Liraglutide

Origin and structure

Liraglutide is a modified copy of GLP-1, a gut hormone released after meals whose half-life in the body is only 1.5 to 2 minutes. Novo Nordisk replaced the lysine at position 34 with arginine and attached a 16-carbon fatty acid, palmitic acid, through a glutamic-acid spacer to the lysine at position 26. The fatty acid makes the molecule bind to albumin in the blood and cluster under the skin, so it is absorbed slowly, resists the enzymes that break down the natural hormone and has a half-life of about 13 hours: long enough for one injection a day. It keeps 97% of the natural hormone's amino-acid sequence. Novo Nordisk makes the peptide backbone in yeast (Saccharomyces cerevisiae); the copies authorised across the EU in 2026 are made by chemical synthesis instead.

Novo Nordisk developed it under the code NN2211. It was the first GLP-1 agonist for once-daily injection; exenatide, the only one approved before it, was injected twice a day. Besides Victoza and Saxenda, liraglutide is one of the two active substances in Xultophy, a fixed combination with the long-acting insulin degludec for type 2 diabetes. Its molecular formula is C172H265N43O51 and its molecular weight 3751 daltons.

How it works

Liraglutide binds to the GLP-1 receptor and activates it in the same way as the natural hormone. In the pancreas it raises insulin release and lowers glucagon only when blood glucose is high, which is why on its own it rarely causes low blood sugar. It also slows the emptying of the stomach.

The weight loss comes from eating less, not from burning more: the US label notes that liraglutide does not raise energy expenditure over 24 hours. GLP-1 receptors sit in brain areas that regulate appetite, and in animal studies liraglutide reached several of them, including the hypothalamus, but the regions responsible for the effect on appetite have not been identified.

Is liraglutide approved?

Yes. Liraglutide has been an authorised medicine in the EU since 2009 and in the US since 2010, at first only from Novo Nordisk and now also from other manufacturers.

In the Netherlands it is prescription-only. Besides Victoza and Saxenda, the Farmacotherapeutisch Kompas lists Nevolat (Zentiva), Diavic and Byesilor (Sun Pharmaceutical), Diavorin and Vobexoryn (Pharmamedic) and generic liraglutide pens. Basic health insurance reimburses liraglutide only under the conditions in annex 2 of the Regeling zorgverzekering.

Liraglutide sold as a research chemical is not one of these medicines. It has no marketing authorisation, is not made under a medicines licence and may not be used in people. The approvals below describe the licensed products only.

• EU, Novo Nordisk: Victoza authorised on 30 June 2009 for type 2 diabetes, since 2019 also for children from 10 years; the LEADER results are in its product information, but cardiovascular risk reduction is not a separate EU indication. Saxenda authorised on 23 March 2015 for weight management in adults with a BMI of 30 or more, or 27 or more with a weight-related condition; extended in 2021 to adolescents from 12 years (over 60 kg) and in 2025 to children aged 6 to 11 (at least 45 kg).
• EU copies: on 15 July 2026 the European Commission authorised STADA's Ablymico (a copy of Saxenda) and Liraglutide STADA (a copy of Victoza) throughout the EU. The EMA classes them as hybrid medicines, because their active substance is made by chemical processes rather than in living cells.
• US: Victoza approved on 25 January 2010, in August 2017 also to reduce major cardiovascular events in adults with type 2 diabetes and established cardiovascular disease, and in June 2019 for children from 10 years. Saxenda approved on 23 December 2014 and in December 2020 for adolescents from 12 years; the US label does not cover younger children. The FDA approved the first generic of Victoza in December 2024 (Hikma) and the first generic of Saxenda in August 2025 (Teva), and more have followed.

What the research shows

Liraglutide went through two phase 3 programmes, LEAD in type 2 diabetes and SCALE in weight management, followed by the LEADER cardiovascular outcomes trial and separate trials in children and adolescents. These were randomised trials against placebo or another diabetes drug, mostly funded by Novo Nordisk; STEP 8 compared it openly with semaglutide. The headline results:

• LEAD-3 Mono (Lancet 2009): 746 people with early type 2 diabetes; after 52 weeks HbA1c fell by 0.84 and 1.14 percentage points on 1.2 and 1.8 mg daily, against 0.51 on the sulfonylurea glimepiride.
• LEADER (NEJM 2016): 9,340 people with type 2 diabetes and high cardiovascular risk, followed for a median of 3.8 years; cardiovascular death, non-fatal heart attack or non-fatal stroke in 13.0% on liraglutide versus 14.9% on placebo (hazard ratio 0.87, 95% CI 0.78 to 0.97). Cardiovascular death 4.7% versus 6.0% (hazard ratio 0.78) and death from any cause 8.2% versus 9.6% (hazard ratio 0.85).
• SCALE Obesity and Prediabetes (NEJM 2015): 3,731 adults without diabetes with a BMI of at least 30, or 27 with high blood pressure or abnormal blood lipids; after 56 weeks −8.4 kg on liraglutide 3.0 mg versus −2.8 kg on placebo. 63.2% lost at least 5% of their weight (placebo 27.1%) and 33.1% more than 10% (placebo 10.6%).
• STEP 8 (JAMA 2022): 338 adults with overweight or obesity and no diabetes; over 68 weeks −6.4% on daily liraglutide 3.0 mg versus −15.8% on weekly semaglutide 2.4 mg, and 27.6% stopped liraglutide early for any reason, against 13.5% for semaglutide.
• Children and adolescents: separate placebo-controlled trials in 10- to 16-year-olds with type 2 diabetes, in adolescents with obesity (SCALE Teens) and in children aged 6 to 11 with obesity (SCALE Kids) are the basis of the paediatric indications listed above.

Side effects and warnings

Most side effects are gastrointestinal and occur while the dose is being raised. In five placebo-controlled trials in which 3,384 adults received Saxenda, nausea was reported by 39.3% against 13.8% on placebo, diarrhoea by 20.9% against 9.9%, constipation by 19.4% against 8.5% and vomiting by 15.7% against 3.9%. In all, 9.8% stopped early because of side effects, against 4.3% on placebo.

The product information warns about acute pancreatitis; gallstones and gallbladder inflammation (gallstones in 2.2% against 0.8% in the Saxenda trials, most of them treated by removing the gallbladder); kidney injury from dehydration after vomiting or diarrhoea; low blood sugar when combined with insulin or a sulfonylurea; serious allergic reactions; and a faster resting heart rate, on average 2 to 3 beats per minute. Both the Farmacotherapeutisch Kompas and the US label advise stopping when the resting heart rate stays raised. Because liraglutide slows stomach emptying, the US label also warns about inhaling stomach contents during general anaesthesia or deep sedation.

Liraglutide caused thyroid C-cell tumours in rats and mice; whether it does so in humans is unknown. The US labels carry a boxed warning and exclude people with a personal or family history of medullary thyroid carcinoma or MEN 2; the Farmacotherapeutisch Kompas asks for caution in people with thyroid disease. The US Saxenda label dropped pregnancy as a contraindication in May 2025, while still saying to stop when a pregnancy is recognised, and in February 2026 removed its warning on suicidal behaviour and ideation. The Farmacotherapeutisch Kompas advises against use in pregnancy.

Liraglutide versus semaglutide

Semaglutide is Novo Nordisk's successor to liraglutide: the same albumin-binding approach taken further, so that one injection a week replaces seven. In STEP 8, the only head-to-head trial in weight management, semaglutide produced more than twice the weight loss at 68 weeks (−15.8% against −6.4%), and 70.9% against 25.6% of participants lost at least 10%. Gastrointestinal side effects were about as common with either drug (84.1% against 82.7%), but twice as many people stopped liraglutide early (27.6% against 13.5%).

Liraglutide still has a few things of its own: a track record going back to 2009, an EU indication for weight management in children from 6 years, and generic versions on both sides of the Atlantic.

Frequently asked questions

What is the difference between Victoza and Saxenda?

They contain the same molecule. Victoza is authorised for type 2 diabetes and its pen stops at a lower maximum dose; Saxenda is authorised for weight management and its pen goes up to a higher daily dose. The US labels advise against using two liraglutide products together, and Saxenda's also against combining it with any other GLP-1 agonist.

Is liraglutide as effective as semaglutide?

Not for weight. In STEP 8, the only direct comparison, adults lost 6.4% of their body weight on daily liraglutide against 15.8% on weekly semaglutide over 68 weeks, and more people stopped liraglutide early. Liraglutide is injected every day, semaglutide once a week.

Is there a generic version of liraglutide?

Yes. In the Netherlands the Farmacotherapeutisch Kompas lists, besides Victoza and Saxenda, Nevolat, Diavic, Byesilor, Diavorin, Vobexoryn and generic liraglutide pens. In July 2026 two EU-wide copies were added, Ablymico and Liraglutide STADA. In the US, generic versions of Victoza have been approved since December 2024 and of Saxenda since August 2025. The copies are prescription medicines too.

Is liraglutide legal in the Netherlands?

As a medicine, yes, on prescription: Victoza, Saxenda and the generic versions are registered in the Netherlands, dispensed by pharmacies on a doctor's prescription and reimbursed by basic insurance under conditions. Liraglutide sold as research material is not a registered medicine. It may not be sold or promoted for use in people, and it is not the same as a pharmacy pen, whose dose and quality are fixed under pharmaceutical rules.

Is liraglutide banned in sport?

No. GLP-1 agonists, liraglutide included, are not on the WADA Prohibited List, which the Dutch anti-doping rules also apply. The Dopingautoriteit's Dopingwaaier shows the current status of individual medicines.

Storage and handling

Store according to product-label instructions and batch handling notes. Lyophilized research peptides are commonly kept dry, protected from light, and handled with clean laboratory technique.

References

Checked against these sources on 28 October 2026.