Exenatide is an injectable medication used to lower blood sugar in people with type 2 diabetes. It should be used along with an appropriate diet and exercise plan. This medication comes in short-acting (Byetta) and long-acting (Bydureon BCise) versions.
Type 2 diabetes, in combination with diet and exercise (adults) - Byetta only
Type 2 diabetes, in combination with diet and exercise (adults and children age 10 years and older) - Bydureon BCise only
Exenatide is a glucagon-like peptide-1 (GLP-1) receptor agonist. It acts like GLP-1, a hormone that tells your body to release insulin after you eat. Also like GLP-1, exenatide blocks your liver from releasing sugar into your blood. These actions help control and maintain blood sugar levels in people with type 2 diabetes.
Source: DailyMed
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Incidence not known
Agitation
bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
bloated or feeling of fullness
chills
confusion
dark urine
decreased awareness or responsiveness
decreased urination or urine output
difficulty with swallowing
dizziness
fainting
fast heartbeat
headache
hives or welts, itching, or skin rash
hostility
increase in heart rate
indigestion
irritability
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
lightheadedness
loss of appetite
loss of consciousness
muscle twitching
pains in the stomach, side, or abdomen, possibly radiating to the back
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
rapid breathing
rapid weight gain
seizures
severe sleepiness
sunken eyes
swelling of the face, ankles, or hands
thirst
tightness in the chest
unusual bleeding or bruising
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
vomiting
wrinkled skin
yellow eyes or skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Decreased appetite
increased sweating
lack or loss of strength
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Can lower your A1c (average blood sugar over time)
Not as likely to cause very low blood sugar as other diabetes medications
Might help some people with weight loss
Bydureon BCise (once-weekly injections) can be taken any time of day, with or without food
Slows stomach emptying, which can affect how other medications are absorbed
Short-acting version (Byetta) must be used within 60 minutes before meals
Not safe for people with severe kidney problems
Brand-name only, so it can be expensive
Exenatide comes as either a short-acting or long-acting medication, both of which have different dosing schedules and devices for injection. Make sure you know how to use the medication you're taking. The "Instructions for Use" that comes with your medication will provide detailed directions on how to use it. And if you have any questions, speak to your provider or pharmacist.
If you're prescribed both insulin and exenatide, don't mix them together in the same injection. You can give an injection of exenatide and insulin in the same body area (e.g., your stomach), but avoid injecting them right next to each other.
Your risk for getting low blood sugar is higher if you take exenatide with another medication that can cause low blood sugar, such as insulin. Your provider might need to adjust the dose of your other diabetes medications when you start taking exenatide.
Talk to your healthcare provider if you use too much exenatide, because this can cause a dangerous drop in your blood sugar. This can also raise your chance of experiencing side effects like severe nausea and vomiting.
Sometimes our immune systems can develop antibodies to fight exenatide. If enough antibodies develop, the medication won't work as well. Talk to your provider if you notice changes in your blood sugar that can't be explained by diet or exercise.
Byetta (short-acting exenatide)
Unopened Byetta should be stored in the refrigerator. After first use, you can keep it at room temperature. Throw it away if it's been 30 days after you've used it, even if some medication remains in the pen.
There should be at least 6 hours between your 2 daily injections of Byetta. Don't use it after a meal. If you miss a dose, just pick back up with your next dose at your normal time.
Bydureon BCise (long-acting exenatide)
You can store Bydureon BCise in the refrigerator, or keep it at room temperature for no more than 4 weeks.
If you miss a dose of Bydureon BCise, give the injection as soon as you remember, as long as the next scheduled dose is due at least 3 days later. Then you can continue your usual weekly dosing schedule. If you miss a dose and the next scheduled dose is due 1 or 2 days later, just skip the dose you missed and continue with your next regularly scheduled injection.
Exenatide can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk factors: Personal or family history of thyroid cancer
Using exenatide, specifically the long-acting version (Bydureon BCise), might put you at higher risk for certain thyroid cancers. Let your provider know if you or a family member have ever had thyroid cancer. Call your provider right away if you have a lump in your neck, trouble breathing or swallowing, or hoarseness that won't go away.
Exenatide might raise your risk for inflammation of the pancreas (also called pancreatitis), including serious cases that can lead to death. This side effect is rare, but let your provider know right away if you have severe abdominal pain that doesn't go away, especially if it moves to your back, or if you also have vomiting. If you experience pancreatitis while taking exenatide, your provider will probably tell you to stop taking it and will change you to a different medication to treat your diabetes.
Risk factors: Using insulin | Taking sulfonylurea medications (e.g., glimepiride, glipizide)
Taking exenatide on its own isn't likely to cause low blood sugar, but you could experience this side effect if you're taking it with insulin or sulfonylureas. Some examples of sulfonylureas are glimepiride (Amaryl) and glipizide (Glucotrol). Signs of low blood sugar include headache, drowsiness, weakness, hunger, fast heart beat, dizziness, confusion, anxiety, sweating, blurred vision, and slurred speech. Be sure to check your blood sugar regularly and know how to treat low blood sugar when you recognize the signs (e.g., 15-15 rule). If low blood sugar is a consistent problem, talk to your provider. They might need to adjust the dose of your other diabetes medications while taking exenatide.
Risk factors: Use of diuretics, ACE inhibitors, or NSAIDs | Current or previous kidney problems
Exenatide might affect how well your kidneys work. The risk of kidney problems is higher if you're taking other medications that affect the kidneys like diuretics, ACE inhibitors, or NSAIDs. Let your provider know if you have nausea, vomiting, diarrhea, changes how often you urinate, swelling in legs or ankles, tiredness, or trouble breathing. Typically, people with severe kidney problems shouldn't take exenatide.
Rarely, exenatide can cause severe allergic reactions, such as rash, blistering, trouble breathing, or swelling of the lips, mouth, tongue, or throat. If you experience any symptoms of an allergic reaction, stop using exenatide and get medical help right away.
Sometimes a serious blood problem known as drug-induced thrombocytopenia can occur in people taking exenatide. This happens when you have too few platelets in your blood (a part of the blood that helps with clotting), which can lead to dangerous bleeding. Talk to your provider right away if you notice unusual bleeding, bleeding when you brush your teeth, easy bruising, or pinpoint red spots on your skin. If you experience this problem, you'll probably have to stop taking exenatide.
Since exenatide is injected into the skin, some people can experience reactions at the injection site. Most of the reactions are mild side effects like redness, rash, or itching. But you should contact your provider if you have a nodule (round lump) under the skin, or if you have changes in your skin that could be signs of an infection like warmth, redness, swelling, and pain.
Some people taking exenatide might experience gallbladder problems. This can include gallstones or inflammation of the gallbladder, which can require surgery. Let your provider know if you have stomach pain that doesn’t go away, nausea, vomiting, fever, or yellowing of the skin and eyes while taking exenatide.
Byetta (short-acting): The typical dose is 5 to 10 mcg injected under the skin twice a day. Inject within 60 minutes before the two main meals of the day, at least 6 hours apart.
Bydureon BCise (long-acting): The typical dose is 2 mg injected under the skin once a week at any time of day with or without meals.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Personal or family history of certain types of thyroid cancer
History of drug-induced immune-mediated thrombocytopenia from exenatide
Type 2 diabetes, in combination with diet and exercise (adults) - Byetta only
Type 2 diabetes, in combination with diet and exercise (adults and children age 10 years and older) - Bydureon BCise only
Type 2 diabetes in people age 10 and older, in addition to diet and exercise
Lowering the risk of major heart-related problems (like heart attack) in adults with Type 2 diabetes and heart disease
Manage Type 2 diabetes in people 10 years and older, along with diet and exercise
Lower the risk of heart problems like heart attack, stroke, or death in adults with Type 2 diabetes who have heart disease or heart-related risk factors
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