Dr. Ahmed
Xultophy injection is a combination of two antidiabetic medications. It contains Insulin degludec and liraglutide. Insulin Degludec is an ultra-long-acting insulin while liraglutide is a GLP-1 analog.
Xultophy pen is available as 100/3.6 mg per ml pen. One ml of Xultophy pen contains 100 units of insulin Degludec and 3.6 mg of liraglutide. Liraglutide is also available alone under the brand name Victoza and Saxenda.
Liraglutide or Victoza is a GLP-1 analog that was primarily launched for the treatment of obesity. However, because of its excellent anti-diabetic efficacy, it is now commonly used to treat patients with diabetes who are obese.
Insulin Degludec is an ultra-long-acting anti-diabetic medicine that is used to treat patients with diabetes.
Because of its ultra-long half-life, it is used as a once-daily injection to provide basal insulin coverage. It is best to use it in patients who have uncontrolled pre-meals or fasting blood sugars.
Compared to insulin glargine, it can be administered at any time of the day. The time schedule can be changed as well. For example, it can be administered after dinner on one day and at noon the next day.
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Starting Dose of Xultophy Injection:
It is initially given as 10 units that contain 10 mg of insulin Degludec and 0.36 mg of liraglutide. The dose may be increased gradually to achieve the target blood sugars.
What are the Benefits of Xultophy Injection?
Apart from the antidiabetic effects of Insulin Degludec and Liraglutide, the combination offers the following advantages:
Single Injection:
Both liraglutide and insulin Degludec are injectable medications. Their combination in the form of Xultophy provides the ease of a single injection. This reduces the number of pricks and is more patient-friendly.
Weight-neutral effect:
Insulin, including insulin Degludec, may cause weight gain. On the other hand, liraglutide induces weight loss.
The combination is thus used in patients who are prone to gain weight with insulin. It may induce some weight loss as well.
Xultophy is less costly:
Victoza or liraglutide injection costs around $1092 USD per month at goodRx.com. Insulin Degludec costs $62.95 USD per pen [Ref].
One injection of Xultophy costs around $1207 USD at goodRx.com. The overall cost is the same or less than if both medicines are administered separately.
Better Glycemic Control:
Lastly, Injection Xultophy is superior to Victoza and Tresiba when compared in terms of their A1C reduction. Xultophy is also superior to Soliqua (a fixed-dose combination of Insulin Glargine and Lixisenatide)
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Who should not use Injection Xultophy?
It is important to note that some patients might be allergic to either insulin Degludec or liraglutide and should avoid Xultophy.
It is also contraindicated in pregnant women and in acutely ill patients. Patients with an acute hyperglycemic crisis should avoid Xultophy.
GLP-1 analogs including liraglutide are also contraindicated in patients with medullary thyroid carcinoma including patients with a past history or those with a family history of medullary thyroid carcinoma.
Individuals with multiple endocrine neoplasia type 2 (MEN II) should also avoid using this drug.
It should be used with extreme caution in patients with pancreatic diseases or disease of the gall bladder. Lastly, intramuscular or intravenous administration of the drug should be avoided.
Xultophy Dosing Chart is published here: Xultophy Dosing Chart
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