Exenatide belongs to a group of medications known as glucagon-like peptide-1 (GLP-1) receptor agonists. It is used along with other medications (e.g., metformin, glyburide, gliclazide, or insulin glargine) to improve blood glucose (sugar) levels for people with type 2 diabetes. It works by helping your body make more insulin and control blood glucose levels.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are using this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.

The usual starting dose of this medication is 5 µg (micrograms) injected subcutaneously (under the skin) in the thigh, abdomen, or upper arm twice daily. Inject this medication within 60 minutes before breakfast and dinner. You can also inject this medication before lunch and dinner as long as they are at least 6 hours apart. Do not inject this medication after a meal.

The maximum dose is 10 µg twice daily. This medication is clear and colourless and should not contain particles. Do not use it if the solution appears cloudy or coloured.

This medication is available as a prefilled pen for injection. Read the user manual for instructions on how to properly use this medication. If you are not sure how to use this medication, contact your doctor or pharmacist.

If you are taking a sulfonylurea (e.g., glyburide, gliclazide), your doctor may suggest a lower dose of the sulfonylurea when you are starting this medication or are increasing the dose.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important that this medication be used exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not use a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Before first use, store this medication in the refrigerator, protect it from light, and keep it out of the reach of children. Do not allow it to freeze.

After the first use, store this medication at room temperature. Discard any unused medication that is still in the pen 30 days after first use. Do not store this medication with the needle attached as this may cause the medication to leak.

Each mL of sterile, preserved solution contains exenatide 250 µg. Non-medicinal ingredients: m-cresol (2.20 mg), mannitol, glacial acetic acid, sodium acetate trihydrate, and water for injection. Available as prefilled pens: 1.2 mL prefilled pen (60 doses of 5 µg/dose) and 2.4 mL prefilled pen (60 doses of 10 µg/dose).

Do not use this medication if you:

• are allergic to exenatide or any ingredients of the medication
• have diabetic ketoacidosis (accumulation of ketones in the blood and urine)
• have severe kidney disease or are on dialysis
• have type 1 diabetes

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is used in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who uses this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• abdominal pain
• bloating
• diarrhea
• dizziness
• feeling jittery
• headache
• heartburn
• nausea
• pain, swelling, burning, or bruising at the place of injection
• reflux
• vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• prolonged nausea or diarrhea
• signs of kidney problems (e.g., increased urination at night, decreased urine production, blood in the urine)
• symptoms of dehydration (e.g., thirst, headache, tiredness, weakness, lack of sweating, low blood pressure, decreased urination)
• symptoms of low blood sugar (e.g., anxiety, blurred vision, confusion, difficulty concentrating, difficulty speaking, dizziness, drowsiness, fast heartbeat, feeling jittery, headache, hunger, irritability, nausea, weakness, nervousness, numbness or tingling in the lips or tongue, sweating, tiredness, trembling, weakness)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of bleeding (e.g., bloody nose, blood in urine, coughing blood, bleeding gums, cuts that don't stop bleeding)
• symptoms of a severe allergic reaction (e.g., hives; difficulty breathing; swelling of the mouth, face, tongue, or throat)
• symptoms of an abnormal heart rhythm (e.g., dizziness, seizures, fainting, or a fast or pounding heartbeat)
• symptoms of pancreatitis (inflammation of the pancreas) such as abdominal pain and vomiting

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Bleeding problems: There have been reports of bleeding problems for people taking exenatide. If you notice signs of bleeding, such as excessive bruising, nosebleeds, or cuts that do not stop bleeding, contact your doctor as soon as possible.

Blood sugar control: If you have a fever, an infection, surgery, or trauma, you may experience a loss of blood sugar control and may need to stop this medication and use insulin until you recover. Your doctor will recommend when this is needed.

Diabetes identification: It is important to either wear a bracelet (or necklace) or carry a card indicating you have diabetes and are taking medication to manage your blood glucose levels.

Electrolytes (e.g., potassium and magnesium): If you have low blood potassium or magnesium levels or have a condition that could result in dehydration (e.g., diarrhea, vomiting), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Heart problems: Exenatide may increase your heart rate and may affect how electrical impulses travel through the heart muscle. If you have heart disease (e.g., recent heart attack, angina, heart failure) or an abnormal heart rhythm (e.g., heart block or fast heart rate), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

If you experience dizziness, palpitations (a rapid, pounding, or irregular heartbeat), fainting or seizures, get immediate medical attention.

Kidney problems: This medication may cause kidney problems. Your doctor will monitor your kidney function with blood tests while you are using this medication. If you have had a kidney transplant or have reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you are on dialysis or have severely reduced kidney function, you should not use this medication.

Low blood sugar (hypoglycemia): This medication may cause low blood sugar when it is used with sulfonylureas (e.g., glyburide, gliclazide) or insulin. If you are taking any of these types of medications, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

You may also be more at risk of experiencing low blood sugar levels if you have pituitary or adrenal failure, have an eating disorder, are on a diet, skip a meal, exercise intensely, or drink excessive amounts of alcohol.

If you experience symptoms of hypoglycemia such as a cold sweat, nervousness or shakiness, fast heartbeat, headache, hunger, confusion, lightheadedness, weakness, and numbness or tingling of the tongue or lips, contact your doctor. Your doctor may need to adjust the dose of your medication(s).

Pancreatitis (inflammation of the pancreas): Exenatide may cause pancreatitis that can be serious or life threatening. If you experience symptoms of pancreatitis such as severe and persistent abdominal pain that may move to your back and may be accompanied by vomiting, stop taking this medication and contact your doctor or get immediate medical attention.

If you have previously had pancreatitis, gallstones, or alcohol use problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Stomach and intestinal problems: The safety and effectiveness of using this medication for people with inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis) or who have slowed movement through the intestinal tract due to diabetes have not been established. If you have any of these conditions, you should not use this medication.

Thyroid cancer: If you or a family member have ever had medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), you should not use this medication.

Weight loss: This medication may cause weight loss. If you experience weight loss of more than 1.5 kilograms (3.3 pounds) per week, contact your doctor. Losing weight this quickly can be harmful.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while using this medication, contact your doctor immediately.

Breast-feeding: It is not known if exenatide passes into breast milk. If you are breast-feeding and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children and adolescents less than 18 years of age.

Seniors: If you are a senior, you may be more sensitive to the effects of this medication and be more likely to experience side effects.

There may be an interaction between exenatide and any of the following:

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.