Home Drug Guide Exenatide

Drug Guide

Generic Name

Exenatide

Brand Names Byetta, Bydureon, Bydureon Pen, Bydureon Bcise

Classification

Therapeutic: Antidiabetic agent

Pharmacological: GLP-1 receptor agonist

FDA Approved Indications

Type 2 diabetes mellitus, as adjunct to diet and exercise

Mechanism of Action

Exenatide mimics incretin hormones, stimulating glucose-dependent insulin secretion, suppressing glucagon secretion, slowing gastric emptying, and reducing appetite, thereby improving glycemic control.

Dosage and Administration

Adult: Byetta: 5 mcg twice daily subcutaneously, may increase to 10 mcg twice daily. Bydureon: 2 mg once weekly subcutaneously. Bydureon Bcise: 2 mg once weekly subcutaneously, administered by healthcare provider.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution in elderly; standard doses as above.

Renal Impairment: Adjust dosing in severe renal impairment (CrCl <30 mL/min).

Hepatic Impairment: No specific dose adjustment required.

Pharmacokinetics

Absorption: Peak plasma concentrations in approximately 2 hours after injection.

Distribution: Vd not well established, predominantly remains in plasma and interstitial fluids.

Metabolism: Broken down by proteolytic cleavage and renal elimination, not metabolized by liver enzymes.

Excretion: Renal route mainly.

Half Life: Approximately 2.4 hours (exenatide).

Contraindications

History of medullary thyroid carcinoma.
Multiple endocrine neoplasia syndrome type 2.

Precautions

Use with caution in renal impairment, pancreatitis, and in patients with a history of gastroparesis.

Adverse Reactions - Common

Nausea (Frequent)
Vomiting (Occasional)
Diarrhea (Occasional)
Hypoglycemia (especially when used with insulin or sulfonylureas) (Common)

Adverse Reactions - Serious

Pancreatitis (Rare)
Medullary thyroid carcinoma (Rare)
Severe allergic reactions (Rare)

Drug-Drug Interactions

Insulin (increase risk of hypoglycemia)
Sulfonylureas (risk of hypoglycemia)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood glucose levels regularly, assess for signs of pancreatitis and allergic reactions.

Diagnoses:

Risk for hypoglycemia
Impaired skin integrity at injection site

Implementation: Administer subcutaneously as prescribed, educate on proper injection technique.

Evaluation: Maintain blood glucose within target range, monitor for adverse reactions.

Patient/Family Teaching

Take medication as prescribed.
Report severe abdominal pain or symptoms of pancreatitis.
Notice injection site reactions.
Follow dietary and exercise recommendations.

Special Considerations

Black Box Warnings:

Thyroid C-cell tumors, including medullary thyroid carcinoma, have been observed in rodents; human risk unknown.

Genetic Factors: Patients with a history of medullary thyroid carcinoma or MEN 2 should not use.

Lab Test Interference: No significant interference reported.

Overdose Management

Signs/Symptoms: Severe nausea, vomiting.

Treatment: Supportive care, symptomatic management, no specific antidote.

Storage and Handling

Storage: Store unopened pens refrigerated; discard after expiration date. Bydureon pens may be stored at room temperature for up to 4 weeks.

Stability: Stable under recommended storage conditions.