Saxenda and multiple sclerosis is a topic of growing interest for people living with MS who are seeking effective weight management solutions. Saxenda (liraglutide 3.0 mg) is a GLP-1 receptor agonist licensed in the UK for weight management, whilst multiple sclerosis is a chronic neurological condition affecting approximately 130,000 people in the UK. Weight management can be particularly challenging for people with MS due to reduced mobility, fatigue, and certain medications. This article examines whether Saxenda is suitable for people with MS, explores potential risks and considerations, and discusses alternative weight management approaches tailored to the needs of those living with this condition.

What Is Saxenda and How Does It Work?

Saxenda (liraglutide 3.0 mg) is a prescription medicine licensed in the UK for weight management in adults with obesity or those who are overweight with weight-related health conditions. It belongs to a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists, which were originally developed for treating type 2 diabetes.

The medication works by mimicking a naturally occurring hormone called GLP-1, which is released in the gut after eating. Saxenda acts on specific receptors in the brain that regulate appetite and food intake, helping you feel fuller for longer periods and reducing hunger sensations. This mechanism makes it easier to consume fewer calories and adhere to a reduced-calorie diet. Additionally, liraglutide slows gastric emptying, meaning food remains in the stomach longer, which contributes to increased satiety.

Saxenda is administered as a once-daily subcutaneous injection using a pre-filled pen device. The dose is gradually increased over several weeks to minimise gastrointestinal side effects, starting at 0.6 mg daily and increasing weekly by 0.6 mg until reaching the maintenance dose of 3.0 mg.

Under NICE guidance (TA664), Saxenda is available on the NHS only through specialist weight management services for people who meet specific criteria: a BMI of at least 35 kg/m² (or 32.5 kg/m² for people from South Asian, Chinese, Black African or African-Caribbean backgrounds) with weight-related comorbidities, and only as part of a comprehensive programme including diet, physical activity and behavioural support. NHS treatment is typically limited to a maximum of two years.

Important safety considerations include avoiding use during pregnancy and breastfeeding, and risks of pancreatitis, gallbladder disease and dehydration. Treatment should be discontinued if patients do not achieve at least 5% weight loss after 12 weeks at the maintenance dose.

Multiple Sclerosis: Understanding the Condition

Multiple sclerosis (MS) is a chronic, progressive neurological condition affecting the central nervous system, including the brain, spinal cord, and optic nerves. In MS, the body's immune system mistakenly attacks the protective myelin sheath surrounding nerve fibres, causing inflammation and damage. This process, known as demyelination, disrupts the transmission of electrical signals between the brain and the rest of the body.

The condition affects approximately 130,000 people in the UK, with most individuals diagnosed between the ages of 20 and 40. According to the NHS, MS presents in several forms, including relapsing-remitting MS (the most common type, characterised by periods of symptoms followed by partial or complete recovery), secondary progressive MS (where disability gradually worsens), and primary progressive MS (steady progression from onset).

Symptoms vary considerably between individuals and may include fatigue, mobility difficulties, visual disturbances, muscle weakness or spasticity, sensory changes (numbness or tingling), cognitive problems, bladder and bowel dysfunction, and pain. The unpredictable nature of MS means that symptoms can fluctuate, with relapses occurring when new symptoms appear or existing ones worsen.

Weight management can be particularly challenging for people with MS. Reduced mobility due to fatigue or physical disability may limit exercise capacity, whilst some disease-modifying therapies and symptomatic treatments (particularly corticosteroids used during relapses) can contribute to weight gain. Conversely, some individuals may experience unintended weight loss due to swallowing difficulties or reduced appetite. The NHS emphasises that maintaining a healthy weight is important for overall health and may help manage some MS symptoms, though this must be balanced against the practical challenges faced by people living with the condition.

Can You Use Saxenda If You Have Multiple Sclerosis?

There is no official contraindication preventing people with multiple sclerosis from using Saxenda, and MS is not listed among the conditions that preclude its use in the Summary of Product Characteristics approved by the MHRA. However, this does not automatically mean Saxenda is appropriate for everyone with MS, as individual circumstances vary considerably.

The decision to prescribe Saxenda to someone with MS requires careful consideration of several factors. Healthcare professionals must assess the person's overall health status, current MS disease activity, other medications being taken, and the presence of any complications or comorbidities. Importantly, there is limited specific research examining the use of liraglutide in people with MS, so clinical decisions are typically based on the general safety profile of the medication and individual patient factors.

One consideration is that Saxenda commonly causes gastrointestinal side effects, including nausea, vomiting, diarrhoea, and constipation, particularly during the dose escalation phase. For someone with MS who may already experience bowel dysfunction as part of their condition, these additional effects could be particularly problematic and may affect quality of life.

Another important factor is the requirement for self-injection. Saxenda must be administered daily via subcutaneous injection, which requires adequate manual dexterity and visual acuity. Some people with MS may experience tremor, reduced hand function, or visual impairment that could make self-administration challenging. In such cases, support from a carer or family member may be necessary.

It's important to note that on the NHS, Saxenda is only available through specialist weight management services for people meeting specific NICE criteria. Additionally, key safety considerations include avoiding use during pregnancy and breastfeeding, and monitoring for signs of pancreatitis or gallbladder disease.

Ultimately, the suitability of Saxenda for someone with MS is an individualised decision that should be made collaboratively between the patient and their healthcare team, taking into account the potential benefits of weight loss against any risks or practical challenges specific to that person's situation.

Potential Risks and Considerations for MS Patients

When considering Saxenda for someone with multiple sclerosis, several specific risks and considerations warrant careful evaluation. Whilst there is no evidence suggesting that Saxenda directly affects MS disease activity or progression, the medication's side effect profile may interact with existing MS symptoms in ways that require monitoring.

Gastrointestinal effects represent the most common adverse reactions to Saxenda. Nausea occurs in approximately 40% of users, whilst vomiting, diarrhoea, and constipation are also frequently reported. For people with MS who may already experience neurogenic bowel dysfunction, these additional gastrointestinal disturbances could significantly impact daily functioning and quality of life. Severe or persistent vomiting and diarrhoea can lead to dehydration and potentially acute kidney injury, which may temporarily worsen MS symptoms.

Fatigue is already one of the most debilitating symptoms of MS, affecting up to 80% of people with the condition. Fatigue is also a known adverse reaction to Saxenda listed in the SmPC, so patients should be aware that the medication might compound existing tiredness. Additionally, if gastrointestinal side effects lead to reduced nutritional intake, this may further contribute to fatigue.

Pancreatitis and gallbladder disease are important safety concerns with Saxenda. Patients should be advised to stop taking the medication and seek urgent medical attention if they experience severe, persistent abdominal pain, which could indicate acute pancreatitis. The risk of gallstones and related complications is also increased.

Regarding drug interactions, while Saxenda may delay the absorption of oral medications due to slowed gastric emptying, clinically significant interactions are uncommon according to the SmPC. However, for medications with a narrow therapeutic window (such as warfarin), additional monitoring may be prudent when starting or stopping Saxenda.

Hypoglycaemia (low blood sugar) is a potential risk, particularly if Saxenda is used alongside certain diabetes medications, though this is less common with Saxenda monotherapy. However, people with MS should be aware that symptoms of hypoglycaemia (such as dizziness, confusion, and tremor) may overlap with or be mistaken for MS symptoms.

Finally, the practical aspects of injection require consideration. People with MS experiencing hand tremor, reduced grip strength, visual impairment, or cognitive difficulties may find daily self-injection challenging. Healthcare professionals should assess whether patients can safely and effectively administer the medication independently or whether caregiver support is needed.

Alternative Weight Management Options for People with MS

For people with multiple sclerosis who are unable to use Saxenda or for whom it is not appropriate, several alternative approaches to weight management exist. The foundation of any weight management strategy should be dietary modification and physical activity, adapted to individual capabilities and MS-related limitations.

Dietary approaches should be personalised and sustainable. Working with a registered dietitian who understands MS can be invaluable. They can help develop eating plans that accommodate swallowing difficulties (dysphagia), address constipation through adequate fibre and fluid intake, and ensure nutritional adequacy whilst creating an appropriate calorie deficit for weight loss. The Mediterranean diet pattern has been studied in MS populations and may offer benefits beyond weight management, though evidence for disease modification remains limited. Practical strategies might include portion control, reducing energy-dense processed foods, and increasing vegetable and fruit intake.

Adapted physical activity is crucial but must be tailored to individual functional capacity. Many people with MS can benefit from exercise programmes designed specifically for their needs. Aquatic therapy (hydrotherapy) is particularly valuable as the water supports body weight and helps with temperature regulation, addressing common MS-related heat sensitivity. Other options include seated exercises, yoga adapted for limited mobility, and physiotherapist-supervised programmes. The MS Trust and MS Society UK provide resources for safe, appropriate exercise for people with MS.

Behavioural support through psychology services or weight management programmes can address emotional eating, motivation challenges, and the psychological impact of living with a chronic condition. Cognitive behavioural therapy (CBT) techniques may help manage the relationship between mood, MS symptoms, and eating behaviours.

Alternative pharmacological options may be considered in some cases. Orlistat, which works by reducing fat absorption from the diet, is available both on prescription and over the counter in the UK. Unlike Saxenda, it does not require injection and works through a different mechanism. However, it can cause gastrointestinal side effects that may be problematic for people with MS-related bowel dysfunction. Orlistat may interact with warfarin and can reduce the absorption of fat-soluble vitamins, so supplementation may be necessary.

Semaglutide (Wegovy) is another GLP-1 receptor agonist approved by NICE (TA875) for weight management, with similar NHS eligibility criteria to Saxenda but requiring only weekly rather than daily injections.

For individuals with severe obesity and significant comorbidities, bariatric surgery may be an option following specialist assessment. NICE recommends considering bariatric surgery for people with a BMI of 40 kg/m² or more, or 35 kg/m² or more with other significant diseases that could be improved with weight loss. Referral to NHS Tier 3/4 specialist weight management services would be required. The suitability of surgery for someone with MS requires careful evaluation of surgical risks, anaesthetic considerations, and post-operative rehabilitation capacity.

Speaking to Your Healthcare Team About Saxenda

If you have multiple sclerosis and are considering Saxenda for weight management, having an open and thorough discussion with your healthcare team is essential. This conversation should ideally involve your GP, MS specialist nurse, and neurologist to ensure all aspects of your condition are considered.

Prepare for your appointment by gathering relevant information. Document your current weight, any previous weight loss attempts and their outcomes, your current MS symptoms and how they affect daily activities, all medications you currently take (including over-the-counter medicines and supplements), and any other health conditions you have. Consider keeping a brief symptom diary noting fatigue levels, mobility, and any bowel or bladder issues, as this information helps clinicians assess whether Saxenda's side effects might be particularly problematic for you.

Key questions to ask your healthcare team include:

• Is Saxenda appropriate given my specific MS symptoms and current disease activity?

• How might Saxenda's side effects interact with my existing MS symptoms?

• Will Saxenda interact with my current medications, including my disease-modifying therapy?

• What are the realistic expectations for weight loss in my situation?

• How will I be monitored whilst taking Saxenda?

• What should I do if I experience side effects?

• Are there alternative weight management options more suitable for my circumstances?

• Am I eligible for NHS specialist weight management services?

Be honest about your capabilities and concerns. If you have difficulties with hand function, vision, or cognitive tasks, discuss whether you can safely self-inject or whether you need support. Explain any existing gastrointestinal symptoms, as these may influence the decision.

Your healthcare team should provide clear information about how to use Saxenda, what to expect during treatment, and when to seek medical advice. They should explain that treatment will be discontinued if you don't achieve at least 5% weight loss after 12 weeks at the maintenance dose. Regular monitoring of weight, tolerability, hydration status and relevant blood tests may be required.

Stop taking Saxenda and seek urgent medical attention if you experience severe, persistent abdominal pain (which could indicate pancreatitis), signs of dehydration (dark urine, dizziness, reduced urination), or if you notice any significant worsening of your MS symptoms.

Remember that weight management is a long-term commitment, and finding the right approach may require patience and adjustment. Your healthcare team is there to support you in making informed decisions that prioritise both your weight management goals and your overall health with MS.

If you experience any suspected side effects from Saxenda, report them through the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk or the Yellow Card app).

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