Short answer: The Xultophy 100/3.6 label says to resume your once-daily schedule with the next scheduled dose. Do not take an extra dose or a bigger dose to make up for it. If more than 3 days have passed since your last dose, the label says to restart at the recommended starting dose, so call your prescriber.
| Situation | What the label says |
|---|---|
| Schedule | Once daily, same time each day, with or without food (2.1) |
| Missed a dose | Resume with the next scheduled dose (2.4) |
| Extra dose | Do not take an extra dose or increase the dose (2.4) |
| More than 3 days since last dose | Restart at the recommended starting dose (2.4) |
| Starting dose | 10 units, or 16 units if already on basal insulin or a GLP-1 (2.2) |
Section 2.4 says patients who miss a dose should resume the once-daily schedule with the next scheduled dose, and should not take an extra dose or increase the dose to make up for the missed one. The Medication Guide adds: do not take 2 doses at the same time.
Example: you inject Xultophy every morning and realize at night that you missed today. Under the label you would wait and take your usual dose tomorrow morning, not a catch-up dose tonight.
Section 2.4 says that if more than three days have passed since the last dose, Xultophy should be restarted at the recommended starting dose. The reason given is to lower the risk of stomach and gut side effects that come with restarting the liraglutide part. The starting dose is 10 units, or 16 units for people already on basal insulin or a GLP-1 (section 2.2).
The Medication Guide tells patients who miss more than 3 days to call their healthcare provider for instructions.
Xultophy combines insulin degludec (half-life about 25 hours) with liraglutide (half-life about 13 hours) (section 12.3). The liraglutide part is the one that causes nausea when started at full strength, which is why the Victoza and Saxenda labels also restart lower after more than 3 days off.
This page summarizes FDA labeling. It is not personalized medical advice; confirm what to do with your prescriber or pharmacist.