Microdosing GLP-1s: Does It Work for Weight Loss?
Can tiny doses of powerful GLP-1 drugs help people lose weight or maintain weight loss? Here’s what an obesity doctor has to say about microdosing GLP-1s.
The FDA just approved an authorized generic version of Victoza. It gives people an affordable alternative to weight loss meds. And, insurance may cover it.
While many brand-name medications have generic versions, drugs to treat type 2 diabetes and aid weight loss, such as GLP-1s (glucagon-like peptide-1s), haven’t had generics available. That’s about to change: the US Food and Drug Administration (FDA) just granted approval for a generic form of Victoza®, the brand-name liraglutide drug manufactured by Novo Nordisk. In late June, Teva Pharmaceuticals announced it’s launching an authorized generic of Victoza.
According to Biospace, a publication that tracks the pharmaceutical industry, the patents for liraglutide started expiring at the end of 2023 and will continue to expire through the first half of 2024. This includes the primary patent for the diabetes drug Victoza, opening the door to generic drugs. Other manufacturers are readying generic liraglutide, with the first products expected this summer.
Why is this important? “I think generic version of Victoza may be seen as an affordable and readily available alternative to Saxenda,” said Christine Marshall, MD, associate medical director of Pippen Health, a clinical partner to Found. Saxenda is liraglutide in doses that are FDA-approved for treating obesity, while Victoza is liraglutide dosed and FDA-approved for treating type 2 diabetes in adults. “I think we'll see a rise in the use of generic version of Victoza for weight management given the current lack of availability for other GLP-1s."
There are several reasons this could be significant for those who take drugs like Victoza or who are thinking about starting the medication. Let's take a look at the top considerations.
According to the American Academy of Family Physicians, generic drugs require the same active ingredient, strength, and dosage as brand-name drugs, meaning there’s no significant difference between the two. And they're often less expensive; in some cases, the cost of a generic is significantly lower.
Because generic medications tend to cost less, many insurance plans encourage members to use generic versions over brand-name versions, and there are cases where an insurer will only cover the generic. An insurer may make an exception when a generic version is imminent, or you'll only have to pay out of pocket for a short time while waiting for insurance coverage for a generic. So, while a generic version of Victoza is just coming on the market, it may be that some insurance plans may cover it. (Check with your plan for specific information about your coverage.)
One survey found that generics have a kind of stigma for some patients. Published in the journal Health Affairs, the research found that 56% of those surveyed said Americans should use more generics because they're a better value and just as safe—but only 37.6% reported that they prefer to take generics.
Researchers noted that patients claimed brand-name drugs seemed more effective, which is why the most respondents preferred them. However, keep in mind that generics are formulated to be identical. They don't cost less because the ingredients are inferior or processed more cheaply way—it's because generic drug applicants don't have to repeat the extensive and costly animal and human clinical studies that are required to gain approval for a brand-name drug before it can be on the market, according to the Food and Drug Administration (FDA).
The agency notes that FDA does a rigorous review on generic drug versions, particularly to determine if a generic will have the same therapeutic effect as its branded counterpart. To be approved, a generic must have:
In essence, if you start on Victoza and switch to the recently-approved generic version of liraglutide when it becomes available, you'll be getting the same medication. You’ll also be able to use it in the same way: In the case of Victoza, the generic version will be available as a subcutaneous injection, possibly as a pre-filled pen, as with the brand name version.
When a pharmaceutical company has an active patent on a drug, no one else is allowed to make or sell the drug for a specified period of time. (After the patent expires, other companies can file an application with the FDA, and once it is approved, they can sell generic versions of the drug.) Having only one manufacturer can create a limited supply if a medication sees a spike in usage. For example, the popularity of the type 2 diabetes drug Ozempic® has led many people to wonder when a generic form will be available, but the manufacturer (drugmaker Novo Nordisk) will hold Ozempic’s patent until at least 2031. After that, generic semaglutide will likely be available, manufactured with the same rigor and FDA approval as generic liraglutide.
Even with other obesity and diabetes medications like ZepboundTM, Mounjaro®, Wegovy®, and others, there may still be shortages since production is restricted only to the respective manufacturers that hold the patents.
Once a patent expires, however, other companies can begin creating generic versions. That leads to multiple manufacturers working on the same medications, which clears supply bottlenecks. Also, because the FDA approved the original drug, the generic versions don't have to go through the same lengthy approval process of a new drug. Instead, the generic drug can be FDA approved and then manufactured on accelerated schedules.
In addition to Teva Pharmaceuticals, three other manufacturers—Pfizer, Mylan (now a part of Viatris), and Sandoz—are currently working on generic versions of liraglutide (Victoza), which are expected to be rolled out this year.
Better access to GLP-1 drugs may not only help people with weight loss, but also those with type 2 diabetes and cardiovascular disease.
Victoza is FDA-approved to manage type 2 diabetes in adults and children over ten. Victoza works by managing blood sugar levels, regulating insulin, and reducing appetite. Healthcare providers prescribe Victoza off-label to help people lose weight. Healthcare providers may also prescribe Victoza to reduce the risk of major cardiovascular events such as heart attack, stroke or death in adults with type 2 diabetes and known heart disease.
Like any drug, Victoza and other GLP-1 receptor agonists have potential side effects. The FDA has people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 should not take liraglutide, semaglutide, Victoza, Saxenda, Ozempic, Wegovy, Zepbound, or Mounjaro.
There is a black box warning on Victoza and other medications in the same GLP-1 drug class. Do not take these medications if you have ever had thyroid cancer. GLP-1 agonists can cause fetal harm. If you are pregnant, breastfeeding, or planning to become pregnant, do not take a GLP-1. Find detailed side effect and risk information for these drugs in our medication directory. Seek medical advice if you experience any side effects or drug interactions while taking a GLP-1 receptor agonist.
In addition to those considerations, it's important to understand if Victoza or liraglutide is the right fit for you. When you’re ready, a Found-affiliated healthcare provider trained in obesity medicine will be able to determine if this medication is the best choice. Prescriptions are up to a medical provider’s discretion. See if you’re eligible for Victoza or another medication and get started today by taking our quiz.
About Found
Found is among the largest medically-supported telehealth weight care clinics in the country, having served more than 250,000 members to date. To discover your MetabolicPrint and start your journey with Found, take our quiz.
GLP-1 and tirzepatide prescriptions, filled through your local pharmacy, are now available as part of Found's weight-loss toolkit. While GLP-1s and tirzepatide are effective for weight loss, they are not clinically appropriate for everyone. Eligibility for a drug is based on a thorough evaluation of your medical history, eating behavior, lab work, and insurance coverage. If a GLP-1 or GLP-1 / GIP is not appropriate for you, Found’s providers will work with you to determine an effective medication for your health profile.
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