each New Pen—Follow manufacturer's instructions only once with each new pen or if pen is dropped.

Patient/Family Teaching

• Instruct patient on use of Victoza pen and to take liraglutide as directed. Pen should never be shared between patients, even if needle is changed. Store pen in refrigerator; do not freeze. After initial use, pen may be stored at room temperature or refrigerated up to 30 days. Keep pen cap on when not in use. Protect from excessive heat and sunlight. Remove and safely discard needle after each injection and store pen without needle attached. Advise patient to read the Patient Medication Guide before starting liraglutide and with each Rx refill.
• If a dose is missed do not make up, skip and take next scheduled dose the next day. If more than 3 days are missed, reinitiate at 0.6 mg to minimize GI effects. Notify health care professional and increase dose as directed.
• Inform patient that nausea is the most common side effect, but usually decreases over time.
• Advise patient taking insulin and liraglutide to never mix insulin and liraglutide together. Give as 2 separate injections. Both injections may be given in the same body area, but should not be given right next to each other.
• Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long-term.
• Review signs of hypoglycemia and hyperglycemia with patient. If hypoglycemia occurs, advise patient to take a glass of orange juice or 2–3 tsp of sugar, honey, or corn syrup dissolved in water and notify health care professional.
• Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hypoglycemic or hyperglycemic episodes.
• Instruct patient in proper testing of serum glucose and ketones. These tests should be closely monitored during periods of stress or illness, and health care professional should be notified if significant changes occur.
• Advise patient to tell health care professional what medications they are taking and to avoid taking new Rx, OTC, vitamins, or herbal products without consulting health care professional.
• Advise patient to notify discontinue liraglutide and health care professional immediately if signs of pancreatitis (nausea, vomiting, abdominal pain) occur.
• Advise patient to inform health care professional of medication regimen before treatment or surgery.
• Inform patient of risk of benign and malignant thyroid C-cell tumors. Advise patient to notify health care professional if symptoms of thyroid tumors (lump in neck, hoarseness, trouble swallowing, shortness of breath) or if signs of allergic reaction (swelling of face, lips, tongue, or throat; fainting or feeling dizzy; very rapid heartbeat; problems breathing or swallowing; severe rash or itching) occur.
• Insulin is the preferred method of controlling blood glucose during pregnancy. Counsel female patients to notify health care professional if pregnancy is planned or suspected or if breast feeding.
• Advise patient to carry a form of sugar (sugar packets, candy) and identification describing disease process and medication regimen at all times.
• Emphasize the importance of routine follow-up exams.

Evaluation/Desired Outcomes

• Improved glycemic control.