Saxenda side effects and how to manage them

Everyone says that you “just” need to eat a balanced diet and exercise regularly to lose weight. The reality often looks different: losing weight is not easy, and that has little to do with how much willpower you have (despite popular belief). Since obesity is a disease with multiple contributing factors, it also often takes numerous approaches to treat it successfully, and in the long term. A balanced diet and getting more activity is essential, but many people also need prescription weight loss medications to achieve their weight goals, and keep their weight down.

One of those medications that can help with weight loss is Saxenda. But what about Saxenda's side effects? Read on to learn more about the most common side effects of Saxenda and how to manage them. 

Saxenda (active ingredient liraglutide) is an injectable prescription drug that helps with weight management. It is FDA-approved to treat adults with a body mass index (BMI) of 30 kg/m2 or more or who have a BMI of 27 kg/m2 or greater and at least one weight-related condition (like hypertension, type 2 diabetes mellitus, or high cholesterol). It belongs to the glucagon-like peptide-1 (GLP-1) receptor agonists drug class, which are medications used to treat type 2 diabetes mellitus along with promoting weight loss. Other examples of GLP-1 receptor agonists include Victoza, Ozempic, and Weygovy. A big difference between these drugs is that you inject Saxenda once daily, while other GLP-1 drugs are only used once weekly.  

When combined with healthy food choices and regular exercise, Saxenda can give you that boost you may need to reach and maintain your long-term weight goals. It does this by decreasing your appetite and slowing how fast food moves out of your stomach (also called ‘gastric emptying’), allowing you to feel fuller longer and ultimately consume fewer calories. Clinical trials of people with obesity have reported losing 5-10% of their body weight while on Saxenda. The average weight loss was 12–23 pounds over a 1 year timeframe.

Because Saxenda slows down how quickly your stomach empties and food stays in there longer, many of its side effects are related to your digestive system. Everyone’s experience with Saxenda differs, but in general, gastrointestinal (GI) side effects with Saxenda are fairly common. Clinical trials show that almost 70% of adults taking Saxenda experience GI side effects, with nausea being the most common.

While this percentage may seem like a lot, most people who experienced the most common side effects reported them as mild. Typically, these side effects tend to appear when the dose of Saxenda goes up and they resolve on their own over time. 

Some of the most common side effects include: 

• Nausea

• Diarrhea

• Constipation

• Vomiting

• Skin reaction at the injection site 

• Heartburn (gastroesophageal reflux disease)

• Abdominal Pain

• Headache 

• Fatigue

• Dizziness

• Low blood sugar (especially if you take other diabetes meds)

• Indigestion

• Bloating

• Frequent burping

• Flatulence 

Let’s dive a little deeper into the 10 most common side effects and how to manage each one. 

Nausea

Nausea is one of the most common side effects of Saxenda, affecting close to 40% of adults taking the drug. For those who do develop nausea, it typically starts within a few days of increasing your dose and usually gets better on its own over time.

The best way to try to prevent nausea is to pay attention to your body during the first few days after increasing your injection dose. You may find that eating smaller portions or eating more slowly may help to alleviate or even prevent nausea. Some people also find that eating certain foods, like fried, oily, or spicy foods, or exposure to strong smells makes symptoms worse. On the other hand, foods like ginger may help relieve nausea. Lastly, taking small sips of water or sucking on ice chips throughout the day may help. 

If your nausea does not improve or becomes so severe that you are not interested in eating at all, you should seek medical advice from your healthcare provider.  

Diarrhea

Diarrhea occurs in around 1 in 5 people taking Saxenda. Fortunately, there are a few things you could try to feel better.

If you have diarrhea, make sure that you are staying hydrated with drinks like water, fruit juices, broth, etc. But avoid drinks with caffeine, as they can worsen your diarrhea. Many people also find that dairy products containing lactose or cow milk protein make their diarrhea worse, so staying away from these foods may help your symptoms. Instead, stick with high-fiber foods like bananas and whole grains, such as brown rice or oatmeal, as these foods take longer to digest and may help slow things down. You may also consider an over-the-counter medication like Pepto-Bismol. 

However, if your diarrhea lasts more than several days, be sure to reach out to your healthcare professional. 

Constipation

Like with diarrhea, if you are experiencing constipation with Saxenda, make sure you are drinking plenty of liquids throughout the day. Getting 25–30 grams of fiber daily from high-fiber foods like fruits and vegetables, whole grains, etc. can also help move things along. If diet alone doesn’t help, you may consider adding fiber supplements or over-the-counter laxatives or stool softeners like Miralax or Colace to your daily routine until the constipation resolves. 

If your constipation keeps coming back or if you’re having a hard time fixing it in the first place, check in with your healthcare provider. 

Vomiting

When food stays in your stomach longer, as happens with Saxenda, you are at a higher risk of having it come back up. This is especially true if you are already experiencing nausea, the most common side effect of Saxenda. If you are experiencing vomiting, know that it will likely get better in a few days. 

Like with nausea, eating smaller portions or avoiding trigger foods (fried, oily, spicy foods, etc.) may help prevent vomiting—you may even want to take a break from solid foods altogether or just stick to bland food for a few days (think toast, crackers, etc.). Ginger may help decrease your nausea and prevent vomiting. Even if you can’t keep cups of water down, you still want to make sure you are hydrating adequately. You can accomplish this by sucking on ice chips or ice pops.

If your vomiting is not improving, reach out to your healthcare provider. You may benefit from a prescription anti-nausea medication like Zofran (generic ondansetron). 

Injection site reactions

When any medication is injected into the skin, irritation and other issues can develop at the injection site. 

A small amount of tenderness, mild redness, or very mild swelling at the injection site are not unusual and will typically resolve on their own. You can decrease the odds of experiencing these symptoms by cleaning the skin well before the injection and injecting the medication at a 90-degree angle to the skin. You can also prevent this by rotating your injection sites so you are not always injecting in the same spot. If you develop mild tenderness or irritation, applying a cool compress (a cool, damp towel or washcloth) to the area can help. 

Heartburn

Heartburn, or acid reflux, while taking Saxenda is most likely due to the slowing of your stomach emptying and digestion. If you had heartburn before taking Saxenda, those same foods that triggered it may worsen your heartburn. It makes sense if you think about it—having things like spicy foods, fried foods, tomatoes, coffee, bubbly drinks, etc. stick around in your stomach for longer increases your likelihood of heartburn.

One way to prevent heartburn is by avoiding these triggering foods, especially in the few days after increasing your Saxenda dose. If you do develop heartburn, over-the-counter medications like TUMS or famotidine (brand name Pepcid), or even chewing gum or ginger may be helpful. Certain positions, like lying flat, can exacerbate heartburn—if this is the case for you, elevate your head with a second pillow or try sleeping on your side.

If your heartburn worsens or doesn’t improve, regardless of what you try, contact your healthcare provider for advice. 

Abdominal pain

Most of the time, abdominal pain after taking Saxenda is due to one of the other side effects already mentioned—nausea, diarrhea, constipation, or heartburn. Other times, stomach pain may result from indigestion or general belly discomfort. Unsurprisingly, you can thank the slowing down of your stomach emptying. You can try to prevent this feeling by taking small bites and eating smaller portions. 

Rarely, the belly pain can become severe and may be a sign of acute pancreatitis, a serious side effect involving inflammation of the pancreas. If you develop severe abdominal pain, pain that won’t go away, pain that seems to radiate toward your back, or pain that’s associated with intractable vomiting, seek urgent in-person medical care right away.

Headache

Many medications list headaches as a potential side effect. One reason that Saxenda may lead to headaches is that it affects your eating and drinking habits. Some people develop headaches when they don’t eat or drink as much as they normally do. Hydration is especially important—drinking plenty of water can help you both prevent and alleviate a headache. You can also consider taking over-the-counter medications, such as Tylenol (acetaminophen) or Advil (ibuprofen). 

If your headaches won’t go away, grow severe, or are associated with vomiting or changes in vision, stop taking your medication and contact your healthcare provider right away.

Fatigue

Like headaches, fatigue is a general, nonspecific side effect that may be due to the change in your eating and drinking habits that happens with Saxenda. Be sure to eat and drink enough throughout the day. Getting enough quality sleep can also help prevent and improve tiredness.

Dizziness

Eating and drinking less can lead to another side effect—dizziness. Not hydrating enough or losing fluids through diarrhea or vomiting may make your dizziness worse. If you are taking other diabetes medications that lower your blood sugar, like insulin or metformin, you are at risk of your blood sugar dropping too low (hypoglycemia) and causing dizziness. 

If you are feeling dizzy, make sure that you are eating and drinking enough. And if the dizziness does not improve, contact your healthcare provider. 

Most people will experience the mild side effects mentioned above; however, other, less common side effects may arise in less than 2% of people taking Saxenda.  

• Fast heartbeat (tachycardia): If you experience a change in heart rate, it’s usually an increase of 1–4 beats per minute (bpm) on average from your resting heart rate. Some people may notice a larger bump in heart rate, closer to 10–20 bpm or more from their resting heart rate. 

• Facial swelling: As with any drug, serious allergic reactions, like swelling of the face, lips, throat, or tongue can occur with Saxenda. Other symptoms of anaphylaxis include problems breathing or swallowing, a severe rash or itching, feeling faint or dizzy, and a very rapid heartbeat. If you develop any of these symptoms, stop using the medication and seek emergency medical care. 

• Depression or suicidal thoughts: Rarely, people reported feelings of depression or thoughts of harming themselves while taking Saxenda. If you or your loved ones notice you are showing any of these unusual changes in mood or behavior, stop the medication immediately and seek medical advice.  

• Yellowing of the skin or eyes: Gallbladder problems are rare, but potentially serious side effects of medication like Saxenda. Problems with your gallbladder, like gallstones, can manifest themselves with the yellowing of your skin or the whites of your eyes (jaundice), abdominal pain, and clay-colored stool.  If you experience symptoms of gallbladder disease, stop using the medication and contact your healthcare provider. 

• Kidney problems: Rarely, people have developed new or worsening kidney failure while taking Saxenda, especially in people with severe nausea, vomiting, or diarrhea.

You should also know that Saxenda carries a black-box warning from the FDA regarding the risk of thyroid cancer. Animal studies of drugs similar to Saxenda showed an increased risk of thyroid cancer. But this has not been demonstrated in humans. Regardless, the FDA warning states that anyone with a personal or family history of medullary thyroid carcinoma (a type of thyroid cancer) or a history of Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) should not use GLP-1 agonists like Saxenda.

Fortunately, most people who experience side effects from Saxenda report them as being mild or moderate and usually lasting a few days to weeks, typically being worse in the days following an increase in your weekly injection dose. Stopping the medication altogether usually leads to a resolution of the side effects. However, less than 10% of people in clinical trials felt that their side effects were bad enough to warrant discontinuing their Saxenda.

The best way to deal with the side effects of Saxenda is to educate yourself on what to expect and what you can do about them. The recommended way to take Saxenda involves starting at the lowest dose and gradually working your way up, taking into consideration not only your weight loss goals but also any side effects you may be experiencing. Here are some tips to follow to try to avoid the side effects of Saxenda:

• Take your Saxenda at the right time: You can take Saxenda at any time of the day, as long as you are consistent and do it at the same time every day. You may find that taking Saxenda at a particular time improves your side effect experience. 

• Rotate the injection site: Always injecting Saxenda into the same spot increases your chances of developing a skin reaction. Try to rotate your sites—you can inject Saxenda into your abdomen, thigh, or upper arm on either side. 

• Drink plenty of water: Many of the more common side effects are related to not getting enough hydration. Make a plan to get enough fluids while taking Saxenda to try to avoid potential side effects. 

Of course, you can always talk to your healthcare provider as they may have additional tips for you to try to avoid Saxenda side effects.

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Current version

June 05, 2023

Written by

Chimene Richa, MD

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.