Class: Glucagon-Like Peptide-1 Receptor Agonist
Dosage Forms. Subcutaneous Solution for Injection: 5 mcg/0.02 mL, 10 mcg/0.04 mL; Subcutaneous Suspension for Injection: 2 mg
Common FDA Label Indication, Dosing, and Titration.
1. Diabetes mellitus, Type II: Immediate release, 5-10 mcg sq bid; Extended release, 2 mg sq weekly
Off-Label Uses. None
MOA. Exenatide is an incretin mimetic agent that mimics the enhancement of glucose-dependent insulin secretion and several other antihyperglycemic actions of incretins. Incretins enhance glucose-dependent insulin secretion and exhibit other antihyperglycemic actions following release into circulation from the gut.
Drug Characteristics: Exenatide
Medication Safety Issues: Exenatide
Drug Interactions: Exenatide
Adverse Reactions: Exenatide
Efficacy Monitoring Parameters. Preprandial blood glucose between 70-130 mg/dL; HbAlc <7%.
Toxicity Monitoring Parameters. Symptoms of hypoglycemia include nausea, sweating, and loss of consciousness; seek medical attention if severe GI upset, changes in urination, shortness of breath, or severe skin rash.
Key Patient Counseling Points. Immediate-release product is dispensed in a prefilled pen containing 60 doses. Use this medicine 1 h before eating. Store new, unused pens in the refrigerator in the original carton. After using the pen for the first time, store it in a closed container at room temperature. Remove the needle from the pen before storing the medicine. Throw the pen away after using it for 30 d, even if there is some medicine left in it. Monitor FPG in frequent intervals (2-4 times per day). Carry candy or some type of sugar with you at all times, especially if you are away from home, for episodes of hypoglycemia. Extended-release product is dispensed as powder with diluent in prefilled syringe. Patient instructions on weekly dose preparation and administration must be provided.
Clinical Pearls. Metformin is first-line therapy for Type II diabetes. Exenatide may be added if HbAlc goals are not achieved with metformin alone. Many clinicians would try an oral sulfonylurea prior to exenatide. Dose- and duration-dependent thyroid C-cell tumors have developed in animal studies with Bydureon therapy; relevance in humans unknown. May increase risk of pancreatic duct metaplasia. Medication guide required with dispensing.