Exenatide (Subcutaneous)

Exenatide medication is prescribed as a once weekly injection that is prescribed by doctors for the treatment of type two diabetes.

Overview

Sold under the trade names Bydureon and Byetta, Exenatide is a GLP-1 agonist medication that has been approved for type two diabetes treatment since 2005. Exenatide is a prescription injection that the patient gives themselves under the skin of the thigh, abdomen or arm. The Byetta version of the drug is given twice daily and the Bydureon version is prescribed as a once weekly injection.

Exenatide is a lab created version of a hormone that was discovered to have regulatory properties with regard to blood glucose. This hormone is found naturally in the saliva of a large lizard native to the US called a Gila monster, giving a comical nickname to Exenatide of 'lizard spit' in some medical circles. Further testing in a clinical environment has also uncovered appetite-suppressant properties in the hormone.

Exenatide is often prescribed with other drugs such as metformin, insulin, pioglitazone, sulfonylureas and others to work together on controlling a patient's glucose levels. Some patients don't respond readily to other medications designed to regulate their glucose levels. Exenatide is used in these patients because it offers another means of this regulatory function as well as suppressing the pancreas secretions of glucose, offering a more regulated emptying of the stomach contents which leads to reduction of appetite. All these functions represent normal human blood sugar levels, giving the patient the chance to lead a more normal life.

Like the human hormone GLP-1, Exenatide enhances insulin creation in the body only when appropriately triggered by high glucose levels in the blood, which results in a regulated amount of insulin. This includes post-meal hyperglycemic activities as well as normalizing the rate that the stomach digests food, which suppresses the appetite of the patient.

Exenatide belongs to a class of drugs known as incretin mimetics, also known as GLP-1 agonist drugs. By mimicking natural incretin hormones, Exenatide regulates blood sugar levels by stimulating the pancreas to release insulin after eating. This prevents the pancreas from releasing glucagon, another hormone that triggers the liver to release stored sugar. Finally, by regulating the speed at which food is digested, Exenatide normalizes glucose absorportion.

Type two diabetes mellitus is a disorder involving the metabolic functions of the body that leads to high glucose levels in the blood, a condition known as hyperglycemia. In a type two diabetic, insulin does not effectively interact with the body in order to turn glucose found in the bloodstream into energy. This may be because they may not be able to effectively process the insulin that their body produces, a condition known as insulin resistance, or they may not be able to produce enough insulin themselves.

Being unable to metabolize glucose leads to an elevated level of this enzyme in the body, which can lead to damage in the vital organs if left untreated. Food essentially becomes poisonous to a type two diabetic if they do not avoid sources of sugar in their diets. Diet control does work for many type two diabetics, but for others who cannot control their symptoms this way; Exenatide is available to help them lead a more normal life.

Conditions Treated

  • Type two diabetes

Type Of Medicine

  • Incretin mimetic

Side Effects

Exenatide's glucose balancing properties may cause it to give patients health effects that are unexpected and, in some cases, annoying and bothersome. If you have any of the following side effects, report them to your health care professional immediately as you may need medical attention:

  • Agitation
  • Full, bloated stomach
  • Coma
  • Confused mind
  • Constipated
  • Coughing
  • Urine is dark
  • Urine amount or frequency is decreased
  • Depressed mood
  • Swallowing is difficult
  • Dizzy
  • Mouth is dry
  • Feeling lightheaded
  • Fever, chills
  • Headache
  • Welts, rashes or hives on skin
  • Hostile, combative demeanor
  • Rapid heart rhythm
  • Indigestion
  • Irritable moods
  • Hives on sex organs, tongue, throat, face, eyelids, hands, lips, feet or legs
  • Lethargic demeanor
  • Fainting
  • No appetite
  • Twitching muscles
  • Nausea
  • Stomach pains that reach around the side to the back
  • Swollen, puffy eyes, tongue, lips or face
  • Shallow breathing
  • Gaining weight rapidly
  • Seizures
  • Gasping for breath
  • Mental stupor
  • Eyes appear sunken
  • Swollen hands, ankles or face
  • Elevated thirst
  • Weak muscles or fatigue
  • Chest tightness
  • Yellow skin or eyes
  • Wrinkles
  • Vomiting

Seek emergency medical help if you have the following side effects:

  • Anxiousness, paranoia or nervous demeanor
  • Vision is blurred
  • Skin feels cool
  • Pale skin
  • Cold sweats
  • Nightmares
  • Hunger is increased
  • Vomiting
  • Shaking
  • Speech is slurred

The following side effects may occur in some patients and are typically mild in nature and are relieved as their bodies become used to the treatment with Exenatide. Your medical team may have advice for you on how to lessen these side effects or prevent them completely. Check with your physician if you have:

  • Acid reflux
  • Diarrhea
  • Gas
  • Jittery feeling
  • Heartburn
  • Upset stomach
  • Less appetite than normal
  • Sweating more than normal
  • Weak muscles
  • Skin appears discolored
  • Abdominal swelling
  • Rashes, hives, swelling of skin
  • Drowsy or sleepy
  • Blistered, bleeding skin
  • Sense of taste has changed
  • Stomach pressure
  • Skin is red or has lesions
  • Swollen, tender, stinging skin
  • Skin ulcers
  • Warm skin at the site of injection
  • Skin feels cold
  • Skin has a burning sensation
  • Painful skin

Still, other side effects may occur in some patients. Should you have any changes to your health while being treated with Exenatide, notify your physician right away.

Dosage

Depending on several factors, the dosage is determined specifically for you by your physician. Follow the instructions your doctor has given you on how, when and how much Exenatide to give yourself to the letter, never skipping a dose. The information given here is in general terms; always follow what your doctor has prescribed for you.

Adult type two diabetes patients who are prescribed the extended release formula of Exenatide known as Bydureon will typically be instructed to inject two milligrams under their skin once every seven days at any time of day that suits them. Pediatric patients will have their dosage set for them by their physician.

For adults with type two diabetes who are prescribed the Byetta formulation of Exenatide, five micrograms is the initially prescribed dosage to be given twice daily within one hour of eating, at least six hours apart. With regular monitoring of blood sugar, this dosage may increase to 10 micrograms for some patients. Use of Byetta in pediatric patients must be prescribed specifically for them by their doctors.

Bydureon prescriptions arrive in a tray that holds one dose of powdered Exenatide in a vial. The patient will use the included vial connector to attach the pre-filled syringe that contains a solution to the vial of medication and one of the needles also supplied to inject the drug into the skin on their thighs, upper arms or abdomen.

Byetta prescriptions, on the other hand, arrive in a pen-like injection format that contains 60 doses of Exenatide. Byetta is also for injection into the skin of the stomach, upper arms or thighs.

Regardless of which format of Exenatide you are prescribed, be sure to review the medication guide leaflet that arrives with your prescription and ask your physician or pharmacist if you have any questions. Your physician will instruct you how to inject yourself with Exenatide; make sure you are clear on exactly how to give yourself the injection safely.

Allow Byetta to come to room temperature before injecting, as it must be stored in a refrigerated environment. Bydureon should be used immediately once the powder in the vial has been mixed with the solution in the syringe. Be sure your medication looks normal with normal coloring and isn't cloudy or show floating substances. If it does not look normal, do not use the medication and contact your healthcare professional immediately.

New needles should be used for every injection; never share needles with others and never share injection pens with others even if they have the same condition as you. Dispose of pens and sharp objects like needles safely, using a rigid container meant for that purpose. Keep the container out of sight and reach of children and pets.

Double dosing in the case of a missed dose is not advised; return to your regularly scheduled dose as soon as possible. If your dose is a weekly prescription, give yourself the injection as soon as you remember as long as your next scheduled dose will be three days or more after the missing dose. Patients who are instructed to inject their Byetta medication before eating and forget should wait until one hour before their next meal and inject their medication then.

Interactions

Any previous reactions to other medications that have been determined to be allergic in nature should be reported to your physician prior to being prescribed Exenatide. You may also be at risk for allergy symptoms related to Exenatide if you have allergies to preservatives, additives, foods or animals. Inform your health care provider if you have allergies of any kind to avoid unwanted health effects.

With regard to use of Exenatide in children, no studies have provided data to determine if this medication is safe or effective for type two diabetes in pediatric patients. Use of Exenatide in this age group is not advised.

Geriatric patients are typically prescribed Exenatide in similar dosage formats as adult patients, with caution in case the patient has kidney disease that would require adjustment to the dose of Exenatide. As kidney problems are prevalent in this age group, testing may be required prior to prescribing Exenatide.

Women who are pregnant or who are breastfeeding have not been studied with regard to any risk this medication may pose. Your doctor should be informed if you are pregnant or breastfeeding before prescribing you any form of Exenatide so that a treatment plan can be formulated that keeps you and your child safe.

Exenatide is safely used with many drugs, but others are problematic in that they decrease how effective this drug is at controlling type two diabetes. Still, others may cause dangerous health effects that require emergency medical attention. Make sure that you disclose your prescribed drug regimen to your doctor as well as any vitamins or over-the-counter drugs you may be taking. Herbal and holistic remedies should also be detailed, as some natural substances may also interact.

The following medicines are known to interact with Exenatide but may be required for your overall treatment plan. Your doctor will want to be aware and make dosage adjustments if you are taking:

  • Besifloxacin
  • Balofloxacin
  • Enoxacin
  • Ciprofloxacin
  • Flumequine
  • Fleroxacin
  • Gemifloxacin
  • Gatifloxacin
  • Levofloxacin
  • Lanreotide
  • Moxifloxacin
  • Lomefloxacin
  • Norfloxacin
  • Nadifloxacin
  • Ofloxacin
  • Octreotide
  • Pazufloxacin
  • Pasireotide
  • Prulifloxacin
  • Pefloxacin
  • Sparfloxacin
  • Rufloxacin
  • Tosufloxacin
  • Thioctic Acid

Some unwanted effects may experience an increased risk if the following drugs are taken with Exenatide:

  • Atenolol
  • Acebutolol
  • Bisoprolol
  • Betaxolol
  • Carteolol
  • Celiprolol
  • Carvedilol
  • Insulin
  • Digoxin
  • Insulin Aspart, Recombinant
  • Esmolol
  • Insulin Glulisine
  • Levobunolol
  • Insulin Bovine
  • Labetalol
  • Insulin Lispro, Recombinant
  • Metoprolol
  • Metipranolol
  • Insulin Glargine, Recombinant
  • Nebivolol
  • Nadolol
  • Insulin Detemir
  • Penbutolol
  • Insulin Degludec
  • Oxprenolol
  • Practolol
  • Pindolol
  • Sotalol
  • Propranolol
  • Warfarin
  • Timolol

Exenatide may interact with some foods or with foods in general; your doctor will alert you to any foods to avoid or if you should take this medication with or without food. Use of alcoholic beverages, tobacco products or illegal drugs should be discussed with your health care professional if these are regular substances you consume.

Patients who have the following medical conditions may not be able to be prescribed Exenatide or may have their dosage regulated. This is because these health issues may become worse with use of this medication or may render it ineffective. Your full medical history should be disclosed to your physician so that the best course of treatment can be safely prescribed for you. Specifically, notify your doctor if you have the following conditions:

Warnings

Tests of your urine or blood must be regularly performed by your physician in order to monitor the effects that Exenatide is having on your disease or if it is causing unwanted effects.

If you are using insulin, notify your doctor as some forms of insulin should not be used with Exenatide including prandial forms of insulin like Lantus or Apidra. Use of these medications in tandem may cause side effects that are unpleasant and dangerous.

Read and follow all instructions, asking your medical care team if you have any questions. This includes all patient leaflets provided and dosing instruction information. You may also be given special instructions with the following lifestyle changes in mind:

  • Alcoholic beverage consumption may lower blood sugar levels
  • Drug interactions are common and may be dangerous
  • Family counseling can help deal with side effects
  • Lifestyle counseling can benefit patients in coping with their disease
  • Diet and exercise coaching can benefit patients in many ways
  • Pregnancy and fertility counseling, if necessary
  • Travel considerations with regard to time zones, meals and emergencies should be planned for ahead of your trip

An emergency identification necklace or bracelet should be worn or an ID card should be carried by the patient at all times in case of emergency. A medical history and list of medications should also be kept handy for any urgent requirements.

Patients should be alert for symptoms of thyroid tumors, which have been known to demonstrate an increased risk with use of Exenatide. Any swollen spots or lumps in the throat or neck area should be reported to your physician immediately. Trouble breathing or swallowing or a voice that sounds hoarse could also be signs and should be made known to your doctor.

Exenatide may increase your risk for pancreatitis, which is exhibited through symptoms such as abdominal pain that can be severe, constipation, chills, vomiting, nausea, lightheadedness or fever. Report these symptoms to your healthcare provider right away.

Anaphylaxis, a life-threatening condition requiring emergency medical services may occur with use of Exenatide. Skin rashes, itchy skin, hoarse voice, difficulty breathing or swallowing or any swelling of your body should be reported to your doctor immediately.

The site where you inject your medication should never appear depressed or indented or be a strange color such as black, blue or green. There should be no skin peeling, pain or redness; if any of these describes your injection site, let your doctor know right away.

Other medications, when improperly used with Exenatide, may cause your blood sugar to drop dangerously low, a condition called hypoglycemia. Missing a meal or snack could also cause this condition as could strenuous exercise, alcohol consumption or vomiting. If you experience symptoms such as changes in your behavior or mood, a drunken appearance, muddled thinking, sleepiness, shaking, slurring speech, weak muscles or a continuous headache, report these symptoms right away and consume a snack such as honey, sugar cubes, fruit juice, full-calorie soft drinks, sugar water or glucose tablets or gel. Check the level of sugar in your blood and have a glucagon kit handy in case of emergency. Make sure you know how and when to administer this kit and that your friends and family know as well.

Another condition called hyperglycemia or high blood sugar levels can happen if you've skipped doses of any anti-diabetic medications or if you overeat or go off your meal plan. If you have a fever, infection or stop exercising, this could also put your body into a hyperglycemic state. Blurred vision, dry mouth, sleepiness, dry skin that appears flushed, fruity breath and more frequent or higher volume urination are signs of hyperglycemia. Stomach problems including nausea and vomiting, fatigue, trouble breathing and unconsciousness may also occur with this condition. Check your blood and notify your physician immediately.

Storage

Your dose of Exenatide should be stored in the refrigerator, but never allowed to freeze. Allow your dosage to come up to room temperature prior to giving yourself the injection. Keep Exenatide and all needles, syringes and vials out of sight and reach of children and pets. Your doctor will advise you on how to safely dispose of any unused medication as well as any sharp needles and other items.

Patients prescribed the pen dosage format known as Byetta should store their pens in the original box in the refrigerator, away from light and protected from freezing. Unopened, the pen can remain at room temperature or in the refrigerator for up to 30 days but must be disposed of after that time. Removing the needle portion of the pen before storage of Byetta will prevent the medicine from leaking out as well as keeping air from forming bubbles in the pen itself.

Bydureon patients should store their medication in the original box in the refrigerator, protected from light and never allowed to freeze. Unopened, Bydureon is safe until the expiration date detailed on the packaging. At room temperature, Bydureon doses are safe for four weeks only.

Summary

Exenatide is a GLP-1 antagonist drug that is classed as an incretin mimetic and is sold under the trade names of Byetta and Bydureon. Prescribed for the treatment of type two diabetes, Exenatide is injected under the skin of the upper arm, the thigh or the abdomen by the patient. Dosage depends on several factors as well as the format of the drug.

Byetta must be injected an hour prior to eating twice daily while Bydureon is injected once per week. Both formats of the prescription come complete with syringe and needle or pen and needle, depending on the administration.

Exenatide works by increasing the secretion of insulin in the pancreas, which is a natural response to consumption of food. By increasing insulin at this time, blood sugar is not allowed to rise to abnormal levels. This, in turn, stops the pancreas from producing too much insulin. Additionally, Exenatide goes a step further and stops the pancreas from releasing glucagon during food consumption, which keeps the liver from making too much sugar and causing an elevation in those levels. Finally, by prolonging the stomach's digestion of food, Exenatide makes the patient feel more satisfied with a lesser amount of food, typically leading to weight loss over the long term which benefits their health condition as well.

Depending on the patient's specific condition and overall health, other drugs may be prescribed in conjunction with Exenatide treatment. A special diet and exercise plan may also be prescribed along with other lifestyle changes. All instructions and prescriptions should be followed exactly to ensure the safety of the patient while taking Exenatide as well as to maximize the effectiveness of the drug.

Patients who are taking other medications, even those not requiring a prescription, or who have health conditions unrelated to their type two diabetes should disclose this information to their healthcare provider in case of any potentially dangerous interactions between the drugs or health conditions. Dosage instructions with regard to frequency and amounts should be followed as closely as possible.

Any unwanted effects on health that could be allergy related or potentially involve an infection at the injection site should be reported to medical personnel right away. Sudden changes in health that could be related to using Exenatide should be reported. This drug has been associated with risks involving thyroid tumors, pancreatitis and other unwanted health effects. While Exenatide does not cause low blood sugar, this condition can occur even when patients are taking Exenatide. Risk of hyperglycemia or high blood sugar is also possible even when dosage instruction has been followed. Any ill health symptoms should be reported to your doctor immediately in case emergency medical care is required.

Exenatide should be stored in the refrigerator in its original packaging, protected from light and never being allowed to freeze. Children and pets should be protected from this drug in all possible ways including needle disposal and storage in a safe manner.