Saxenda: what it is used for, dosage and side effects

What Saxenda is and which active substance it contains

Saxenda contains the active substance liraglutide. Liraglutide belongs to the GLP-1 receptor agonists, substances that imitate the action of a natural gut hormone released after a meal, which takes part in regulating blood sugar and in the feeling of fullness.

In the European Medicines Agency data for the Maltese market the medicine is listed with the active substance liraglutide and the route of administration: subcutaneous. It is supplied as a pre-filled pen for injection under the skin; it is not a tablet and it is not insulin.

The same active substance is on the Maltese list under the name Victoza, which is authorised in type 2 diabetes rather than for weight management, and it also appears in a fixed combination with insulin under another name. That is the usual source of confusion in this group: the same substance, different names, different authorised uses and different strengths. Swapping one product for another is not justified in itself, and that decision belongs to a doctor.

Newer medicines from the same or a related group are described on /medicines/wegovy/ and /medicines/mounjaro/, with an overview of the whole group in /weight-loss-injections/. Strengths, the schedule for stepping up and storage rules are in the patient information leaflet in your pack, and the list of medicines authorised in Malta is kept by the Medicines Authority.

Who this treatment is intended for

Saxenda is authorised for weight management in adults with obesity, and in adults who are overweight and have at least one weight related condition, such as high blood pressure, disturbed blood fats, disturbed blood sugar or obstructive sleep apnoea. It is used together with a reduced calorie diet and increased physical activity, not instead of them.

The authorised use sets a frame; inside it, the assessment is individual. A doctor looks at your weight history, other conditions, everything else you take and what you have already tried. What the numbers used to describe weight actually mean is explained in /health-guide/obesity-and-bmi/.

This is not a medicine for cosmetic weight reduction in someone of healthy weight, and it is not a short course before a particular date. Treatment is long term, and stopping it usually means that appetite returns and part of the lost weight comes back.

For children and adolescents the assessment is separate and belongs with a doctor who examines the patient in person and can follow them up. Our questionnaire is not a suitable route for a first assessment of that kind.

How liraglutide works

Liraglutide binds to GLP-1 receptors, including in the areas of the brain that regulate appetite. What most patients describe in practice is weaker hunger, a meal satisfying sooner and less pull towards eating between meals.

The substance also slows the emptying of the stomach, which reinforces the feeling of fullness and at the same time explains the digestive complaints that are most common at the start of treatment. It increases the release of insulin when blood sugar is raised and reduces the release of glucagon, which is why blood sugar can change during treatment.

The medicine does not act on fat directly. It lowers the amount eaten, and the weight change follows from that together with the changes in diet and activity that go with it.

Liraglutide acts for a shorter time than the newer substances in this group, which is why it is injected on a daily rhythm rather than weekly. The full effect is not there at the start, because treatment begins at a low strength that is raised in steps. Whether the treatment is working, and whether to continue it, is judged by a doctor from measurements taken over a longer period.

Dosage and use: what the doctor decides

The starting dose, the pace of stepping up and the dose to aim for are set by a doctor. Treatment begins low and rises in steps, which is what makes nausea and the other digestive complaints manageable. If a step up is not tolerated, a doctor may hold the dose or go back down.

We do not quote specific strengths or intervals on this page. They depend on the pack and on the doctor's decision, and they are stated in the patient information leaflet in your pack.

The medicine is injected under the skin and it makes sense to change the injection site between doses. Do not share a pen with anyone else, even after changing the needle. Follow the storage and refrigeration rules on the pack.

If a dose is missed, follow the leaflet for your own pack rather than doubling up. After a longer break, a doctor may decide to start again at a lower strength, because tolerance falls during a break. Do not stop and restart the treatment on your own initiative.

Side effects and when to contact a doctor

The most common side effects are digestive: nausea, vomiting, diarrhoea, constipation, indigestion and a feeling of bloating. They are strongest at the start and after each step up, and they settle for most people. Smaller portions, eating slowly and avoiding very fatty food help.

Headache, tiredness, dizziness, a raised pulse and reactions at the injection site are also described. Gallstones and inflammation of the gallbladder are recognised risks, and the risk rises with rapid weight loss, so pain in the right upper abdomen is a reason to contact a doctor.

Stop the medicine and seek medical help in the case of severe and persistent abdominal pain, especially spreading to the back and with vomiting, or signs of an allergic reaction such as swelling of the face, lips or throat and difficulty breathing. In an emergency in Malta, call 112.

Low blood sugar is not typical when the medicine is used alone, but the risk rises where it is combined with insulin or a sulfonylurea. Information on how often each effect occurs is in the patient information leaflet for your pack; we do not repeat those figures here.

Interactions, alcohol and when the medicine is not suitable

Slower stomach emptying can affect how medicines taken by mouth are absorbed. For most of them it makes no practical difference, but a doctor takes it into account for medicines with a narrow margin of safety. Bring a complete list of what you take, including products bought without a prescription, supplements and herbal preparations.

Where insulin or a sulfonylurea is used at the same time, a doctor usually adjusts those doses and advises measuring blood sugar more often. Oral contraception is worth raising in the assessment as well, because severe vomiting and diarrhoea can reduce how well it is absorbed.

Alcohol adds calories, works against the aim of the treatment, loads the pancreas and makes worse the digestive complaints that are most common here. It also lowers blood sugar in a delayed way. There is no direct incompatibility, but the combination is not neutral.

This treatment is not suitable in pregnancy, when planning a pregnancy or while breastfeeding. A past inflammation of the pancreas, serious disease of the digestive system, gallbladder disease, severe kidney or liver disease, an eating disorder and a family history of rare thyroid and endocrine disease all need to be raised before a prescription, not after.

Prescription status, cover and the price at the pharmacy

Saxenda is prescription only. A pharmacy does not supply it without a prescription, and the decision to prescribe belongs to a doctor after an assessment of your medical information. We do not sell medicines and we do not ship them; our service is a medical assessment and the issuing of a document.

Whether medicines used in weight management are covered by the public health service in Malta, and on what terms, is decided by the health authorities. Our service is private and is not covered by them, so the pharmacy price of the medicine and our fee are two separate items.

The price depends on the pack and on the strength reached and changes over time, so we do not quote it on an information page. A pharmacy will tell you the current amount, and a pharmacy is the only lawful source of supply. Pens offered outside a pharmacy are a known route for falsified medicines. How the fee for an assessment and the price of a medicine relate to each other is explained in /blog/online-prescription-cost-malta/.

What we can do and what the fee covers

Our model is a medical questionnaire that a doctor reviews asynchronously, from your answers and any records you attach. There is no video call, no phone call and no live chat with a doctor. A questionnaire cannot replace a physical examination, so a first prescription for this kind of treatment needs a doctor who examines you and then follows you up.

If a doctor has already started your treatment and this is a continuation, you can ask for an assessment at /weight-loss/ for 29,90 €. Priority handling is available for an extra 9,90 €, which is not a promise of a deadline. What a doctor looks for when renewing is described in /blog/repeat-prescription-without-a-visit/, and what to do when a pack runs out in /blog/ran-out-of-medication-in-malta/.

If the doctor issues a prescription, you receive the document by email as a PDF in the standard EU cross-border format set out in Directive 2012/52/EU; its recognition in another member state is governed by Directive 2011/24/EU. There is no code and the document is not entered in any Maltese state health record, so you go to the pharmacy with a printout or with the PDF on screen, together with photo identification. A pharmacy in Malta may dispense it; the decision rests with the pharmacist, who can refuse, for example where the medicine is not available locally. What a pharmacy checks is explained in /blog/eu-prescription-maltese-pharmacy/.

The fee covers the doctor's assessment, not the issuing of a document. If the doctor declines on medical or legal grounds, we refund the fee. If we ask you for medical records, you have at least 7 days to reply. We then send a reminder and extend the deadline on request, and where the assessment still cannot be completed we close the request and refund the fee. The assessment is carried out by Damian Wojno, a doctor registered in Poland, licence no. 3211301, MEDINOW Sp. z o.o. He is not registered with the Medical Council of Malta, which keeps the register of doctors practising here; his licence to practise is Polish. Narcotic and psychotropic substances are excluded from cross-border prescriptions under Article 11(6) of Directive 2011/24/EU, and liraglutide is not in that group.