This guide is part 1 in a series I am writing about how to properly and effectively use weight loss medications (including dosing, duration of therapy and titration).
This post is primarily designed for those who have an understanding of Victoza (the medication) and understand generally how it is used for weight loss and in this way is different from many of my blog posts.
In this guide, I will discuss some considerations on how to use Victoza, how long therapy is, how to increase dosing and other benefits of using it for Weight loss.
If you aren't familiar with Victoza then I would recommend reading this article first which goes into details about the basics of GLP-1 agonists and how they work for weight loss.
Let's jump in:
*Note: Information in this article should not be considered medical advice nor can I offer medical advice to you. This information is provided as an educational resource.
What is Victoza?
Victoza is a medication that was actually designed to treat type II diabetes.
It falls into the class of medications known as the GLP-1 agonists (1).
These medications sit on the glucagon receptor and influence their effects through this mechanism.
While Victoza was primarily designed to treat type II diabetes it has some very special benefits to those suffering from obesity and can actually be used as a weight loss medication.
This benefit is primarily mediated through its influence on insulin, glucagon, and leptin (2).
In some studies, Victoza has been shown to alter leptin resistance and leptin signaling (3).
Leptin, together with insulin, probably accounts for a large majority of weight gain among individuals so targeting these two hormone imbalances may be the reason that Victoza is so helpful in treating weight loss.
Victoza is used to treat type II diabetes but it has also been FDA approved to treat weight loss but under a different name: Saxenda.
Saxenda and Victoza share the same active ingredient and therefore have similar benefits to weight loss, they just differ in what they are FDA approved to treat.
In many cases, it may be easier and cheaper to purchase Victoza compared to Saxenda even though they are the same medication.
With this basic information out of the way, we can discuss the specifics of using Victoza.
Who should Consider using Victoza:
Victoza (along with Saxenda) is probably one of the most powerful weight loss medications currently out.
Using it correctly (which means focusing on dosing) can lead to dramatic and lasting weight loss.
The problem with Victoza (and Saxenda) is that many physicians tend to be aggressive in the dosing which may reduce its long term effects.
They also tend to use Victoza as monotherapy - meaning they use Victoza as a weight loss medication by itself.
Perhaps a better way to use this medication is to COMBINE it with other weight loss medications and therapies such as diet, exercise, intermittent fasting and so on.
Combining these therapies together will increase the total amount of weight loss, reduce the dose necessary for weight loss and lead to long-lasting results.
Many individuals jump into dosing and reach the max dose very quickly which does result in weight loss, but then they plateau very quickly and are unable to lose any further weight.
A better approach to dosing is to slowly increase the dose and only when necessary (but more on this below).
So now that we understand how it is effective we can talk about who should use this medication.
Patients who might consider using Victoza include:
- Those with documented leptin resistance
- Those with documented insulin resistance
- Those with weight loss resistance (inability to lose weight despite diet and exercise)
- Most people who are interested in long term and sustained weight loss
- Those with PCOS, estrogen dominance or other hormone imbalances that may lead to weight gain
Victoza may not work for ALL individuals but it has a very high success rate for those who use it correctly.
Like any medication, you should consider the risks vs the benefits before using it.
Victoza Dosing & Titration for Weight Loss
One of the most important aspects to consider when using Victoza is your dosing schedule.
One of the worst things you can do is jump into using Victoza and rapidly increase your dose up to the maximum dose of 1.8mg per day.
This strategy will result in weight loss but it will lead to a weight loss plateau and the inability to lose weight later on.
Think of Victoza as an adjunct therapy to your existing weight loss therapies and one of the best tools that you have in your arsenal to fight weight loss plateaus.
This makes increasing your Victoza dose something that you should NOT take lightly.
If you burn through the dosing schedule rapidly then you have nothing powerful to fall back on at a later date.
In addition, Victoza is a medication that DOES have side effects (4).
Perhaps the best approach to using weight loss medications is to only use the amount that is necessary to get results and try to keep both your total dose and the length of time that you use it down to a minimum.
This strategy will reduce negative side effects while maximizing the benefits.
This log is also the reason that Victoza should ALWAYS be paired with other weight loss therapies including medications, supplements, dietary changes, exercise changes and so on.
You can think of Victoza as a medication that will augment your ability to lose weight but it will ALWAYS be more effective when combined with other therapies.
With this in mind let's jump into dosing...
There are basically 3 different doses and concepts to understand in this area:
#1. Starting Dose (0.6mg to 1.8mg/day)
The first is your starting dose.
Your starting dose should ALWAYS be the lowest dose (0.6mg per day).
The goal in setting your starting dose is to find the lowest dose possible that still results in some (even minor) weight loss.
Because each person is different your starting dose may be higher or lower than the next person.
And this is a very important point to consider.
Some people experience rapid weight loss upon starting 0.6mg per day while others experience no weight loss at that dose.
So how do you go about finding your starting dose?
The best approach is to start with the 0.6mg dose and stay at this dose for at least 2 weeks while you monitor your weight and symptoms.
If you experience NO change in your weight then you can consider slightly increasing your dose up to 1.2mg.
Rinse and repeat the same steps above at the higher dose.
If you don't experience any weight loss despite increasing your dose then it may be worth increasing your dose up to 1.8mg.
Most people will experience weight loss between the 0.6mg dose and the 1.2mg dose range, but rarely some individuals may need 1.8mg per day.
#2. Titration Dosing (0.6mg based on weight loss)
Once you find your starting dose, it's then time to determine your titration dose.
Titration is a fancy way of discussing how you should go about increasing your dose over time.
And like your starting dose, this will vary among individuals.
The most important thing to remember when determining when (or if) you should increase your dose is your weight.
If you are losing weight at the 0.6mg dose then there is no reason to increase further.
You should never increase your dose as long as you are losing weight.
Your dose should only be increased or titrated once you reach a weight loss plateau.
And a weight loss plateau has a very strict definition.
A weight loss plateau is defined as no weight loss or loss in inches over a 3-4 week period despite taking your medication daily, exercising regularly and doing all other weight loss therapies.
The reason for this is simple:
Your weight WILL fluctuate over time and this isn't anything to be concerned about.
Sometimes you might find that your weight goes up 1-2 pounds one week then drops 3-4 the next and so on.
Some of this variation may have to do with how the medication works, but also might be a product of inconsistencies when using a scale.
In addition, because of the way that Victoza works, it may cause a simultaneous change in your body which results in increased muscle mass and fat loss at the same time.
An increase in muscle mass and a loss in fat mass may result in no net change to your weight even though it IS working.
For this reason, you'll want to constantly measure your hips/waist/arms, etc. during therapy.
Many people start Victoza, experience some weight loss, get excited and try to jump the gun in increasing their dose.
You'll have to exercise some patience because doing this is a big mistake.
You can continue titrating each time you hit a weight loss plateau as necessary until you hit your target goal.
The typical dose range for Victoza is 0.6mg per day up to 1.8mg per day.
The typical dose range for Saxenda is 0.6mg per day up to 3.0mg per day.
So if you get up to the maximum dose of Victoza at 1.8mg per day and need to increase your dose you may need to switch to Saxenda.
#3. Duration of Therapy (How long should you be on it)
The last thing to consider when dosing and using Victoza is the duration of therapy.
This translates to how long should you use it before you stop the medication.
Your goal in using Victoza for weight loss should be to use it only when necessary, to minimize the dose and to minimize the duration of therapy.
With this in mind you really only want to be using this medication during the active weight loss phase.
Once you've reached your desired weight you can continue using Victoza for a few months and then discontinue using the medication at that point.
This logic and way of using Victoza differ from what is generally recommended.
Most pharmaceutical companies want you to use their medication indefinitely (meaning basically forever).
But you don't have to use Victoza in this way.
You can use it only while necessary to lose weight and then stop it once you have reached your desired weight.
In most cases, you will need to use this medication daily for up to 3 to 6 months (usually if you have around 20-50 pounds to lose).
For those who have 50+ pounds to lose you may need a longer duration of therapy.
Following Labs during Therapy
How do you know if Victoza is working for you?
You obviously want to be tracking both your weight on the scale and your body measurements during use, but you can also track some lab tests.
These lab tests help to determine if the medication is working in your body and can also help adjust dosing.
Lab tests to check during dosing include:
- Reverse T3 - Because Victoza should always be used with minor calorie restriction (which has a special definition) it's important to check reverse T3 levels. Reverse T3 can be used as a surrogate marker for metabolic function in the body and can help determine if your calorie restriction is too excessive for your body. If reverse T3 rises while you lose weight then you'll want to slow down the weight gain. The rapid elevation in reverse T3 that occurs with calorie-restricted diets may be an early warning that metabolic damage is occurring which will result in regaining any weight that is lost.
- Leptin - Leptin can also be monitored during therapy for those who have leptin resistance. Victoza may help to both lower or increase leptin depending on the person. You'll know if you are on the right track if leptin is high (above 10) AND you are losing weight. If you are not losing weight and leptin is increasing then this may be a sign of leptin resistance.
- Insulin - Insulin is important to check because Victoza will help reduce insulin resistance. A fasting insulin of greater than 5.0 may be an early sign of insulin resistance.
- Blood glucose - Because Victoza can make your body more sensitive to insulin it can theoretically alter blood glucose and may lead to hypoglycemia (low blood sugar). You can fight this by checking blood glucose either with lab tests or through the use of a glucometer.
- Thyroid hormones - It's important to also follow your thyroid hormones during weight loss. The reason is that as you lose weight, and as your metabolism changes, you may find that you need less thyroid hormone over time. This is usually only necessary for those people who have active thyroid disease.
These labs can be ordered as necessary and may help guide treatment especially in the case of those who have difficult weight loss resistance.
How to get Victoza at a Reasonable Price
While Victoza remains a VERY powerful weight loss medication one of the limiting factors to its use is its cost.
Without insurance, Victoza may cost upwards of $800 per month (which isn't feasible for many people who suffer from obesity).
Another potential issue when using Victoza is that insurance companies tend to be very stingy about covering it.
It doesn't make a lot of sense considering that losing up to 50 pounds is likely to considerably reduce your risk of developing debilitating conditions such as high blood pressure, high cholesterol and type II diabetes - but here we are!
Despite how effective it is, it doesn't look like this price is going to drop anytime soon.
All hope is not lost, though, as there may be some strategies you can look into.
If you are having trouble affording Victoza then try some of these strategies:
- You may find that your insurance will NOT cover Victoza, but if you call you might find that they cover other alternative GLP-1 agonist medications. If this is the case then you may consider switching to one of the covered medications. While Victoza is probably one of the most powerful of the GLP-1 agonists, using a medication is better than none at all.
- Another strategy is to use the coupon code that is provided by the pharmaceutical company. Some people may find that using this coupon will reduce the monthly cost down to $25. The problem with the coupon is that it doesn't always work (it has about a 40% success rate in my experience). You can find the coupon here.
- You can try to have your Doctor fill out a prior authorization form with your insurance company. The prior authorization is a way to try and get your insurance to cover the medication by stating your "case". If you can convince them that it is worth it and that losing weight will reduce how much you cost the insurance company then they may be more willing to cover the cost.
- Another consideration (that I don't necessarily endorse) is to look at Canadian pharmacies. I've seen reports that this works for some people, but it will still require a physician prescription. The cost of purchasing Victoza through this route is around $200 compared to the $800 in the US.
- Lastly, if all other options fail, you can try and have your physician prescribe medications such as Metformin or Glipizide. If you fail these medications sometimes insurance companies will automatically cover third line therapies such as Victoza.
Even when using all of these strategies there will be some people who won't be able to get the medication.
My hope is that this will change over time as people understand how effective these medications can be for weight loss.
If we can lower the cost of this medication, and start using it correctly, we can really make an impact on the obesity epidemic that we currently face.
Side Effects of Victoza
Because Victoza is a powerful medication you should be aware of the symptoms associated with its use.
You'll need to determine if experiencing some of these side effects is worth the weight loss.
This is something that you'll need to discuss at length with your prescribing physician.
- Nausea - This is usually a symptom related to delayed gastric emptying and is often an indication that the medication dose is sufficient and it is working in your body. Nausea should fade over time.
- Vomiting - Victoza should not be continued if you experience Vomiting. Some minor nausea may be okay, but vomiting may be a sign that your dose is too high and you should reduce it or discontinue the medication.
- Rapid weight loss - Some individuals experience rapid weight loss over 2-3 weeks upon starting the medication. This isn't necessarily a negative side effect but monitor your lab tests.
- Abdominal pain - May be an early indication of pancreatic problems. Discuss this symptom with your doctor and have your pancreatic function tested.
- Headache - Headache tends to fade over time as your body adapts to the medication.
- Flu-like symptoms - These symptoms tend to fade over time as your body adapts to the medication.
- Fatigue - Fatigue is usually temporary and tends to fade over time.
Many of the side effects of Victoza tend to fade over time.
If there is any concern with side effects that you are experiencing then discuss those with your Doctor and stop using the medication in the meantime.
Combination Therapy (Using Victoza with other Medications)
Victoza can be combined with other medications which act to increase how effective it will be in the body.
I am going to write in detail about each of these medications in future posts but will include them here as well.
- LDN - LDN or low dose naltrexone may help regulate appetite and reset the body set point. It's often helpful for patients who have a history of metabolic damage from yo-yo dieting.
- Wellbutrin - Wellbutrin is an anti-depressant but it can be combined with LDN to help treat weight loss in patients who have a history of eating disorders.
- HCG - HCG (the hormone, not the diet!) can help balance sex hormones such as estrogen, improve thyroid hormone and may help normalize appetite. It's especially helpful for those who suffer from estrogen/progesterone imbalances.
- Phentermine - Phentermine is an appetite suppressant which can be combined with intermittent fasting (used in a special way) to help make these days easier.
- MIC/B12 - B12 and MIC may help to improve energy levels during weight loss and improve your ability to exercise.
- Cytomel - Cytomel is a T3 medication which can be used to help normalize thyroid function in obese patients who suffer from low T3 syndrome. Maximizing total T3 in the upper reference range has been shown to improve weight loss among obese patients (5).
- Supplements - Certain supplements such as powerful probiotics can help improve gut function and may help alter caloric absorption and utilization in the body.
These medications represent only a part of a complete weight loss plan.
You'll also need to use them in conjunction with diet, fasting, supplements and other weight loss therapies.
Victoza is a very powerful and effective weight loss medication that can be used for most people.
Using Victoza correctly is key if you want long-lasting and efficient weight loss.
This guide is a starting point and should not be considered medical advice.
If you have any questions relating to the use of Victoza please leave them below so I can add to this post and make it more comprehensive over time.
There will be more posts coming on how to use various other weight loss medications in part II.
References (Click to Expand)