Ten times the placebo rate
Decreased appetite sits among the six most common reactions in the US Victoza® label and in the Medication Guide. [1] In the five placebo-controlled adult trials pooled in Table 1, the rate was similar at both doses. [1] The table counts people who reported it at least once; it does not say how strong or how lasting the change was.
| Group | People in group | Reported decreased appetite |
|---|---|---|
| Placebo | 661 | 1% |
| Liraglutide 1.2 mg | 645 | 10% |
| Liraglutide 1.8 mg | 1,024 | 9% |
Two terms in the trial tables
The Canadian monograph and the European table use two terms: anorexia, which here means loss of appetite rather than the eating disorder, and decreased appetite. [2][3] MedlinePlus explains that anorexia is simply the medical word for loss of appetite. [6] Canada also lists early satiety, feeling full soon after starting to eat, in up to 1.3% of people on Victoza® in LEAD-2 and none on placebo. [3]
| Trial and term | Victoza® | Comparison |
|---|---|---|
| LEAD-2, anorexia [3] | 0.6 mg 2.5%; 1.2 mg 4.2%; 1.8 mg 5.8% | Placebo 0.8%; glimepiride 0.4% |
| LEAD-2, decreased appetite [3] | 0.6 mg 1.7%; 1.2 mg 5.8%; 1.8 mg 4.1% | Placebo 0.0%; glimepiride 0.0% |
| LEAD-5, anorexia [3] | 1.8 mg 4.3% | Placebo 0.9%; insulin glargine 0.0% |
| Trial 1860, decreased appetite [3] | 1.2 mg 3.2%; 1.8 mg 5.5% | Sitagliptin 0.9% |
| Trial 1860, anorexia [3] | 1.2 mg 3.6%; 1.8 mg 2.8% | Sitagliptin 0.5% |
| EU frequency class [2] | Anorexia and decreased appetite: common | — |
How liraglutide affects hunger
The European product information says liraglutide lowers body weight and fat mass through reduced hunger and lower energy intake, and that GLP-1 is a natural regulator of appetite, although the exact mechanism is not fully clear. [2] In animal studies, liraglutide reached brain areas involved in appetite and increased satiety signals. [2] The US label adds that it slows stomach emptying. [1]
Two small trials measured this directly in people with type 2 diabetes. In a three-week crossover trial of 18 adults, liraglutide 1.8 mg lowered hunger ratings, raised fullness and reduced estimated energy intake at a free-choice lunch by 18% compared with placebo. [4] In a four-week comparison with placebo and glimepiride, fasting hunger was lower and meals were shorter on liraglutide, stomach emptying was slower and weight fell by 1.3 to 2.0 kg more, while the drop in energy intake did not reach statistical significance. [5] Both trials were short and small, so they describe the effect rather than predict how anyone will feel.
Weight in the diabetes trials, and Saxenda®
Weight change was recorded as a secondary result. In the 26-week comparison with sitagliptin, average weight fell by 2.7 kg on Victoza® 1.2 mg and 3.3 kg on 1.8 mg, against 0.8 kg on sitagliptin. [1] Victoza® is approved to improve blood sugar in type 2 diabetes and to reduce cardiovascular risk in adults with heart disease, not for weight loss. [1]
Liraglutide is also sold as Saxenda® for weight management, and MedlinePlus covers both brands on one page; Saxenda® is a separate product with its own label and dosing. [8] The Victoza® label says using it together with other liraglutide-containing products is not recommended. [1]
Why eating less matters with insulin or a sulfonylurea
Victoza® on its own releases insulin only when blood sugar is raised, which is why the label separates the risk of low blood sugar by background medicine. [1] With a sulfonylurea or insulin the risk is higher, and in patients aged 10 and older the label found it higher whatever else they used. [1] NIDDK explains that not eating enough carbohydrates, or skipping or delaying meals, can lower blood sugar too far in people taking those medicines, and that illness that stops you eating has the same effect. [7]
This is the reason the label suggests your prescriber may lower the dose of a sulfonylurea or insulin when Victoza® starts. [1] It is their decision, based on your readings.
Other reasons for a poor appetite
MedlinePlus notes that almost any illness can reduce appetite and that it is often seen in older adults, sometimes without a clear physical cause. [6] It lists sadness, depression and grief, several cancers, chronic liver or kidney disease, heart failure, an underactive thyroid, dementia, pregnancy and some medicines, including certain antibiotics and opioid painkillers. [6] Nausea from Victoza® itself can also make food unappealing. [1]
What the sources describe
- Regular meals if you use insulin or a sulfonylurea: NIDDK advises an eating plan with enough carbohydrate and carrying a fast-acting source in case of a low. [7]
- Smaller, more frequent meals and favourite foods: MedlinePlus suggests these for people whose illness reduces appetite. [6]
- A food record: MedlinePlus recommends writing down what you eat and drink for at least 24 hours to show your provider. [6]
- Do not stop or change a medicine on your own: MedlinePlus advises asking your provider about appetite loss caused by medicines first. [6]
- Tell your prescriber if decreased appetite on liraglutide is severe or does not go away. [8]
Victoza® and Saxenda® are registered trademarks of Novo Nordisk A/S. PepLabo is not affiliated with or endorsed by Novo Nordisk A/S.
When to get help
| Sign | Who to contact | How fast | Source |
|---|---|---|---|
| Low blood sugar signs that do not improve after sugar, or someone who becomes less alert or cannot be woken | Emergency services (911 or local number) | Emergency | MedlinePlus [9] |
| Shakiness, sweating, hunger or confusion after skipping meals while on insulin or a sulfonylurea | Treat per your plan and tell your prescriber | Today | Medication Guide [1]; NIDDK [7] |
| Unable to eat or drink with ongoing nausea or vomiting | Your provider, the same day | Today | Medication Guide [1] |
| Loss of appetite with low mood, hopelessness or thoughts of harming yourself | Seek medical help | Today | MedlinePlus [6][8] |
| Weight loss you were not trying for | Contact your provider | At your next appointment | MedlinePlus [6] |
| Decreased appetite on Victoza® that is severe or does not go away | Raise it with your prescriber | At your next appointment | MedlinePlus liraglutide [8] |
