For individuals managing type 2 diabetes, medications such as Trulicity (dulaglutide) and Victoza (liraglutide) are often prescribed to aid in blood sugar control. Both drugs belong to the glucagon-like peptide-1 (GLP-1) receptor agonist class, but they have distinct characteristics regarding their administration, dosage, and potential side effects. This article provides a detailed comparison of Trulicity and Victoza to help you understand their similarities and differences, especially concerning weight loss.
Introduction to Trulicity and Victoza
Trulicity and Victoza are prescription drugs used to lower blood sugar levels in adults and children ages 10 years and older with type 2 diabetes and to reduce the risk of certain cardiovascular problems in adults with type 2 diabetes and cardiovascular disease.
Trulicity contains the active ingredient dulaglutide, while Victoza contains liraglutide. Both dulaglutide and liraglutide belong to the same drug class: glucagon-like peptide-1 agonists. A drug class is a group of medications that work in a similar way.
What is Trulicity?
Trulicity is a once-weekly injectable medication primarily used to treat type 2 diabetes. The FDA approved it in September 2014. Trulicity mimics the action of GLP-1, a hormone that enhances insulin secretion, suppresses glucagon release, and slows gastric emptying. Dulaglutide may affect the absorption of other medications that you take by mouth. Talk to your doctor before using alcohol together with dulaglutide.
What is Victoza?
Victoza is another GLP-1 receptor agonist approved earlier than Trulicity, in 2010. It is also used for the treatment of type 2 diabetes and shares similar mechanisms of action with Trulicity. Like Trulicity, Victoza stimulates insulin secretion, inhibits glucagon release, and delays gastric emptying. Liraglutide may affect the absorption of other medications that you take by mouth. Talk to your doctor before using alcohol together with liraglutide.
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How Trulicity and Victoza Work
Both Trulicity and Victoza work by binding to and activating GLP-1 receptors found throughout the body, particularly in the pancreas, stomach, and brain. This activation leads to several beneficial effects:
- Insulin Secretion: GLP-1 receptor agonists enhance insulin secretion from pancreatic beta cells in response to elevated blood glucose levels.
- Glucagon Suppression: They suppress the release of glucagon, a hormone that raises blood sugar levels by stimulating the liver to release glucose.
- Gastric Emptying: GLP-1 receptor agonists slow down the rate at which food empties from the stomach into the small intestine.
Indications and Usage
Trulicity and Victoza are both used to:
- Lower blood sugar levels in adults and children ages 10 years and older with type 2 diabetes. Both drugs are approved for this use when used with diet and exercise.
- Lower the risk of major cardiovascular problems (related to the heart or blood vessels), such as heart attack, stroke, or death from cardiovascular issues. Both drugs are approved for this use in adults who have both type 2 diabetes and cardiovascular disease (CVD). Trulicity is also approved for this use in adults with type 2 diabetes and two or more CVD risk factors.
Weight Loss Potential
Both Trulicity and Victoza have been associated with weight loss in patients with type 2 diabetes. Weight loss is a side effect of Trulicity, and research shows it helps people with type 2 diabetes lose weight.
Weight Loss with Trulicity
In 2021, the journal Diabetes Care published the results of a clinical trial on 1,842 patients with type 2 diabetes and an average body mass index (BMI) of 34 who had tried the first-line diabetes drug metformin. The participants randomly received once-weekly dulaglutide doses of either 1.5 mg, 3.0 mg, or 4.5 mg for 52 weeks. The trial revealed that the 4.5 mg dose of dulaglutide (Trulicity) was the most effective for weight management, with an average weight loss of about 10 pounds after 36 weeks.
Weight Loss with Victoza
Even though Victoza is not FDA-approved for weight management, research shows it’s effective for weight loss when combined with behavior changes. A critical review of five liraglutide studies published in Obesity Science & Practice in 2017 saw significant results in one clinical trial performed in eight European countries on patients with BMIs between 30 and 40. The trial compared 1.2 mg, 1.8 mg, 2.4 mg, or 3.0 mg once-daily subcutaneous injections of liraglutide, once-daily placebo injections, or a 120 mg oral dose of orlistat three times a day. Participants also received counseling on lifestyle changes, including a reduced-calorie diet and increased physical activity during treatment. After 20 weeks, those who received liraglutide lost significantly more weight. Even those who took the lowest dose of liraglutide, 1.2 mg, lost almost twice the weight as the placebo group (an average of about 11 pounds versus about 6 pounds).
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Administration and Dosage
Trulicity is administered once weekly, whereas Victoza is given once daily.
Trulicity
Trulicity comes as prefilled, single-use pens. You discard the pen and needle after each dose. You’ll give yourself a Trulicity dose once per week.
The recommended starting dose for Trulicity is 0.75 mg subcutaneously once weekly. After four weeks, your health care provider can increase the dose to 1.5 mg for additional glycemic control. Then, if you tolerate it well, your health care provider can increase your dose by 1.5 mg every four weeks until you reach the maximum dose of 4.5 mg weekly.
Victoza
Victoza comes as prefilled, multi-use pens. You reuse the same pen but replace the needle for each dose. You’ll give yourself a Victoza dose once per day.
Keep in mind that Victoza is a daily medication. The recommended starting dose is 0.6 mg daily for at least one week, 1.2 mg a day for at least one week, and 1.8 mg for further glycemic control. The 1.8 mg Victoza dose is the highest your health care provider will typically prescribe.
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You can inject either prescription drug into your upper arm, upper thigh, or abdomen.
Side Effects
Like with any medication, side effects can occur while taking Victoza or Trulicity. It’s important to tell your health care provider if you experience any issues when taking a new medication and ask for their medical advice.
The most common side effects for Victoza and Trulicity are similar: nausea, diarrhea, and vomiting. However, a few of their other side effects differ.
Trulicity Side Effects
- Abdominal pain
- Decreased appetite
- Indigestion
- Fatigue
Serious side effect warnings: risk of thyroid c-cell tumors, pancreatitis (inflammation of the pancreas), hypoglycemia, hypersensitivity reactions, diabetic retinopathy complications, and acute gallbladder disease.
Victoza Side Effects
- Constipation
- Upper respiratory tract infection
- Headaches
- Back pain
Serious side effect warnings: possible thyroid tumors (including cancer), pancreatitis (inflammation of the pancreas), kidney problems, severe allergic reactions, and gallbladder problems.
Common Side Effects of Both Trulicity and Victoza
The most common side effects of GLP-1 agonists are related to the gastrointestinal system, and they include nausea, diarrhea, and vomiting. The prescribing information for Trulicity and Victoza both report that approximately 20% of treated patients will experience nausea and roughly 12% will experience diarrhea. Decreased appetite will occur in about 9% of patients treated with either drug. Due to these side effects, it is not uncommon for patients to experience weight loss when taking either Trulicity or Victoza. Gastrointestinal side effects increase with dosage.
Serious Side Effects
In addition to the mild side effects described above, serious side effects may occur in some people using Trulicity or Victoza.
- If you have kidney problems, dehydration from other side effects (such as diarrhea, nausea, and vomiting) may make your kidney problems worse.
- Trulicity and Victoza both have a boxed warning for an increased risk of thyroid cancer. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).
Warnings and Precautions
Trulicity and Victoza have several warnings and precautions that patients need to be aware of.
- Boxed Warning: Thyroid Cancer: Both Trulicity and Victoza have a boxed warning for the risk of thyroid cancer. Both drugs have caused thyroid cancer in animals, but it’s unclear if these drugs increase this risk in humans. You shouldn’t use either drug if you have a rare condition called multiple endocrine neoplasia syndrome type 2 or if you or a family member has ever had medullary thyroid cancer. During treatment with either drug, tell your doctor right away if you experience symptoms of thyroid cancer, as you may need to stop treatment. Examples of these symptoms may include a lump in your neck, difficulty swallowing, shortness of breath, or a scratchy voice.
- Slow Digestion or Digestive Problems: VICTOZA® slows gastric emptying.
- Pancreatitis: Pancreatitis has been reported in patients taking Trulicity and Victoza. Patients should monitor for signs of pancreatitis including severe abdominal pain which may radiate to the back.
- Kidney Problems: Renal function should be monitored in patients taking GLP-1 receptor agonists. Trulicity or Victoza may cause acute renal failure or worsening of chronic kidney problems. Use caution in patients who experience dehydration. Victoza can worsen pre-existing chronic renal failure. It can even induce acute renal failure.
- Severe Allergic Reaction: Do not use Trulicity or Victoza if you have had a history of allergic reactions or hypersensitivity reactions to any GLP-1 receptor agonists.
- Pregnancy and Breastfeeding: Victoza and Trulicity aren’t recommended for those who are pregnant, plan to become pregnant, or are breastfeeding, so speak to your health care provider before starting either drug. Based on animal reproduction studies, there may be risks to the fetus from exposure to VICTOZA® during pregnancy. VICTOZA® should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Animal reproduction studies identified increased adverse developmental outcomes from exposure during pregnancy. Liraglutide exposure was associated with early embryonic deaths and an imbalance in some fetal abnormalities. There are no data on the presence of VICTOZA® in human milk, the effects on the breastfed infant, or the effects on milk production. Liraglutide was present in the milk of lactating rats.
Contraindications
Do not use Victoza or Trulicity if you or anyone in your family has ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you’ve had multiple endocrine neoplasia syndrome type 2 (MEN 2).
Drug Interactions
Trulicity and Victoza delay gastric emptying and therefore may alter the rate of absorption of oral drugs administered with them. This is especially true for narrow therapeutic index drugs like Coumadin (warfarin) and Synthroid (levothyroxine). The risk of serious side effects such as hypoglycemia, or low blood sugar, increases with Trulicity and Victoza when taken with other antidiabetic medications.
Cost and Availability
Trulicity and Victoza are only available as brand-name drugs. Neither is available in biosimilar form. But keep in mind that what you’ll pay for either drug will depend on your treatment plan, your health insurance, and the pharmacy you use.
Trulicity is a prescription medication covered by most Medicare and commercial insurance providers. Some insurance companies may prefer one GLP-1 agonist over another. Your pharmacist can help you determine if that is the case. The out-of-pocket cost for Trulicity can be almost $1,300. Trulicity's list price is $930.88 monthly, per Eli Lilly, but your cost will depend on your insurance. “About 92% of Trulicity prescriptions cost between $0 and $30 per month, and the remaining cost an average of $239 per month,” according to Lilly’s pricing information. Check with your insurance company about coverage.
Victoza is a prescription medication covered by most Medicare and commercial insurance plans. Without insurance, Victoza can cost up to $1,330. Victoza’s pricing varies by insurance coverage. Your copay may be anywhere from $30 to $55 per fill (a 30-day supply) when prescribed for the treatment of type 2 diabetes. Before getting a prescription for Victoza, check with your insurance provider to see if it's covered and how much you’ll pay out of pocket. The good news is that research suggests many insurance companies will cover most of Victoza’s cost when prescribed for its approved use.
Switching Between Trulicity and Victoza
Yes, it’s possible to switch from one of these drugs to the other. They’re also prescribed for similar uses. So, you may be able to switch from one of these drugs to the other. But these drugs come in different strengths and differ in how often they’re used. Trulicity is used once per week, while Victoza is used once per day.
If your doctor approves the switch from one of these drugs to the other, you’ll start the new medication either the next day or the next week. This depends on which medication you were taking previously.
If you’re switching from Victoza to Trulicity, you’ll give your first Trulicity dose the day after you take your last Victoza dose. If you’re switching from Trulicity to Victoza, you’ll give your first Victoza dose 1 week after your last Trulicity dose.
Your doctor will determine what your dosage of the new drug should be based on your blood sugar level and your dosage of the previous drug.
Reminder: Do not switch drugs or stop your current treatment unless your doctor recommends it. If you have questions about changing your diabetes treatment, talk with your doctor.
Trulicity vs. Victoza: Which is More Effective?
Both medications have very similar efficacy, so determining a winner in a Trulicity vs Victoza matchup will depend on what works best for you. You may try one and find that it’s not working, so you can try the other and see if it works better for you. On the other hand, it may be more appealing to have a once-weekly injection instead of a daily one. You and your Found-affiliated provider will decide the best medication for you during your consultation and help you find what works for you during your weight loss journey.
Additional Considerations
Use in Specific Populations
- Pediatric Patients: The safety and effectiveness of VICTOZA® as an adjunct to diet and exercise to improve glycemic control in type 2 diabetes mellitus have been established in pediatric patients 10 years of age and older. Use of VICTOZA® for this indication is supported by clinical trials. The risk of hypoglycemia was higher with VICTOZA® in pediatric patients. VICTOZA® has not been established in pediatric patients less than 10 years of age.
- Geriatric Patients: In clinical trials, no overall differences in safety or effectiveness for VICTOZA® have been observed between patients 65 years of age and older and younger patients.
- Renal Impairment: No dose adjustment of VICTOZA® is recommended for patients with renal impairment. The safety and efficacy of VICTOZA® was evaluated in patients with moderate renal impairment. In clinical trials, no overall differences in safety or efficacy were seen in patients with renal impairment compared to patients with normal renal function.
- Hepatic Impairment: There is limited experience in patients with mild, moderate, or severe hepatic impairment. Therefore, VICTOZA® should be used with caution in this patient population. No dose adjustment of VICTOZA® is recommended for patients with hepatic impairment.
Alcohol Consumption
Alcohol consumption should be limited by anyone with Type 2 diabetes as it affects blood sugar and kidney and liver function.