Episode #147: Why You Should Consider the GLP Medication Liraglutide

In this week’s episode of Conquer Your Weight, Dr. Sarah Stombaugh dives into why liraglutide may be an excellent option for your weight loss journey—especially now that it’s available as a generic medication.

We explore:

• The clinical data behind liraglutide and how it compares to newer GLP-1 receptor agonists.
• Affordability and access: How the availability of generic liraglutide in 2024 has made it a more cost-effective option for many patients.
• Who it’s best for: Why liraglutide can be a great choice for individuals with less metabolic disease, modest weight loss goals, or those planning pregnancy in the near future.
• Dosing and delivery: What to expect when using a daily injectable GLP-1, including practical tips for success.

Whether you’re new to GLP-1 medications or looking for the right fit for your goals, this episode will help you understand where liraglutide shines in the weight loss landscape.

Ready to get started on your weight loss journey? We'd love to help. We're now enrolling patients to be seen in-person at our Charlottesville, Virginia office or by telemedicine throughout the states of Illinois, Tennessee. Visit www.sarahstombaughmd.com to learn more and get started today. 

Transcript

Dr. Sarah Stombaugh:

This is Dr. Sarah Stombaugh, and you are listening to the Conquer Your Weight Podcast.

Announcer:

Welcome to the Conquer Your Weight Podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician, and life coach, Dr. Sarah Stombaugh.

Dr. Sarah Stombaugh:

Hello everyone, and welcome to this week's episode of the Conquer Your Weight Podcast. We are talking about the medication liraglutide. It is an oldy but goody, and I do not think you should sleep on this one. So this is a medication that can be very effective, but is honestly not that popular. And today we are going to talk about uh why and who may be a really good fit for this medication, because it may be the really perfect medication for you in your journey. Now, if you are looking for an obesity medicine physician who will support you in your weight goals, someone who really understands metabolic health, someone who's willing to listen to you and support you, whether you're talking about 20 pounds to lose or 200 pounds or more to lose, I would love to support you in your journey. If you're just feeling stuck, feeling frustrated, I am here for you. I do see patients in person in Charlottesville, Virginia, and by telemedicine throughout the states of Illinois, Tennessee, and Virginia. If you'd like to learn more about me and work with me, you can visit www.sarastombaughmd.com. You can get that information in the show notes, and I would love to support you in your weight loss journey. 

So let's dive into it, talking about the medication liraglutide. Now, this is the generic name for a once-per-day GLP medication. So it has been around for a while. It's one of the older GLP medications, as all of these have been, at least to date. It was first FDA approved for the treatment of diabetes in 2010 as the brand name Victoza. This medication was available in three doses. A few years later in 2014, it was also FDA approved under the brand name Saxenda for the treatment of medical weight management and actually available in five doses. So the dosing went a little bit higher even for weight management than it did for the treatment of type 2 diabetes. So this medication's been around for a little over a decade. And last year we were all getting really excited in the medical community because Victoza, the diabetes version of this medication, but again, that it's all the same medication, it just has two different names, went off of patent, had a couple of different patents. They all expired, went generic. There was a little bit of time from when it went generic in 2024, when all those patents expired, rather, to when it was actually commercially available as a generic medication. And earlier this year in 2025, at the time of this recording, the medication is finally available as a generic medication. Now, we've been seeing it being made at a lot of compounding pharmacies, and that um may be an acceptable thing also. That's a different conversation for a different day. But as a FDA-approved generic medication, you can buy this medication anywhere. So you could go to your CVS, your Walgreens, whatever your local pharmacy is, and buy this medication. Of course, you do need a prescription for this medication, and we'll talk about what that prescription would entail. Or you could work with your physician or provider to decide if any sort of compounding pharmacy would make more sense. The reason, though, that we're talking about the traditional generic liraglutide that you get at your regular pharmacy is the price of it is really pretty decent and actually better than what I've seen at a lot of the compound pharmacy offerings. 

So, you know, why get the generic at a compounding pharmacy if you could get it at your local pharmacy instead? Nonetheless, we are talking about this medication and why it may be a good fit for you. So this medication is a once-per-day GLP medication. And if you rewind about a decade or a little bit more, and I remember when I very first started residency, I had this interest in supporting patients with weight management. And I was learning about all of the new medications that had just been approved. Now, this is the early 2010s, just been approved for the treatment of obesity. And at that time, we were looking at a couple of new medications that had just been approved. There was the medication called Saxenda, liraglutide, which is what we're talking about today in 2014. But there were also a couple of other formulations. There was a medication called Contrave, which is still available. It's a combination of bupropion and naltrexone. There's a medication called Qsymia, also still available, combination of phentermine and topiramate, and then a medication, Belviq or lorcaserin, that has actually been removed from the market due to concerns about safety. 

But these four medications all got FDA approved within a couple of years of one another. And it was really exciting because here we are, the early, early to mid-2010s. And all of a sudden, for you know, decades, we've had very few options available. There's been, you know, there's bariatric surgery, of course, and that has been an option for a while. But from a pill form, it's like we had phentermine, we had fen-phen, there's a lot of over-the-counter things, a lot of stimulant type medications, but not really a lot of medications available. And then all of a sudden it was like, bam, there's four medications available. Now, when we look at comparing all of those medications and the effectiveness, none of them, not even Saxenda or liraglutide, meets the effectiveness that we have seen with the newer once-per-week GLP medications. So Ozempic was FDA-approved in the end of the 2018s. Then we saw the FDA-approval for Wegovy’s same medication, but again, the two different diabetes and weight indications. And then a few years later, we saw Mounjaro and Zepbound being approved. And these medications were once-per-week medications, and their effectiveness is significant. You know, there's a reason that all of a sudden these medications really took off in popularity in the last couple of years because they really work and they really work to treat the underlying metabolic disease for people who've been struggling with their weight for a long time. 

Now, a decade ago, that wasn't the case. A decade ago, when I would have conversations with patients, we're talking about an injectable medication because liraglutide, Saxenda, Victoza , this is an injection still. It's a teeny tiny injection. So don't, you know, don't turn this off if you're like, ugh, I don't want an injection. I want a pill. That may be another conversation for another day, but some cool medications that are oral form pills coming down the pike, um, end of 2025-2026. So that is just around the corner. But if we're talking about liraglutide, Saxenda, that is an injection. And a decade ago, when we were talking about the Saxenda, liraglutide as an injection compared to a medication like Qsymia, for example, that's this combination of phentermine and topiramate, they were pretty similarly effective, with maybe Qsymia nudging out Saxenda a bit, a little bit more effective. And so the conversation at that time was well, Dr. Stombaugh, why would I take an injection if I could just take a pill instead? And the answer to that question was like, hmm, you know, good point, right? 

We also, of course, even a decade ago, the coverage for these medications was questionable, even though a lot of the medications were pills that were available at the time. The Saxenda was the only injection. The other three were pills. They were still really pretty expensive and um may or may not have been covered by insurance, depending on one's insurance coverage and what that looked like. So we still didn't have really great options available. And Saxenda liraglutide did not stand out above the rest. But with this popularization now in the last couple of years of the once-per-week GLP medications, it has raised this question well, you know, what about Saxenda? And I actually think that this medication is a really good fit for the right person. Now, let me tell you a little bit about the clinical data because it's not that impressive, but I'll tell you who I think this medication is exactly right for. So when we look at the clinical trials to say, okay, we're getting this medication, liraglutide, FDA approved as Saxenda for medical weight reduction in people who have a history of long-standing obesity that has not been responsive to diet and exercise changes alone. What does that look like on average for patients taking these medications? Now, in the clinical trial, there were patients on average who had a BMI, a body mass index of 38, and that corresponded to a weight of about 234 pounds. Then they took a look at how many patients lost 5% or more, 10% or more, 20% or more of their total body weight. Now, about 62% of patients in the clinical trial taking the Saxenda liraglutide medication lost 5% or more. About 33.9% of patients taking Saxenda liraglutide lost 10% or more. And 6% of patients taking this medication lost 20% or more of their total body weight. Now, these numbers were over the course of 56 weeks, I believe. Um, close to that, don't quote me on the exact number, but just a little over a year. And so on average, these patients had lost um, you know, a third of the patients had lost 10% or more, 6% of patients had lost 20% or more. And when you look at what that came to in the average, for patients who completed the study, so they stayed on the Saxenda liraglutide medication for the duration of that 56-week study, on average, there was a weight reduction of 9.2%. So you're like, okay, that's not that impressive, you know? But here's a thing that I will really point out for you is that there's a really broad discrepancy in how people respond to these medications. I think also with the popularization of some of the newer medications, the Ozempic, Wegovy, Zepbound, Mounjaro, we are finding that there are people who may have less metabolic disease or less weight loss that uh less weight, excess weight that's needed. They have less smaller weight loss goals. And sometimes medications like Ozempic, Wegovy, Zepbound, Mounjaro are simply too potent for patients. 

I've had patients who've reached out because they've been prescribed any of those once per week medications. And even at the lowest dose of these medications, they're having very significant side effects, like such severe nausea, they can't eat at all, maybe actually have having vomiting from these medications, and it can be very effective to lose weight quickly if you're just not eating at all or if you're vomiting the whole time. And that, of course, is not the goal for anybody. And so a lot of times that is because the medications that they're being prescribed, again, these newer medications that are much more potent, they may be simply too potent for what that individual needs. And so that can be true just generally. One of the things that's really interesting is there's a group of patients who I think a lot of us obesity medicine clinicians would describe as super responders to these medications. And even now, we look at Zepbound, for example, which has been FD approved for about two years at the time of this recording. And I have patients who've been on it for two years at some of the lowest doses, patients who've taken the 2.5, the five milligram dose. So those are the two lowest doses of the Zepbound medication. And people who even two years later are taking these teeny tiny weeny doses of medication and have done phenomenally, lost, losing 20, 30% plus of their total body weight, despite that being far above the average weight loss on those doses of medication. Now, a lot of times these were also patients who starting out had, you know, had and felt that effective medication, maybe even from a side effect standpoint. So when we think about these patients who are really super responders to the medication, could we respond then by giving them a less potent medication, a medication like Saxenda liraglutide, that although it's less potent, and a lot of times that of course sounds like a bad thing, maybe it's the perfect amount of potent for someone who is a super responder to the medication. Now we don't always know who will be and won't be super responders to the medication. There are certain clues that can point us in that direction, though. So the biggest things are people who do have less weight to lose, the amount of time that they've struggled with their weight, as well as how many weight loss attempts that they have had in the past. The person who has just struggled with weight, maybe since menopause or since having children, but had never really struggled with their weight before, maybe have less metabolic disease, maybe much more responsive to these medications compared to someone who's had much more long-standing issues with their weight. 

On the other hand, also people who have had a lot of weight regain and loss over the past may be less responsive to pair compared to patients who've not had as many weight loss attempts in the past. So those are some factors that can predict it. We do know that on average, women are much more responsive to these medications compared to men. And it's not fully understood, at least at the time of this recording, why that may be the case. But when we're thinking about these people who are super responders and getting really significant side effects and like too, you know, too much effect from the medication, a less potent medication like Saxenda liraglutide, like I said, might be just the right amount of perfect for or uh the right amount of potent for that patient. Also, when we think about people, for example, who would do really well with a short half-life of medication. Now, we think of a once daily injection, and a lot of people are like, oh my gosh, I don't want to take an injection, let alone one every single day. The thing I will always respond with is showing them the needles for these medications, which are teeny teeny, teeny teeny tiny. If you've ever seen someone who takes insulin, so not checking their blood sugar or anything like that, but takes insulin, it's the same type of needle. These needles are often very small, 30, 31, 32 gauge needles and short, you know, usually about a quarter of an inch, between a quarter of an inch and a half an inch, depending on the specific prescription, but tiny needles. So if you think about going to the lab and having your blood drawn, if you think about going in to get your flu shot, those needles are exponentially larger compared to the needle that we're talking about for medications like Saxenda liraglutide. So there's this teeny teeny tiny needle. And so once-a-day injection, while that may not be the right fit for everybody, and you know, I don't think anyone like loves giving themselves injections, there may be people for whom a very short-acting medication makes a lot of sense. So when we think about the way medication is metabolized, how long it lasts in our body, for a medication like Saxenda liraglutide, the half-life is about 13 hours. So what that means when you take the medication every day, you build up this effect within a couple of days, actually, where it reaches somewhat of a steady state. Now, there's some fluctuations, of course, a couple hours after taking the medication, you'll be at the peak, maybe a couple of hours before taking the medication, you'll be at its lowest point, but you'll reach this generally steady state within a few days of taking the medication. And so if you're taking that medication consistently, you'll notice the effect of it. Usually day one, you'll probably have some effect from that medication, but certainly within a couple of days, we'll be really feeling that effect. The effect may be most potent, like I said, a few hours after the peak. 

And so for someone, for example, who's really struggling with nighttime cravings or afternoon cravings, I typically recommend dosing the medication in the morning. Honestly, most people are going to do best with Saxenda liraglutide dosing in the morning time because they're going to have that peak coming up later in the day into the evening hours and being really supportive during those times, then it would be weaning off in the or kind of wearing off in the early morning hours where ideally you're just sleeping anyway. Now, the best time of day to take the medication is the time of day that you'll remember it. And so if you're like, there's literally 0% chance that I would remember to take it in the morning, then taking it in the evening is certainly better than, you know, randomly taking it in the morning or missing doses pretty often. But that being said, we usually recommend once daily dosing in the morning time. And then within a few days, you're reaching the steady state of that medication. And the good news is that if you stopped taking the medication, so let's say you were taking it every single day and then you just stop and you're measuring blood levels of that medication and saying, okay, how long does it take for this medication to get fully out of your system? Now, if we think about the half-life of 13 hours, by five or six half-lifes, that medication will be out of your system completely. So, really, within three days, that medication is gone. It's completely out of your system. So there are people for whom this really will work nicely. The top group of patients that falls into this category is patients who are trying to conceive, patients who desire pregnancy in the really near future. When you look at the once per week medications, those last in your system for a lot longer. You know, certainly it'll take about a month for those medications to get out of your body, but maybe even longer. And we see physicians recommending everything from being off of the medication for two months or three months. And that can be really distressing to be off of the medication and both A really experience sometimes hunger and metabolic disease coming back really quickly, but then also seeing weight gain correspond to that or the weight regain correspond to that. And when you've been working so hard on your weight loss goals, just to feel like you have to have this medication sort of abruptly ripped away from you, that can be a really big challenge. 

So something that can be really nice about a medication like Saxenda liraglutide is especially for this patient population who is considering pregnancy soon, maybe they're trying to conceive, maybe they're in the IVF journey already. This can really help us bring the medication pretty close up to when we would need to discontinue it. Now, I want you, if you're in that situation, you're like, oh, that sounds really interesting. Make sure you talk to your own doctor, your OB/GYN, your obesity medicine doctor, your reproductive endocrinologist, if you're in the IVF journey, to help you to understand this a little bit better, to make sure that you have a plan that is specific to you. But this is something we do very frequently in the practice because this is a group of patients who oftentimes, you know, if there may be polycystic ovarian syndrome or other metabolic uh contributors that are making fertility a challenge, medications like the GLPs, including medications like Saxenda liraglutide, can really, really make a difference for these patients. So those are some of the groups that are really think about it. People who have less metabolic disease, so no type 2 diabetes, maybe prediabetes, people who have less weight loss goals or who've struggled with their weight for a shorter period of time, people who are looking for that short half-life, like people who are considering pregnancy. The other thing is if you do not have coverage for weight loss medications or the treatment of medical weight management, this is a pretty cost-effective option. 

So as this medication went generic, what we're seeing, and these prices are as of the time of this recording, we do see fluctuations on this thing from time to time. So I'll encourage you to go online. You can look up coupons for liraglutide generic medication. Some of the common places that you could look up coupons are things like GoodRX or SingleCare. Those are two great options. And what you can search for is okay, how much would it cost if I got one pen or two pens or three pens of this medication? And in my area, I'm in Charlottesville, Virginia. If you look at the cash pay price for this medication, it's about $83 per pen. And of course, that goes up if you were to get more, like two pens or three pens, for example. So if you're starting at the starting dose of the medication, which is 0.6 milligrams once per day, a single pen will last for a full month. And so potentially, if you're on that lowest dose, this could be about $83 per month to get that medication. Now, if you increase the dose, you'll go through the medication more quickly. And it's a multi-dose pen. And so the cost effectively becomes less cost effective. So the cost would effectively double. So if you went to the 1.2 milligram dose, it would take in 30 days, you would go through two whole pens. And so the cost of that would be about 165, 67, I think, I think it was 167 when I looked a couple of days ago for two of those pens. So that would be the cost of it effectively per month. And while that may be out of budget for some individuals, that's certainly much more affordable compared to the prices that we're seeing for Zepbound, that we're seeing for Wegovy, that we're seeing for Ozempic. And so can be a really decent option. Now, in addition to getting the prescription for the medication, you do actually need a separate prescription for the little needles that you would attach to the pen. And these, interestingly, are usually covered by insurance because it's the exact same type of needles that somebody would use on an insulin pen. And so you would need two separate prescriptions, one for the medication, one for the needles. And then to indicate to your insurance, especially for that liraglutide, that hey, I'd be paying out of pocket for this medication, excuse me, because your insurance is unlikely to cover this medication. They really only cover this medication still for patients with type 2 diabetes, because the this version is for quote diabetes, even though, like I said, it's the exact same medication. 

So, you know, ask your doc, hey, is this something that could be a good option for me? The Saxenda or liraglutide medication. You know, we think about the way these medications are designed to be increased or titrated over time. And it says, hey, every single week you could start at the lowest dose and then every week increase to the next dose. But there's no reason that you have to start at the low dose, see how it's feeling. If you're doing well, if side effects are managed, you're seeing a movement on the scale, then you could stay at that dose. There's no reason that you would have to increase. It'll really depend on what your individual response is to this medication. So if you were looking for a doctor, let's say you bring it up to your doc and they're like, I like don't know what you're talking about, or I'm not sure about that. And you're like, I don't like who can I talk to about this? My best recommendation would be to see a doctor who is board certified in obesity medicine. These are doctors who prescribe these medications every single day who will feel very confident in supporting you, whether it is with something like Saxenda, liraglutide or with some of the newer options. Again, this will really depend on your individual health conditions, on your individual insurance coverage, lots of different factors that we'll consider in making that. Like I've said, I would love to support you in your journey, especially if you're in my area. I see patients in person in Charlottesville, Virginia and throughout the states of Illinois, Tennessee, and Virginia by telemedicine. I also have a lot of online programs available as well from everything from this podcast and social media content, as well as the GLP Guide, which is our online video guide for patients who are looking for answers to some of those most frequently asked questions for the GLP medications. If you are looking for more support, I would love to be the one who helps you. You can learn more about me at my website, www.sarasdomba md.com. You can also schedule a free meet and greet if you have questions in trying to figure out what would make them white, you know, most sense and how I can best support you in this journey. Thank you so much for joining me for today's episode. We'll see you all next time. Bye bye.