exenatide


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Related to exenatide: Pramlintide

exenatide

(ex-en-a-tide) ,

Bydureon

(trade name),

Byetta

(trade name)

Classification

Therapeutic: antidiabetics
Pharmacologic: incretin mimetic agents
Pregnancy Category: C

Indications

Management of type 2 diabetes as an adjunct to diet and exercise.

Action

Mimics the action of incretin which promotes endogenous insulin secretion and promotes other mechanisms of glucose-lowering.

Therapeutic effects

Improved control of blood glucose.

Pharmacokinetics

Absorption: Well absorbed following subcutaneous administration.
Distribution: Unknown.
Metabolism and Excretion: Excreted mostly by glomerular filtration followed by degradation.
Half-life: Immediate-release—2.4 hr.

Time/action profile (effects on post-prandial blood glucose)

ROUTEONSETPEAKDURATION
Subcut (immediate-release)within 30 min2.1 hr8 hr
Subcut (extended-release)unknown9 wkunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Type 1 diabetes or diabetic ketoacidosis;Severe renal impairment or end-stage renal disease (CCr <30 mL/min);Severe gastrointestinal disease;Personal or family history of medullary thyroid carcinoma (extended-release only)Multiple Endocrine Neoplasia syndrome (extended-release only) Obstetric: Has caused fetal physical defects and neonatal death in animal studies; Lactation: Excretion into breast milk unknown.
Use Cautiously in: History of pancreatitis;Moderate renal impairment (CCr 30–50 mL/min);Concurrent use of insulin (extended-release only) Pediatric: Safety not established.

Adverse Reactions/Side Effects

Cardiovascular

  • dizziness
  • headache
  • jitteriness
  • weakness

Gastrointestinal

  • pancreatitis (life-threatening)
  • diarrhea (most frequent)
  • nausea (most frequent)
  • vomiting (most frequent)
  • dyspepsia
  • gastroinestinal reflux

Endocrinologic

  • thyroid t-cell tumors (extended-release) (life-threatening)
  • hypoglycemia

Genitourinary

  • acute renal failure

Dermatologic

  • hyperhydrosis

Metabolic

  • ↓ appetite
  • weight loss

Interactions

Drug-Drug interaction

Concurrent use with sulfonylureas or insulin may ↑ risk of hypoglycemia (↓ dose of sulfonylurea or insulin if hypoglycemia occurs); concomitant use of insulin with extended-release exenatide not recommended.Concurrent use with nateglinide or repaglinide may ↑ risk of hypoglycemia.Due to slowed gastric emptying, may ↓ absorption of orally administered medications, especially those requiring rapid GI absorption or require a specific level for efficacy; take oral anti-infectives and oral contraceptives at least 1 hr before injecting exenatide).

Route/Dosage

Immediate Release (Byetta)
Subcutaneous (Adults) 5 mcg within 60 min before morning and evening meal; after 1 mo, dose may be ↑ to 10 mcg depending on response.

Renal Impairment

Subcutaneous (Adults) CCr 30–50 mL/min—Use caution when ↑ dose from 5 mcg to 10 mcg.
Extended Release (Bydureon)
Subcutaneous (Adults) 2 mg every 7 days.

Availability

Solution for subcutaneous injection (Byetta): 250 mcg/mL in prefilled pen-injector that delivers either 5 mcg/dose (1.2-mL pen) or 10 mcg/dose (2.4-mL pen) for 60 doses (30 days of twice daily dosing)
Suspension for subcutaneous injection (Bydureon): 2 mg/vial

Nursing implications

Nursing assessment

  • Observe for signs and symptoms of hypoglycemic reactions (abdominal pain, sweating, hunger, weakness, dizziness, headache, drowsiness, tremor, tachycardia, anxiety, confusion, irritability, jitteriness), especially when combined with oral sulfonylureas.
  • Assess for signs and symptoms of pancreatitis (persistent severe abdominal pain, sometimes radiating to the back, may or may not be accompanied by vomiting) at beginning of therapy and with dose increases. If suspected, promptly discontinue therapy and initiate appropriate management. If pancreatitis is confirmed, do not restart exenatide. Consider other antidiabetic therapies in patients with a history of pancreatitis.
  • Lab Test Considerations: Monitor serum glucose and glycolysated hemoglobin periodically during therapy to evaluate effectiveness of therapy.
    • Monitor renal function prior to and periodically during therapy. Renal dysfunction may be reversed with discontinuation of therapy.

Potential Nursing Diagnoses

Imbalanced nutrition: more than body requirements (Indications)
Noncompliance (Patient/Family Teaching)

Implementation

  • Some medications may need to be taken 1 hr before exenatide.
    • Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma, infection, or surgery may require administration of insulin.
  • Subcutaneous: Immediate release: Follow directions for New Pen Setup in Information for Patient prior to use of each new pen. Inject exenatide in thigh, abdomen, or upper arm at any time within the 60–min period before the morning and evening meals. Do not administer after a meal. Do not mix with insulin. Solution should be clear and colorless; do not administer solutions that are discolored or contain particulate matter. Refrigerate; discard pen 30 days after 1st use, even if some drug remains in pen. Do not freeze. Do not store pen with needle attached; medication may leak from pen or air bubbles may form in the cartridge.
  • Subcutaneous: Extended release: Dilute with diluent and needles included in tray. Suspension should be white or off-white and cloudy. Administer without regard to meals. Inject into upper arm, abdomen, or thigh; change site each week. Refrigerate; each tray can be kept at room temperature if not >77°F for up to 4 wks. Do not use beyond expiration date.

Patient/Family Teaching

  • Instruct patient to take exenatide immediate release as directed within 60 min before a meal. Do not take after a meal. If a dose is missed, skip the dose and take the next dose at the prescribed time. Do not take an extra dose or increase the amount of the next dose to make up for missed dose. If a dose of exenatide extended release is missed, administer as soon as remembered as long as the next dose is due at least 3 days later; if 1 or 2 days later skip dose and administer next dose as scheduled. The day of weekly administration can be changed as long as the last dose was administered 3 or more days before.
  • Instruct patient in proper technique for administration, timing of dose and concurrent oral medications, storage of medication, and disposal of used needles. Patients should read the Information for Patient insert prior to initiation of therapy and with each Rx refill. Advise patient that New Pen Setup should be done only with each new pen, not with each dose.
  • Inform patient that pen needles are not included with pen and must be purchased separately. Advise patient which needle length and gauge should be used. Caution patient not to share pen and needles.
  • Explain to patient that exenatide helps control hyperglycemia but does not cure diabetes. Therapy is usually long term.
  • Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hyperglycemic or hypoglycemic episodes.
  • Review signs of hypoglycemia and hyperglycemia with patient. If hypoglycemia occurs, advise patient to take a glass of orange juice or 2–3 tsp of sugar, honey, or corn syrup dissolved in water, and notify health care professional. Risk of hypoglycemia is increased if sulfonureas are taken concurrently with exenatide.
  • Advise patient to notify health care professional immediately if symptoms of pancreatitis (unexplained, persistent, severe abdominal pain which may or may not be accompanied by vomiting) occur.
  • Inform patient that therapy may result in reduction of appetite, food intake, and/or body weight. Dose modification is not necessary. Nausea is more common at initiation of therapy and usually decreases over time.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any other Rx, OTC, or herbal products. Exenatide delays stomach emptying. Some medications (such as anti-infectives and oral contraceptives) may need to be taken 1 hr before exenatide injection.
  • Instruct patient in proper testing of blood glucose and urine ketones. These tests should be monitored closely during periods of stress or illness and health care professional notified if significant changes occur.
  • Advise patient to inform health care professional of medication regimen before treatment or surgery.
  • Advise patient to notify health care professional if pregnancy is suspected or planned.
  • Advise patient to carry a form of sugar (sugar packets, candy) and identification describing disease process and medication regimen at all times.
  • Emphasize the importance of routine follow-up exams and regular testing of blood glucose and glycosylated hemoglobin.

Evaluation/Desired Outcomes

  • Control of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes.

exenatide

(ĕk′sĕn′ə-tīd′, ĭg-zĕn′-)
n.
An injectable drug that is a synthetic analog of a digestive hormone and stimulates insulin secretion when blood sugar levels are high, used to treat type 2 diabetes.

exenatide

an antidiabetic drug.
indications This drug is given in combination with metformin or a sulfonylurea to treat type 2 diabetes mellitus.
contraindications Known hypersensitivity to this drug prohibits its use.
adverse effects Adverse effects of this drug include feeling jittery, restlessness, weakness, nausea, vomiting, diarrhea, dyspepsia, anorexia, gastroesophageal reflux, and weight loss. A life-threatening side effect is hypoglycemia. Common side effects include headache and dizziness.

exenatide

; Byetta synthetic analogue of a salivary protein (from a North American lizard) that mimics human incretin, decreases gut carbohydrate absorption and promotes satiety; it is administered as a twice-daily, pre-meal, subcutaneous injection in combination with oral metformin and/or sulphonylurea therapy in the treatment of type 2 diabetes
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