Saxenda (Liraglutide) after Bariatric Surgery

Have you wondered about Saxenda (Liraglutide) after bariatric surgery? If you’re not as familiar with this medication as the newer Wegovy or Zepbound GLP1s, keep reading. This medication started the GLP1 party!

Liraglutide, the active ingredient in Victoza for diabetes, is also approved for obesity treatment in the medication Saxenda. This GLP 1 receptor agonist is a once-a-DAY injection and was approved before the newer once-a-week options we see with Wegovy and Zepbound. Find out about all 7 FDA approved medications for Obesity here!

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There is a lot of information to overwhelm yourself with regarding medication management. Instead, stick with me and I will tell you what you need to know about medications like Saxenda, even after bariatric surgery.

TL;DR (stands for too long didn’t ready) the GLP1s in order of results: Tirzepatide, Semaglutide, Liraglutide.

Or to use brand names: Zepbound, Wegovy, Saxenda.

So why would someone take Saxenda instead of the newer medications? I’ll cover that!

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What is Saxenda (Liraglutide)?

The active ingredient in Saxenda is Liraglutide. This is the same ingredient in the medication Victoza. The dosage differs depending on if the medicine is being prescribed for Diabetes or Obesity management.

Liraglutide is a GLP-1 receptor agonist. This is why you might also hear these medications called GLPs or GLP1s. It was the first medication to use GLP 1 as a mechanism for blood sugar control and yield positive weight change as well. Other medications that use GLP-1 receptor agonists include Zepbound and Wegovy.

You can find out about Zepbound here. Saxenda was the first medication to use GLP1 as a mechanism but is a once-a-day injection so things got really exciting when Wegovy/Ozempic came along with a once-a-week option and with more results.

When or why use a medication like Saxenda after bariatric surgery?

Bariatric surgery continues to be the most effective treatment to the disease of obesity. It’s super exciting that we also have medication options to add to the toolbox because weight reoccurrence after the first year post-op can be a common part of the journey. What we don’t know is how much. Everyone is different.

A medication like Saxenda after bariatric surgery is safe and effective and can help continue to manage Obesity and Obesity-related diseases in the long run.

Post-op patients also have the benefit of already undertaking major lifestyle changes so the learning curve to introduce a medication is likely not as steep!

Side effects and contraindications of taking Saxenda after bariatric surgery?

Like any of the GLP-1 receptor agonists, nausea is the most common side effect. The symptom is most present when the medication is first started or anytime the dose is increased. For many patients, it will improve but for some, they will give up on the struggle. No one wants to live with constant nausea and in fact, it’s not recommended to ignore nausea for too long.

Other symptoms to manage include gas, bloating, belching, GERD, constipation, diarrhea, or headaches. Many symptoms are a result of delayed gastric emptying (and something I coach patients through often!)

Here is who Saxenda is NOT for. Anyone with a history of thyroid cancer or pancreatitis, or is pregnant. Other GI issues like inflammatory bowel disease or a history of kidney or liver disease may also not be a good candidate. An Obesity Medicine doctor will be able to help identify if or when a medicine is right for you.

Cost and supply issues

As of late June 2024, Liraglutide is available in Generic at a 1.8 mg dose. Source That makes it the first GLP1 with a generic version. It takes 20 years of a patent to expire before a drug can be approved. And sometimes a patent can be extended. It can take awhile so it’s a big deal that Liraglutide has hit that milestone!

Many people will qualify for Saxenda using the metrics of BMI. That doesn’t mean it will be covered by insurance, but that they are medically appropriate. The medication is for anyone with a BMI over 30 (or BMI over 27 with a weight-related co-morbidity) or for those experiencing a weight plateau or weight reoccurrence after bariatric surgery.

Though many qualify, affordability and supply are the next big hurdles.

Some patients may get coverage for a GLP-1 if they have diabetes and can get Ozempic, Mounjaro or Victoza for treatment. Many obesity medications are not covered and are quite expensive. You can look for savings cards or coupons, although it may be over $500-1,000 a month even with the savings. Even if patients can afford it at first, it could become a big struggle to afford it long term.

It’s possible (I’m hopeful!) that coverage may increase with time but until then, patients may look at all the options to see what fits their budget. (Follow the Obesity Action Coalition to help advocate for more Obesity coverage!)

If supply is the issue, you might have to call around all the pharmacies in your area and ask if they have it in stock. Be specific with the dosage of pen you need and I’ve heard patients have more luck at smaller pharmacies.

This is one reason why patients may chose Saxenda over the newer medications: supply. If they can’t get Zepbound or Wegovy reliably, their doctor may prescribe Saxenda if they have more confidence the supply with prevent gaps in taking the medicine.

Where to go for Saxenda prescription and monitoring?

This is a sticky area, especially in light of cost and supply. When it comes to healthcare, you do want to make sure you are working with qualified experts. Compounding pharmacies have been found to use salt forms of drug ingredients that are not FDA-approved. You’ll find warnings from the FDA online about using compounded versions of GLP-1 medications.

I recommend contacting your surgical team to ask if they offer medical management of obesity. If you don’t have access to your team, visit obesitymedicine.org and use the Find a Provider option. These are obesity medicine experts who know medications and the disease very well.

What happens when you stop taking Saxenda?

I get this question all the time. I’ve even been asked by other dietitians what happens when someone stops taking the medication. How do we teach them to maintain the weight loss?

The short answer is that we don’t. This is a medication treating a chronic disease. It’s not about teaching someone to keep weight off. While some patients may be able to maintain weight when the medicine is titrated down, the vast majority will experience weight relapse when the medicine isn’t present.

That’s a hard pill to swallow (or injection to take). The medications are indicated for long-term use and that means cost and management are long-term.

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