Adriane B. Marino, Pharm.D., is Ambulatory Care Pharmacy Practice Resident; Sabrina W. Cole, Pharm.D., BCPS, is Assistant Professor of Pharmacy; and Donald S. Nuzum, Pharm.D., BCACP, BC-ADM, CDE, CPP, is Associate Professor of Pharmacy, Wingate University School of Pharmacy, Wingate, NC.
Am J Health Syst Pharm. 2014 Feb 1;71(3):223-6. doi: 10.2146/ajhp130301.
Alternative dosing strategies for liraglutide in patients with type 2 diabetes mellitus are described.
Nausea is the most common adverse effect of liraglutide, affecting upward of 40% of patients depending on the dose of liraglutide and concomitant medications. The frequency of nausea is dose dependent, with a lower rate of nausea reported with 0.6 mg (5.2-10.7%) compared with 1.2 mg (10.5-29.2%) or 1.8 mg (6.8-40%). Due to dose-related adverse effects, it is reasonable to assume that smaller or slower dosage adjustments may improve tolerability and increase the likelihood that the patient will be able to continue therapy long term. Depending on the degree of nausea and the necessary reduction in blood glucose levels, it is reasonable to consider a smaller or slower increase in liraglutide dosage than what is currently recommended by the manufacturer. For instance, increasing the dose of liraglutide by 0.3 mg weekly instead of 0.6 mg weekly may help prevent or decrease the severity of nausea. Alternative dosing strategies may also include increasing the dosage every two weeks or even monthly rather than weekly. Depending on the degree of nausea and glycemic control, providers may recommend patients stop increasing the dosage. It is important to proactively assess each patient's ability to comply with special instructions to ensure safe use of the product.
Alternative dosing strategies that allow for slower dosage adjustments or smaller dosages may offer improved tolerability and increase the likelihood that patients will be able to continue long-term therapy with liraglutide.
介绍了用于 2 型糖尿病患者的利拉鲁肽的替代剂量方案。
利拉鲁肽最常见的不良反应是恶心，具体取决于利拉鲁肽剂量和伴随用药，超过 40%的患者会出现这种不良反应。恶心的发生频率与剂量相关，0.6mg 组（5.2%-10.7%）报告的恶心发生率低于 1.2mg 组（10.5%-29.2%）或 1.8mg 组（6.8%-40%）。由于与剂量相关的不良反应，合理的假设是较小或较慢的剂量调整可能会提高耐受性，并增加患者长期继续治疗的可能性。根据恶心的程度和血糖降低的必要性，合理的做法是考虑较小或较慢地增加利拉鲁肽剂量，而不是目前制造商建议的剂量。例如，每周增加 0.3mg 的利拉鲁肽剂量而不是 0.6mg 剂量，可能有助于预防或减轻恶心的严重程度。替代剂量方案还可以包括每两周或甚至每月增加剂量，而不是每周增加。根据恶心程度和血糖控制情况，医生可能会建议患者停止增加剂量。重要的是要主动评估每位患者遵守特殊说明的能力，以确保安全使用产品。
允许较慢剂量调整或较小剂量的替代剂量方案可能会提高耐受性，并增加患者继续使用利拉鲁肽长期治疗的可能性。
