Liraglutide is known to decrease gastric motility and gastric emptying. Liraglutide should be used with caution in patients with or at risk of developing gastroparesis. There have been no studies demonstrating an absolute contraindication for use in these patients. However, added decreases in motility and increased nausea would further decrease gastric emptying and augment nausea and is not generally recommended. (Novo Nordisk Inc., 2013)
Liraglutide’s ability to decrease gastric emptying may lead to alterations in absorption of oral medications. There is a low potential for drug interaction related to cytochrome P450 (Novo Nordisk Inc., 2013, p. 5). Liraglutide was noted to decrease the bioavailability of digoxin, Lisinopril, as well as oral contraceptives. These should be considered when combining these therapies. Of the drugs evaluated, there were no changes noted in bioavailability of atorvastatin, acetaminophen, or griseofulvin (Novo Nordisk Inc., 2013, p. 6). Liraglutide may increase the effects of sulfonylureas and the effects of liraglutide may be augmented by the concomitant use of pegvisomant. The effects of liraglutide may be decreased when combined with both orally administered and inhaled corticosteroids, luteinizing hormone-releasing analogs, somoatropins, and thiazide diuretics (LexiComp, 2014). There are drugs or alternative therapy supplements in which concomitant use is contraindicated (LexiComp, 2014).
Nausea being the primary adverse reaction to liraglutide it is necessary to educate patients on ways to decrease these symptoms and to monitor for fluid and electrolyte losses related to vomiting. These symptoms are reduced with incremental dosing and with continued use of the drug. Tolerability of the symptoms and continued use should be evaluated with the patient who complains of nausea. Additionally, patients who respond appropriately to liraglutide but experience nausea should be educated that symptoms typically subside with continued use of liraglutide and benefits of continuing therapy should be discussed to aid in compliance.
Liraglutide carries a black box warning for the development of thyroid C-cell tumors. The development in thyroid tumors was noted in animal studies of the drug in mice. In these studies, mice subjects underwent monitoring of serum calcitonin as well as thyroid ultrasound to determine the presence of thyroid tumor. This increased surveillance may attribute to the increase in incidence of thyroid tumor findings. However, clinical trials in human subjects could not prove or disprove the risk of the development of thyroid tumors. It is also unclear if routine monitoring of calcitonin or ultrasound evaluation of the thyroid gland would decrease the incidence of thyroid carcinoma in humans. Therefore, patients which are at risk for the development of thyroid tumors, especially those individuals with family or personal history of medullary thyroid...