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Saxenda rash at injection site is a commonly reported side effect of this GLP-1 receptor agonist used for weight management in the UK. Injection site reactions, including rash, redness, itching, and swelling, typically occur within hours to days of administration and are usually mild to moderate in severity. Most reactions resolve spontaneously within a few days to weeks without requiring treatment discontinuation. Understanding why these reactions occur and how to prevent and manage them is essential for patients using Saxenda. Proper injection technique, systematic site rotation, and simple management strategies can significantly reduce the frequency and severity of injection site reactions whilst maintaining treatment efficacy.
Quick Answer: Saxenda rash at injection site is a common, usually mild reaction that typically resolves within days to weeks without treatment discontinuation.
Saxenda (liraglutide 3.0 mg) is a prescription medicine licensed in the UK for weight management in adults with obesity (BMI ≥30 kg/m²) or overweight (BMI ≥27 kg/m²) with weight-related health conditions such as type 2 diabetes, hypertension, or dyslipidaemia. It is also licensed for adolescents aged 12-<18 years with obesity and body weight >60 kg. Saxenda is administered as a once-daily subcutaneous injection and should be used alongside a reduced-calorie diet and increased physical activity.
Saxenda belongs to a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists. Liraglutide is a synthetic analogue of human GLP-1, a naturally occurring hormone released from the intestine in response to food intake. The mechanism of action involves binding to GLP-1 receptors in multiple tissues, including the brain, pancreas, and gastrointestinal tract.
In terms of weight management, Saxenda works primarily by:
Reducing appetite through effects on appetite-regulating centres in the hypothalamus
Increasing feelings of fullness (satiety) after meals
Slowing gastric emptying, which prolongs the sensation of fullness
Influencing brain regions involved in appetite regulation
The medication also has metabolic effects including improved glycaemic control through glucose-dependent insulin secretion and suppression of inappropriately high glucagon secretion.
According to NICE Technology Appraisal 664, Saxenda may be considered as part of specialist weight management services for adults when specific criteria are met, with a maximum treatment duration of 2 years. Treatment should be discontinued if patients do not lose at least 5% of their initial body weight after 12 weeks at the maintenance dose (3.0 mg daily), or at least 3% for adults with type 2 diabetes, as specified in the Summary of Product Characteristics (SmPC).
The standard dosing schedule involves weekly up-titration from 0.6 mg daily, increasing by 0.6 mg weekly to reach the 3.0 mg maintenance dose as tolerated.
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Injection site reactions are commonly reported adverse effects associated with Saxenda. According to the Summary of Product Characteristics approved by the MHRA, these reactions are generally mild to moderate in severity and typically resolve within a few days to weeks without requiring treatment discontinuation.
Common symptoms of injection site reactions include:
Rash – localised red, raised areas at or around the injection site
Erythema – redness and inflammation of the skin
Pruritus – itching that may be mild to moderately bothersome
Bruising – discolouration ranging from red to purple or yellow-green
Pain or tenderness – discomfort when touching the area
Swelling – localised oedema or lump formation
Induration – hardening of the tissue beneath the skin
Most injection site reactions appear within hours to days following administration and are confined to the immediate area where the needle entered the skin. The rash associated with Saxenda typically presents as small, red bumps or a more diffuse area of redness, sometimes accompanied by warmth to touch.
It is important to distinguish between expected injection site reactions and signs of potential complications. Patients should contact their GP or healthcare professional if they experience:
Severe pain or swelling that worsens over time
Signs of infection (increasing warmth, pus, fever, red streaking)
Rash that spreads beyond the injection site
Symptoms of allergic reaction (widespread rash, difficulty breathing, facial swelling)
Reactions that do not improve within several days
Whilst injection site reactions are common, serious hypersensitivity reactions including anaphylaxis have been reported rarely with Saxenda. If signs of a severe allergic reaction occur (such as breathing difficulty, facial swelling, widespread hives, or dizziness), call 999 or attend A&E immediately.
Management of existing injection site reactions typically involves conservative measures, as most reactions resolve spontaneously. For mild rash or irritation:
Apply a cold compress to the affected area for 10-15 minutes to reduce inflammation and discomfort
Avoid scratching the area, as this may worsen irritation or introduce infection
Keep the area clean and dry using gentle soap and water
Consider over-the-counter antihistamines (such as cetirizine or loratadine) if itching is bothersome, after consulting a pharmacist
Use emollients or fragrance-free moisturisers to soothe dry or irritated skin (but not immediately before injection)
Avoid tight clothing over the injection site that may cause friction
For persistent or troublesome reactions, patients should consult their GP, who may recommend topical corticosteroids (such as hydrocortisone 1% cream) for short-term use. Apply a thin layer to the affected area, avoid broken skin, and use only as directed by a healthcare professional.
Prevention strategies are crucial for minimising injection site reactions:
Rotate injection sites systematically – use different areas of the abdomen, thigh, or upper arm, avoiding the same spot for at least one week
Ensure proper injection technique – inject at a 90-degree angle into subcutaneous tissue (with 4-6 mm needles; consider pinch-up technique with longer needles)
Allow the medication to reach room temperature before injecting (remove from refrigerator 15-30 minutes beforehand)
Clean the injection site with an alcohol wipe and allow it to dry completely before injecting
Use a new needle for each injection to ensure sharpness and sterility
Inject slowly and steadily rather than rapidly forcing the medication
Do not inject into areas with existing rash, bruising, scarring, or skin abnormalities
Avoid injecting into the same 2-3 cm area repeatedly
Do not rub or massage the injection site after administration
Never share pens or needles with others
For storage: Keep unused pens refrigerated (2-8°C). After first use, store below 30°C or refrigerated for up to 1 month. Do not freeze and keep the pen cap on when not in use.
Patients should receive proper training from their prescriber or practice nurse on correct injection technique. Many NHS services and specialist weight management clinics offer ongoing support and review of injection technique to optimise treatment tolerability.
If you experience side effects, report them to the MHRA Yellow Card Scheme at www.mhra.gov.uk/yellowcard.
Understanding the underlying mechanisms of injection site reactions can help patients and healthcare professionals manage expectations and implement appropriate preventive strategies. Several factors contribute to the development of rash and other injection site reactions with Saxenda:
Mechanical trauma from the injection process itself causes localised tissue disruption. The needle creates a small wound, and the volume of medication (up to 3.0 mg in 0.5 mL at maintenance dose) deposited into subcutaneous tissue can cause temporary inflammation and immune activation. This mechanical irritation triggers the release of inflammatory mediators such as histamine, prostaglandins, and cytokines, resulting in redness, swelling, and itching.
Chemical properties of the formulation may contribute to local reactions. According to the SmPC, Saxenda contains liraglutide as the active ingredient (6 mg/mL solution), along with excipients including disodium phosphate dihydrate, propylene glycol, phenol, and water for injections. The pH of the solution (approximately 8.15) is slightly alkaline, which can cause mild irritation to subcutaneous tissues. Phenol, used as a preservative, may also contribute to local irritation in some individuals.
Immunological responses represent another mechanism. Some patients may develop a localised hypersensitivity reaction to liraglutide or formulation components. Serious hypersensitivity reactions, including anaphylaxis, have been reported rarely; seek urgent medical attention if they occur. The body's immune system may recognise the medication as foreign, triggering localised inflammation.
Individual patient factors influence susceptibility to injection site reactions:
Skin sensitivity – patients with sensitive skin or dermatological conditions may be more prone to reactions
Injection technique – improper technique, including injecting too rapidly or into muscle rather than subcutaneous tissue
Frequency of use in the same area – inadequate site rotation leads to cumulative tissue trauma
Medication temperature – injecting cold medication directly from the refrigerator increases discomfort and local reaction risk
It is important to note that injection site reactions do not indicate treatment failure and are generally not a reason to discontinue Saxenda unless they are severe, persistent, or accompanied by systemic symptoms. Most reactions diminish over time as patients become accustomed to the injections and refine their technique.
Most Saxenda injection site rashes are mild to moderate and typically resolve within a few days to weeks without requiring treatment. If the rash persists beyond several days, worsens, or is accompanied by signs of infection, contact your GP or healthcare professional for assessment.
Yes, mild injection site reactions including rash are common and generally not a reason to discontinue Saxenda. Continue treatment whilst implementing prevention strategies such as site rotation and proper technique, but seek medical advice if reactions are severe, spreading, or accompanied by systemic symptoms.
Seek immediate medical attention (call 999 or attend A&E) if you experience signs of severe allergic reaction such as difficulty breathing, facial swelling, widespread hives, or dizziness. Contact your GP promptly if you develop severe worsening pain, signs of infection (fever, pus, red streaking), or a rash that spreads beyond the injection site.
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DisclaimerThis content is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional with any medical questions or concerns. Use of the information is at your own risk, and we are not responsible for any consequences resulting from its use.
