EXENATIDE
| Exenatide (e-xe'na-tide) Byetta Classifications: antidiabetic agent, incretin mimetic; Therapeutic: antidiabetic; incretin mimetic Pregnancy Category: C |
Availability
250 mcg/mL injection
Action
Improves glycemic control in people with type 2 diabetes mellitus by mimicking the functions of incretin, a glucagon-like peptide-1 (GLP-1). Exenatide enhances glucose-dependent insulin secretion by pancreatic beta-cells, suppresses inappropriately elevated glucagon secretion, and slows gastric emptying. These actions decrease glucagon stimulation of hepatic glucose output and decrease insulin demand.
Therapeutic Effect
Improves glycemic control by reducing fasting and postprandial glucose concentrations in patients with type 2 diabetes.
Uses
Adjunct treatment of type 2 diabetes mellitus in those inadequately managed by metformin, a sulfonylurea, or a combination of these agents.
Contraindications
Hypersensitivity to exenatide, or cresol; severe GI disease (i.e., ulcerative colitis; Crohn's disease, diabetic ketoacidosis; gastroparesis; end-stage renal disease, renal failure or severe renal impairment (Clcr <30 mL/min); pregnancy (category C).
Cautious Use
Elderly; renal impairment; renal disease; thyroid disease; lactation.
Route & Dosage
| Type 2 Diabetes Mellitus Adult: SC Initial dose of 5 mcg b.i.d., within 60 min prior to the morning and evening meal. After 1 mo, may increase to 10 mcg b.i.d., within 60 min prior to the morning and evening meal. |
Administration
- Give SC into thigh, abdomen, or upper arm within 60 min before the morning and evening meals. Do not administer after a meal.
- Do not give within 1 h of oral antibiotics, an oral contraceptive, or acetaminophen.Store at 36°–46° F (2°–8° C) and protect from light. Discard pen 30 d after first use. Do not use if pen has been frozen.
Adverse Effects (≥1%)
CNS: Asthenia, dizziness, restlessness, jittery feeling. GI: Nausea, vomiting, diarrhea, dyspepsia, anorexia, gastroesophageal reflux. Metabolic: Hypoglycemia, excessive sweating (hyperhidrosis or diaphoresis).Interactions
Drug: Due to its ability to slow gastric emptying, exenatide can decrease the rate and/or serum levels of oral medications that require GI absorption.Pharmacokinetics
Peak: 2 h. Elimination: Primarily in urine. Half-Life: 2.4 h.Nursing Implications
Assessment & Drug Effects
- Monitor for and report S&S of significant GI distress, including NV&D.
- Monitor for S&S of hypoglycemia when used in combination with a sulfonylurea drug.
- Lab tests: Periodic fasting and postprandial plasma glucose and periodic HbA1C; baseline and periodic renal function tests.
Patient & Family Education
- Follow directions for taking this drug (see Administration).
- If a dose is missed, wait for the next scheduled dose.
- Discard any pen that has been in use for greater than 30 d.
- Exenatide may cause decreased appetite and some weight loss.
- Report significant GI distress to physician.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug