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Insulin degludec / liraglutide Side Effects

For the Consumer

Applies to insulin degludec / liraglutide: subcutaneous solution

Along with its needed effects, insulin degludec / liraglutide may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking insulin degludec / liraglutide:

Incidence not known
  • Anxiety
  • bloating
  • bloody urine
  • blurred vision
  • chills
  • cold, clammy skin
  • cold sweats
  • coma
  • confusion
  • constipation
  • convulsions
  • cool, pale skin
  • cough
  • darkened urine
  • decreased frequency or amount of urine
  • depression
  • difficulty swallowing
  • dizziness
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • dry mouth
  • fast heartbeat
  • fast, weak pulse
  • fever
  • flushed, dry skin
  • fruit-like breath odor
  • headache
  • hives, itching, or rash
  • hoarseness when speaking
  • increased hunger
  • increased thirst
  • increased urination
  • indigestion
  • irregular heartbeat
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • lightheadedness
  • loss of appetite
  • lower back or side pain
  • lumps in the neck
  • muscle pain or cramps
  • nausea or vomiting
  • nightmares
  • noisy, rattling breathing
  • numbness or tingling in the hands, feet, or lips
  • pains in the stomach, side, or abdomen, possibly radiating to the back
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • slurred speech
  • sweating
  • tightness in the chest
  • trouble breathing or swallowing
  • troubled breathing at rest
  • unexplained weight loss
  • unusual tiredness or weakness
  • weight gain
  • yellow eyes or skin

Some side effects of insulin degludec / liraglutide may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Body aches or pain
  • chills
  • diarrhea
  • ear congestion
  • loss of voice
  • muscle aches
  • sneezing
  • sore throat
  • stuffy or runny nose
Incidence not known
  • Bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site

For Healthcare Professionals

Applies to insulin degludec / liraglutide: subcutaneous solution

General

The most frequently reported adverse reactions included hypoglycemia and gastrointestinal adverse reactions, such as nausea diarrhea, vomiting, constipation, dyspepsia, gastritis, abdominal pain, flatulence, gastroesophageal reflux disease, and abdominal distention.[Ref]

Gastrointestinal

Common (1% to 10%): Nausea, diarrhea, vomiting, constipation, dyspepsia, gastritis, abdominal pain, flatulence, gastroesophageal reflux disease, abdominal distension, decreased appetite, increased lipase
Uncommon (0.1% to 1%): Pancreatitis, including necrotizing pancreatitis[Ref]

Gastrointestinal adverse events occur more frequently at the beginning of therapy and generally diminish within a few days or weeks of continued use. Nausea was transient for most patients.[Ref]

Metabolic

Weight gain may occur and has been attributed to the anabolic effects of insulin. After 26 weeks of insulin degludec / liraglutide 100/3.6, a mean increase of 2 kg occurred.[Ref]

Very common (10% or more): Hypoglycemia
Common (1% to 10%): Decreased appetite
Uncommon (0.1% to 1%): Dehydration
Frequency not reported: Weight gain[Ref]

Endocrine

Liraglutide:
Frequency not reported: Increased blood calcitonin, goitre[Ref]

Hypersensitivity

Uncommon (0.1% to 1%): Urticaria, rash, pruritus, face swelling
Rare (less than 0.1%): Hypersensitivity manifested with swelling of tongue and lips, diarrhea, nausea, tiredness, and itching
Postmarketing reports: Anaphylactic reaction[Ref]

Hypersensitivity reactions including urticaria, pruritus, and/or swelling of the face have been reported following administration of this drug. Few case of anaphylactic reaction with additional symptoms such as hypotension, palpitations, dyspnea, and edema has been reported postmarketing.[Ref]

Local

Injection site reactions included injection site hematoma, pain, hemorrhage, erythema, nodules, swelling, discolorations, pruritus, warmth, and injection site mass. These reactions are generally mild and transient, disappearing with continued treatment. Lipodystrophy may occur at the injection site. Rotation of injection site may help reduce the risk of developing these reactions.[Ref]

Common (1% to 10%): Injection site reaction
Frequency not reported: Lipodystrophy[Ref]

Cardiovascular

Mean increase in heart rate of 2 to 3 beats per minute has been observed; long-term clinical effects are unknown.[Ref]

Uncommon (0.1% to 1%): Increased heart rate
Frequency not reported: Peripheral edema[Ref]

Dermatologic

Uncommon (0.1% to 1%): Rash, pruritus, urticaria[Ref]

Immunologic

Rare (less than 0.1%): Antibody formation[Ref]

Ocular

Temporary worsening of diabetic retinopathy may occur with abrupt improvement in glycemic control; however, long-term improvement may decrease the risk of progression.[Ref]

Insulin:
Frequency not reported: Temporary worsening of diabetic retinopathy, transitory reversible ophthalmologic refraction disorder[Ref]

Oncologic

Pooled analysis of liraglutide clinical trials reveals the incidence rate for malignant neoplasms at 10.9, 6.3, and 7.2 per 1000 patient-years for liraglutide, placebo, and active comparator treated patients, respectively. Incidence rates were based on investigator-reported events, medical history, pathology reports, and surgical reports from both blinded and open-label studies. Seven cases of papillary thyroid carcinoma were in liraglutide-treated patients and 1 case in a comparator-treated patient. Most were less than 1 cm in greatest diameter and diagnosed in surgical pathology specimens after thyroidectomy prompted by findings on protocol-specified screening with serum calcitonin or thyroid ultrasound. Seven malignant neoplasm events were reported beyond 1-year exposure to study medication: 4 colon, 1 prostate and 1 nasopharyngeal in liraglutide-treated patients with 1 (colon) reported in a comparator-treated patient.[Ref]

Liraglutide:
Frequency not reported: Thyroid neoplasm, malignant neoplasms
Postmarketing: Medullary thyroid carcinoma[Ref]

Renal

Liraglutide
Frequency not reported: Renal impairment, acute renal failure[Ref]

Hepatic

Liraglutide:
Common (1% to 10%): Elevated serum bilirubin, cholelithiasis
Uncommon (0.1% to 1%): Cholecystitis
Postmarketing: Cholestasis, hepatitis, elevated liver enzymes[Ref]

Cholelithiasis and cholecystitis have been reported in liraglutide trials. In doses of up to 3 mg, cholelithiasis and cholecystitis were reported in 1.5% (vs 0.5%) and 0.6% (vs 0.2%), respectively (compared to placebo). The majority of patients with cholelithiasis and cholecystitis require cholecystectomy.[Ref]

Nervous system

Common (1% to 10%): Headache
Frequency not reported: Acute painful peripheral neuropathy[Ref]

Acute painful peripheral neuropathy may occur with abrupt improvement in glycemic control; however, long-term improvement may decrease the risk of progression.[Ref]

Respiratory

Common (1% to 10%): Nasopharyngitis, upper respiratory infection[Ref]

References

1. "Product Information. Xultophy (insulin degludec-liraglutide)." Novo Nordisk Pharmaceuticals Inc, Princeton, NJ.

2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

Some side effects of insulin degludec / liraglutide may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.

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