Saxenda (liraglutide 3.0 mg) is a glucagon-like peptide-1 (GLP-1) receptor agonist used for weight management in the UK. Administered as a daily subcutaneous injection, Saxenda can occasionally cause localised reactions at the injection site, including lumps or nodules. These lumps typically result from inflammation, lipohypertrophy (fatty tissue accumulation), or improper injection technique. Whilst most injection site lumps are benign and self-limiting, understanding their causes and prevention is essential for safe, effective treatment. This article explains why Saxenda injection site lumps occur, how to prevent them through proper technique and site rotation, and when to seek medical advice.

What Causes Lumps at Saxenda Injection Sites?

Saxenda (liraglutide 3.0 mg) 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 with weight-related comorbidities. Administered as a daily subcutaneous injection, Saxenda can occasionally cause localised reactions at the injection site, including the formation of lumps or nodules.

These lumps most commonly result from a localised inflammatory response. The injection itself, or the medication's formulation, may trigger mild inflammation, oedema, or bruising. This reaction usually manifests as temporary redness, swelling, or tenderness and typically resolves within a few days without intervention.

With repeated injections in the same area over time, lipohypertrophy may develop. This is a benign accumulation of fatty tissue beneath the skin that can appear as firm, sometimes painless swellings. While lipohypertrophy is well-documented with insulin therapy, it can also occur with GLP-1 receptor agonists like Saxenda, though less frequently. This is why site rotation is recommended in the Saxenda Patient Information Leaflet.

In rare cases, patients may develop subcutaneous nodules due to local tissue reactions or improper injection technique, such as injecting too superficially or too deeply.

Infection at the injection site is uncommon but possible if aseptic technique is not maintained. Signs of infection include increasing pain, warmth, spreading redness, or purulent discharge, and require prompt medical assessment.

While injection site lumps are generally benign and self-limiting, persistent or worsening symptoms warrant evaluation by a healthcare professional. If you experience signs of a severe allergic reaction (difficulty breathing, facial swelling, widespread rash), seek immediate emergency care by calling 999 or attending A&E.

How to Prevent Injection Site Lumps with Saxenda

Preventing injection site lumps with Saxenda centres on consistent rotation of injection sites. The Saxenda Patient Information Leaflet and Instructions for Use recommend rotating injection sites within the same anatomical region (abdomen, thigh, or upper arm) to avoid repeated trauma to the same area. A practical approach is to divide each region into quadrants or zones and systematically rotate injections, ensuring at least 1 cm distance between consecutive injection sites. Keeping a simple diary or using a body map can help patients track their rotation pattern.

The abdomen is often the preferred site due to its larger surface area and consistent subcutaneous fat layer, which facilitates reliable absorption. According to FIT UK (Forum for Injection Technique) recommendations, patients should avoid injecting within 5 cm of the umbilicus. The anterior and lateral thigh provides an alternative site, particularly for patients who prefer self-administration in a seated position. The outer upper arm may be used, though this site can be more challenging for self-injection and may require assistance.

Allowing the medication to reach room temperature before injection can reduce discomfort and local irritation. Saxenda should be stored in a refrigerator (2–8°C) but can be kept at room temperature (below 30°C) for up to one month, as stated in the SmPC. Injecting cold medication directly from the refrigerator may increase the likelihood of injection site reactions.

Maintaining proper injection technique is essential. Patients should use a new needle for each injection, as reusing needles can cause tissue trauma, increase infection risk, and potentially contribute to injection site reactions. Needles should be disposed of safely in a sharps container, which can be obtained on prescription or through local council schemes. Before injection, the skin should be clean and dry; whilst alcohol swabs are not always necessary for patients with good hygiene, they may be used if preferred. The skin should be allowed to dry completely before injecting to prevent stinging.

Avoiding areas with existing lumps, scars, or skin abnormalities is crucial for consistent absorption of the medication.

Proper Saxenda Injection Technique to Reduce Side Effects

Correct injection technique is fundamental to minimising injection site reactions and optimising Saxenda's therapeutic effect. Saxenda is administered subcutaneously, meaning the medication should be delivered into the fatty tissue layer beneath the skin, not into muscle or intradermally.

Step-by-step injection technique:

• Prepare the pen: Check the Saxenda pen for damage and ensure the medication is clear and colourless. Attach a new needle securely and perform a flow check (as specified in the Saxenda Instructions for Use) before the first use of a new pen to ensure proper function.

• Select and prepare the injection site: Choose a site following your rotation plan. The skin should be clean and dry. There is no need to pinch the skin excessively in most patients, though individuals with minimal subcutaneous fat may benefit from a gentle skin fold to ensure subcutaneous rather than intramuscular injection.

• Insert the needle: Hold the pen at a 90-degree angle to the skin surface, as recommended by FIT UK. Insert the needle swiftly and smoothly with a dart-like motion. The needle should penetrate fully into the subcutaneous tissue.

• Inject the medication: Press and hold the dose button until the dose counter returns to 0. Keep the needle in the skin for at least 6 seconds after the dose counter reaches 0 to ensure complete delivery of the medication, as specified in the Saxenda Instructions for Use. Removing the needle too quickly can result in medication leakage, reducing the delivered dose.

• Withdraw the needle: Remove the needle at the same angle it was inserted. Do not rub the injection site, as this may cause irritation or affect absorption. Light pressure with a clean tissue is acceptable if there is minor bleeding.

• Dispose of the needle safely: Remove and discard the needle immediately after each injection in an approved sharps container.

Common technical errors that increase the risk of lumps include injecting too rapidly, failing to wait after injection, reusing needles, and injecting into the same site repeatedly. Patients should receive initial training from a healthcare professional and be offered periodic review to reinforce correct technique. The NHS and diabetes specialist nurses often provide injection technique consultations for patients using injectable weight management or diabetes medications.

Managing and Treating Lumps from Saxenda Injections

Most injection site lumps associated with Saxenda are benign and resolve spontaneously with appropriate management. Immediate management involves strict avoidance of the affected area for future injections. Continuing to inject into areas with existing lumps may perpetuate the problem.

Conservative measures are usually sufficient for uncomplicated lumps. Patients should continue rotating injection sites meticulously, allowing the affected tissue time to recover. Lipohypertrophic lumps may take several weeks to months to resolve fully, and in some cases may persist indefinitely, though they typically become less prominent over time. Gentle massage of the area is sometimes suggested, though evidence for its efficacy is limited and it should not be performed immediately after injection.

For painful or inflamed injection sites, simple analgesia such as paracetamol may provide symptomatic relief. Applying a cool compress (not ice directly on skin) for 10–15 minutes may reduce swelling and discomfort. As a general precaution, patients should avoid applying heat to injection sites.

When to seek medical advice: Patients should contact their GP or prescribing clinician if they experience:

• Lumps that are enlarging, increasingly painful, or not resolving after several weeks

• Signs of infection (increasing redness, warmth, purulent discharge, fever)

• Systemic symptoms such as malaise or fever

• Persistent bleeding or bruising at injection sites

For urgent concerns that are not life-threatening, contact NHS 111 for advice.

Seek emergency care (call 999 or go to A&E) if you experience signs of a severe allergic reaction, including difficulty breathing, facial swelling, or widespread rash.

Clinical assessment may include examination of injection sites and review of injection technique. In rare cases where infection is suspected, wound swabs may be taken and antibiotic therapy initiated. Persistent lipohypertrophy may require referral to a diabetes specialist nurse or dermatologist for further evaluation, though surgical intervention is rarely necessary.

Patients should be reassured that injection site lumps, whilst inconvenient, are generally not serious and can be effectively prevented with proper technique and site rotation. Ongoing education and support from healthcare professionals can significantly reduce the incidence of injection site complications and improve treatment adherence.

If you suspect an adverse reaction to Saxenda, you can report it through the MHRA Yellow Card scheme, which helps monitor the safety of medicines in the UK.

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