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Exenatide
Exenatide ( Byetta®) is a prescription medication licensed to treat type 2 diabetes (also known as non- insulin-dependent diabetes or adult-onset diabetes). Although the medication is taken by injection, it is not a form of insulin and is not intended to treat type 1 diabetes. Exenatide is approved only for use in combination with certain oral diabetes drugs. Interestingly, this medication was first discovered in the saliva of gila monster lizards.
Side Effects of Exenatide
As with any medicine, side effects are possible with exenatide. However, not everyone who takes the drug will experience side effects. In fact, most people tolerate it well. If side effects do occur, in most cases, they are minor and either require no treatment or can be easily treated by you or your healthcare provider. Serious side effects are less common.
The most common side effects include:
What Should I Tell My Healthcare Provider?
You should talk with your healthcare provider prior to taking exenatide if you have:
- Kidney problems, including kidney failure (renal failure)
- A history of diabetic ketoacidosis (a life-threatening condition that may occur with uncontrolled diabetes)
- Diabetic gastroparesis (a slowing down of the digestive tract due to diabetes)
- Other digestive tract conditions
- Any allergies, including allergies to foods, dyes, or preservatives.
Also, let your healthcare provider know if you are:
Tell your healthcare provider about all of the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.
Exenatide is an incretin mimetic. This means that it mimics the actions of incretin hormones in the body. As an incretin mimetic, exenatide increases insulin production in response to meals and decreases the amount of glucose (sugar) that the liver produces. The medication also slows down the emptying of food from the stomach, which reduces the amount of food that people eat.
Because incretin hormones are more active in response to higher blood sugar levels (and are less active in response to low blood sugar), the risk of dangerously low blood sugar (hypoglycemia) is low with exenatide. However, combining exenatide with other diabetes medications to lower blood sugar can increase the risk of hypoglycemia (see Byetta and Blood Sugar).
Several studies have looked at the effects of exenatide on type 2 diabetes.
Hemoglobin A1c
Hemoglobin A1c (HbA1c) is a test used to measure long-term blood sugar control. For people without diabetes, HbA1c results are usually less than 6 percent, while people with diabetes usually have higher results. In studies, people taking exenatide (in combination with other diabetes medications) lowered their HbA1c by 0.4 to 0.9 percent, on average, while the HbA1c levels in people not taking the drug increased.
Studies have shown that the higher the HbA1c, the greater the chance for developing long-term problems related to diabetes. This includes problems such as heart disease, diabetic retinopathy, diabetic neuropathy, and diabetic nephropathy. By getting blood sugar levels under control with exenatide, it may be possible to decrease the chances for developing these diabetes complications.
Weight
In clinical studies, people taking exenatide lost more weight than people who were not taking it. However, the amount of weight loss was modest; people on the drug lost about two to six pounds over 30 weeks (see Byetta for Weight Loss).
When and How to Take Exenatide
Some general considerations for when and how to take exenatide include the following:
- The medication comes in an injectable form. It is given just under the skin of the thigh, abdomen (stomach), or upper arm. Make sure your healthcare provider explains exactly how to inject exenatide.
- Exenatide should be injected twice a day, before the two main meals, at least six hours apart.
- The medication should be injected within 60 minutes before the meal. It should not be taken after the meal or more than 60 minutes before the meal.
- The dosages should be taken at the same times each day to maintain an even level in your blood.
- For the medication to work properly, it must be injected as prescribed. Exenatide will not work if you stop using it.
The dose of exenatide your healthcare provider recommends will vary, depending on a number of factors, including:
- How well your diabetes is controlled
- Other medical conditions you may have
- Other medications you may be taking.
As is always the case, do not adjust your dose unless your healthcare provider specifically instructs you to do so.
Alternatives to Exenatide
In general, type 2 diabetes treatment begins with lifestyle changes (such as weight loss, exercise, and diet). If lifestyle changes alone are not effective at managing diabetes, medication, such as exenatide, may be necessary.
The main goal of diabetes medication is to lower blood sugar levels enough to reduce your risk of developing problems related to diabetes, such as heart, nerve, eye, or kidney problems. Because exenatide can lower blood sugar levels, people may be able to lower their risk for developing problems related to high blood sugar by taking it.
For most people, exenatide is quite effective at controlling blood sugar. It is also generally well tolerated. However, side effects can occur, or the medicine may not work as well as needed. In these cases, you may need to add another diabetes medication in order to control your blood sugar. You may also wish to consider a substitute. These substitutes can include other diabetes drugs, either by themselves or in combination.
To learn about controlling diabetes through lifestyle choices, click any of the following links:
What If I Take an Overdose?
People who take too much exenatide may have overdose symptoms that could include:
If you happen to take too much, seek immediate medical attention.
How Should Exenatide Be Stored?
Your pharmacist must store exenatide under refrigeration, but you may keep it at room temperature (up to 77 degrees F) after the first use, up to 30 days. Any pens that you have not used yet should be stored in the refrigerator. The medication should not be frozen, and you should not use any exenatide that has been frozen. Do not store your pens with the needles attached (this will prevent leakage). A pen should be thrown away 30 days after the first time you use it, even it there is some medication left in it.
Keep this and all medications out of the reach of children.
What Should I Do If I Miss a Dose?
If you do not take exenatide as scheduled, skip your missed dose and continue with your regular schedule. Do not take the medication after a meal, and do not take a double dose.
Exenatide is made by Amylin Pharmaceuticals, Inc.
Exenatide pens are available in two strengths:
- Exenatide 5 mcg prefilled pens (60 doses each)
- Exenatide 10 mcg prefilled pens (60 doses each).
You will need pen needles to be able to inject exenatide, since the medication does not come with pen needles. Pen needles are special needles used for pen-injecting devices. Ask your healthcare provider about which length and gauge of pen needles will be best for you. In some situations (and in some states), you may need a prescription for them, so be sure to ask your healthcare provider about whether you need a prescription for pen needles.
There is currently no generic exenatide licensed for sale in the United States (see Generic Byetta for more information).
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Written by/reviewed by: Kristi Monson, PharmD; Arthur Schoenstadt, MD
Last reviewed by: Kristi Monson, PharmD;
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