Saxenda (liraglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for weight management in adults with obesity or overweight with comorbidities. Whilst effective for appetite regulation and weight reduction, Saxenda can cause gastrointestinal side effects, including heartburn and acid reflux. These symptoms arise primarily from the medication's mechanism of slowing gastric emptying, which prolongs the presence of stomach contents and increases the opportunity for gastric acid to reflux into the oesophagus. Understanding the frequency, management strategies, and warning signs of serious complications helps patients and healthcare professionals optimise treatment outcomes whilst minimising discomfort.

Can Saxenda Cause Heartburn?

Yes, Saxenda (liraglutide) can cause heartburn-type symptoms and related gastrointestinal effects. Saxenda is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for weight management in adults with a body mass index (BMI) of 30 kg/m² or greater, or 27 kg/m² or greater with weight-related comorbidities. The medication works by mimicking the natural hormone GLP-1, which regulates appetite and food intake through several mechanisms.

The pharmacological action of Saxenda includes slowing gastric emptying, which means food remains in the stomach for longer periods. This delayed emptying is one of the key mechanisms by which the medication promotes satiety and reduces calorie intake. However, this same effect can contribute to gastrointestinal side effects, including heartburn symptoms, acid reflux, and indigestion. When stomach contents remain present for extended periods, there is increased opportunity for gastric acid to reflux into the oesophagus, particularly in susceptible individuals.

Gastrointestinal adverse effects are among the most commonly reported side effects with Saxenda treatment. According to the Summary of Product Characteristics approved by the Medicines and Healthcare products Regulatory Agency (MHRA), nausea, vomiting, diarrhoea, and constipation are very common reactions, while dyspepsia (indigestion) and gastro-oesophageal reflux disease (GORD) are common adverse reactions. These symptoms fall within the spectrum of upper gastrointestinal effects that patients may experience.

It is important to note that whilst Saxenda can cause or worsen reflux symptoms, not all patients will experience these side effects. Individual susceptibility varies considerably, and pre-existing conditions such as hiatus hernia or previous GORD may increase the likelihood of experiencing reflux symptoms during treatment. Understanding these potential side effects allows patients and healthcare professionals to monitor symptoms appropriately and implement management strategies when needed.

Patients are encouraged to report any suspected side effects to the MHRA Yellow Card Scheme.

How Common Is Heartburn with Saxenda?

Gastrointestinal side effects are common with Saxenda, with the UK Summary of Product Characteristics (SmPC) listing specific frequencies. Nausea, diarrhoea, constipation and vomiting are very common (affecting more than 1 in 10 people), while dyspepsia and gastro-oesophageal reflux disease are common (affecting between 1 in 10 and 1 in 100 people). In clinical trials conducted prior to licensing, nausea was the most frequently reported adverse effect, occurring in approximately 40% of participants.

The frequency and severity of gastrointestinal symptoms with Saxenda typically follow a predictable pattern related to dose escalation. Saxenda treatment begins at a low dose of 0.6 mg daily, with weekly increases up to the maintenance dose of 3.0 mg daily. Gastrointestinal side effects, including reflux symptoms, are most pronounced during the initial weeks of treatment and during dose increases. Many patients find that these symptoms improve over time as the body adapts to the medication, though some individuals may experience persistent symptoms throughout treatment. The SmPC recommends temporarily delaying dose escalation if patients experience intolerance to gastrointestinal effects.

Individual risk factors influence the likelihood of experiencing reflux symptoms on Saxenda. Patients with a history of gastro-oesophageal reflux disease, peptic ulcer disease, or functional dyspepsia may be more susceptible. Lifestyle factors such as diet, body position after eating, smoking, and alcohol consumption can also modulate symptom severity. Additionally, concurrent medications that affect gastric acid production or lower oesophageal sphincter tone may compound or worsen reflux symptoms when taken alongside Saxenda.

It is worth noting that most gastrointestinal side effects are mild to moderate in severity and do not require discontinuation of treatment. In clinical trials, approximately 5-10% of participants discontinued Saxenda due to gastrointestinal adverse effects. Healthcare professionals typically assess the balance between therapeutic benefit (weight loss and metabolic improvements) and tolerability of side effects when determining whether to continue treatment. The SmPC recommends that treatment should be reassessed after 12 weeks on the 3 mg daily dose, with discontinuation if at least 5% of initial body weight has not been lost.

Managing Heartburn While Taking Saxenda

Effective management of heartburn whilst taking Saxenda involves both lifestyle modifications and, when necessary, pharmacological interventions. The first-line approach should focus on non-pharmacological strategies that reduce reflux risk and improve symptom control. These measures are consistent with NICE guidance (CG184) on gastro-oesophageal reflux disease management and can be implemented alongside Saxenda treatment.

Dietary and lifestyle modifications form the cornerstone of heartburn management:

• Eat smaller, more frequent meals rather than large portions, as this reduces gastric distension and pressure that can promote reflux

• Avoid trigger foods commonly associated with heartburn, including fatty or fried foods, chocolate, caffeine, alcohol, citrus fruits, tomatoes, and spicy dishes

• Remain upright for at least 2-3 hours after eating to allow gravity to assist gastric emptying and reduce reflux episodes

• Elevate the head of the bed by 15-20 cm using blocks or a wedge pillow, which helps prevent nocturnal reflux

• Maintain a healthy eating pattern that supports your weight management goals whilst minimising reflux triggers

• Avoid eating close to bedtime, ideally finishing meals at least 3 hours before lying down

If lifestyle measures prove insufficient, over-the-counter antacids or alginates (such as Gaviscon) may provide symptomatic relief. These medications work by neutralising stomach acid or forming a protective barrier that prevents reflux. For more persistent symptoms, proton pump inhibitors (PPIs) such as omeprazole or lansoprazole may be appropriate. These medications significantly reduce gastric acid production and are effective for managing GORD symptoms. NICE recommends a 4-8 week trial of full-dose PPI therapy, followed by stepping down to the lowest effective dose or on-demand treatment. For persistent uninvestigated dyspepsia, testing for and treating Helicobacter pylori infection may be considered.

Dose adjustment of Saxenda may be necessary if gastrointestinal symptoms are severe. The SmPC recommends temporarily delaying dose escalation if patients experience intolerance. The recommended maintenance dose is 3.0 mg daily, with treatment efficacy assessed after 12 weeks at this dose. Any consideration of using a lower maintenance dose should be discussed with your prescribing healthcare professional, as this would be outside the licensed recommendations. It is important not to discontinue or adjust Saxenda dosing without medical guidance, as changes may affect treatment efficacy and metabolic control.

When to Seek Medical Advice About Heartburn on Saxenda

Whilst mild heartburn is a recognised side effect of Saxenda, certain symptoms warrant prompt medical evaluation. It is important to distinguish between manageable reflux symptoms and presentations that may indicate more serious underlying conditions or complications requiring investigation and treatment.

Contact your GP or prescribing healthcare professional if you experience:

• Persistent heartburn that does not respond to lifestyle modifications and over-the-counter treatments after a 4-week trial

• Difficulty swallowing (dysphagia), which requires urgent referral for investigation according to NICE guidance (NG12)

• Unintentional weight loss beyond your expected weight management trajectory, particularly if you are aged 55 or over and also have upper abdominal pain, reflux or dyspepsia

• Persistent nausea or vomiting that prevents adequate food or fluid intake, risking dehydration

• Symptoms of gastrointestinal bleeding, including vomiting blood (haematemesis), passing black tarry stools (melaena), or unexplained anaemia

• New or worsening abdominal pain, particularly if severe, persistent, or localised to specific areas

Seek urgent medical attention (contact 999 or attend A&E) if you develop:

• Severe, persistent abdominal pain, especially if accompanied by vomiting, fever, or abdominal rigidity, as these may indicate pancreatitis—a rare but serious adverse effect of GLP-1 receptor agonists

• Signs of severe dehydration due to persistent vomiting, including reduced urine output, dizziness, confusion, or rapid heartbeat

• Chest pain that could represent cardiac symptoms rather than reflux, particularly if associated with breathlessness, sweating, or pain radiating to the arm or jaw

NICE guidance (NG12) recommends urgent (two-week wait) endoscopic investigation for patients with dysphagia, or those aged 55 and over with weight loss and upper abdominal pain, reflux or dyspepsia. Urgent investigation should also be considered for unexplained haematemesis. If you develop any of these features whilst taking Saxenda, your healthcare professional will assess whether urgent investigation is warranted. Regular review appointments during Saxenda treatment provide opportunities to discuss any gastrointestinal symptoms and ensure appropriate monitoring and management strategies are in place.

Remember to report any suspected side effects to the MHRA Yellow Card Scheme.

Frequently Asked Questions