Exanatide is the Injectable Type 2 Diabetes Medication

Exanatide is the generic name for Byetta. It was approved by the FDA in the year 2000.

Byetta is an incretin mimetic agent known as glucagon-like peptide-1 (GLP-1) receptor agonists. GLP-1 is an incretin hormone.

Byetta is given by subcutaneous injection, which is injection into the fat layer under the skin in the thigh, upper arm or abdomen. It is important to note that exenatide is not insulin and should not be used to treat type 1 diabetes.

Byetta is mostly cleared through the kidney.

Inactive ingredients in Byetta are metacresol, mannitol, glacial acetic acid and sodium acetate trihydrate.

How Exanatide works

Byetta works like incretin hormones. Incretin hormones are those hormones that, when present in the blood after meals, increase the making and release of insulin from the pancreas into the blood.

Byetta works by:

  • Causing the pancreas to make and release insulin
  • Slowing the digestive system so that the glucose it puts into the blood from the meals is reduced.
  • Preventing the release of glucose from the glycogen stores in the liver.
  • Helping the body to use insulin to build muscles and helps the storage of glucose in the liver, muscles and fats.
  • Decreasing appetite, thereby reducing the amount of carbohydrate consumed.


When the glucose in the blood gets to normal level, the insulin secretion caused by Byetta reduces. Exenatide does not stop glucagon hormone from correcting hypoglycemia. It lowers glucagon secretion in hyperglycemia


How Exanatide is Supplied

Exanatide is supplied as a clear

liquid solution containing exanatide 250 micrograms/milliliter (250mcg/ml). The medication is supplied as prefilled pens.

  • 1.2ml prefilled pen that delivers 60 doses of 5mcg each dose.
  • 2.4ml prefilled pen that delivers 60 doses of 10mcg each.

The prefilled pens supply 30 days of this diabetes medication at twice a day dosing.

How to Use Exanatide

Only a doctor or other prescribing clinicians can prescribe Byetta and adjust the dose as necessary.

Your health care provider will show you the right way to administer Byetta.

Patient should be monitored closely at the start of treatment and afterwards for serious abdominal pain which may radiate to the back, whether or not there is associated vomiting because these could be signs and symptoms of pancreatitis. Stop Byetta if you experience any of the signs and symptoms and inform your physician. Pancreatitis should be treated promptly.

Byetta is to be used in addition to exercise and diabetic diet in the treatment of type 2 diabetes.

The usual starting dose is 5 micrograms (mcg) twice a day, which is necessary to reduce the possibility of exanatide side effects. This can be increased to 10mcg twice a day which is the maximum dose. The patient is usually monitored on the 5mcg for at least one month before the dose can be increased to 10mcg, if needed.

Store Byetta in the refrigerator when the pen is still sealed. When the prefilled pen is unsealed and in use, it can be stored at room temperature below 77˚F (25˚C). Never freeze Byetta and do not use if has been frozen.

Protect it from light.

Remember to purchase injection needles because the Byetta prefilled pens do not come with injection needles.

Inject within 60 minutes before the two main meals of the day, typically, the morning and evening, at least 6 hours apart.

Inject the correct dose of Byetta directly from the prefilled pen. Do not give with a syringe.

Use a new sterile needle for each injection. Do not reuse the injection needle

Dispose of the prefilled pen 30days after opening.

Dispose of all used needles in secure containers in order to prevent the spread of disease.

Remember not to make up any missed doses. If you miss the dose before meal, wait till the next scheduled time to use another dose.

Monitor the finger stick blood sugar closely when patient is on Byetta in order to determine how well the medication is working to lower blood glucose.

Call your clinician if you experience any serious adverse reactions or any side effect that would not stop.

Byetta Adverse Reactions

Acute pancreatitis can occur from the use of this diabetic medicine. Exenatide has a warning of serious adverse effect of pancreatitis.

Hypoglycemia, especially when used in combination with insulin or insulin secretagogues. Insulin secretagogues are those diabetic medicines that cause the body to release insulin. Examples of insulin secretagogues are sulfonylureas like Diabeta and Amaryl, and meglitinides like Prandin and Starlix.

Kidney disease have resulted from the use of exenatide, up to the point of needing hemodialysis and kidney transplantation.

Allergic reactions that include angioedema and anaphylaxis. Other allergic reactions include injection site reaction, rash and itch. If allergic reactions occur, the medication should be discontinued.

In few cases, high antibody developed in response to exenatide can decrease the effectiveness of the drug in lowering blood glucose.

Other Side Effects

Nausea – this is a common side effect that subsides with time.

Headache

Nervousness

Vomitting – treat severe vomiting to prevent dehydration.

Constipation

Upset stomach

Diarrhea

Dizziness

Body weakness

Flatulence

Burping

Abnormality in taste sensation

Decreased appetite

Hair loss which is also called alopecia.

Drug interactions with Byetta

Some diabetes medications that cause low blood sugar, like insulin and sulfonylurea may cause the patients’ blood glucose to drop and may lead to dangerous hypoglycemia. When given in combination with sulfonylurea or insulin, the patient should be monitored closely and the dose of sulfonylurea or insulin reduced as necessary in order to reach optimal glycemic control. The physician may need to lower the dose of insulin or insulin secretagogue when used concomitant with exenatide.

Exenatide increases the risk of bleeding in patients taking Coumadin. Patients on warfarin should have their INR monitored closely when they start on exenatide. The Coumadin dose may need to be decreased.

Use of exenatide with ACE inhibitors, non-steroidal anti-inflammatory medications (NSAIDS) and or diuretics may worsen kidney damage.

One of the ways exenatide works is the slowing of the digestive system, so that glucose is picked up slowly. This also affects medications that are taken by mouth, resulting in the drug not building enough blood level to work effectively. Patients are advised to take medication about one hour before using exenatine or with other meals or snacks when exenatide is not in use.

Exenatide may reduce the effectiveness of oral contraceptives.


Who Should Not Take Byetta

Patients with type 1 diabetes

Patients in diabetic ketoacidosis or diabetic

non-ketotic coma

Do Not

Do not give to patients who are allergic to exenatide or the inactive ingredients of Byetta.

Do not use in addition to meal-time insulin. Patients on exenatide should not use meal-time insulin.

Do not use in patients with history of pancreatitis, gallstones, alcoholism or high level of triglycerides.

Do not give to people with severe kidney disease.

Do not inject after meals.

Do not use in patients with severe digestive tract diseases.

Do not mix exenatide with insulin in one injection.

Do not use in patients with gastroenteritis.

Do not freeze exenatide.

Do not use the prefilled pen if has been frozen

Do not store with the needle cap on as this may allow bubbles to form inside the pen and may affect the action of the drug.

Do not use exenatide more than 30days after the first dose from the prefilled pen.

Do not use expired medications.

Do not share one prefilled pen between patients.

Special Considerations

Use with caution in those with kidney transplant and those with moderate kidney disease.

Exenatide was found to cause birth defects in animal studies. Use in pregnant women only when the benefit outweighs the potential risk.

Use with caution in nursing mothers because of possibility of the drug being secreted into the mother’s milk.

It is not yet known whether exenatide is safe and effective to be used in pediatric patients.

Use with caution in elderly patients as this population is more likely to have kidney disease than the younger population. Elderly patients with good kidney function have no restriction in the use of exenatide.

Byetta Overdose

The overdose of exenatide could result in serious nausea and vomiting, which can lead to dehydration. Severe hypoglycemia can also result quickly from overdose of exanatide. In case of overdose, the physician and poison control center should be alerted right away. Patient may need to be treated in a hospital setting. The treatment is usually the treatment of the symptoms presented, including fluid replacement therapy if needed. Overdose of Byetta could result in changes of the heart rhythm, so patients in severe overdose should have their heart rhythm monitored.


Lab Tests for Patient on Exanatide

HbA1C should be monitored periodically to check for the continued effectiveness of exenatide

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