Lixisenatide belongs to a group of medications known as glucagon-like peptide-1 (GLP-1) receptor agonists. It is used along with other medications 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 being given 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 recommended adult starting dose of lixisenatide is 10 µg (micrograms) daily injected subcutaneously (under the skin) on your stomach area (abdomen), upper thigh, or upper arm, exactly as instructed by your doctor or diabetes educator. After 14 days, your doctor may increase the dose to 20 µg once daily. Do not change your dose unless your doctor has told you to do so.

Lixisenatide should be injected within an hour before a meal. Choose the most convenient meal and inject it before that same meal each day.

If you are also using insulin, each medication should be injected separately.

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.

Many things can affect the dose of a 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 to take this medication exactly as prescribed by your doctor. If you miss a dose, inject your dose less than 1 hour before your next meal. Do not inject a double dose or increase your 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.

Lixisenatide should be clear and colourless. Do not use lixisenatide if you notice particles or anything unusual in the appearance of the solution.

Store this medication in the refrigerator, do not allow it to freeze, and keep it out of the reach of children. After the first use of the pen, this medication can be stored at room temperature or in the refrigerator for up to 14 days. After 14 days, discard the pen, even if there is medication left in it. To protect this medication from light, always keep the pen cap on when you are not using it. Always store this medication without a needle attached to prevent contamination, infection, and leakage.

10 µg dose Pre-Filled Pen
Each mL of clear, colourless solution contains 0.05 mg of lixisenatide. Nonmedicinal ingredients: glycerol, hydrochloric acid/sodium hydroxide solution for pH adjustment, metacresol (2.7 mg/mL), methionine, sodium acetate trihydrate, and water for injection.

20 µg dose Pre-Filled Pen
Each mL of clear, colourless solution contains 0.1 mg of lixisenatide. Nonmedicinal ingredients: glycerol, hydrochloric acid/sodium hydroxide solution for pH adjustment, metacresol (2.7 mg/mL), methionine, sodium acetate trihydrate, and water for injection.

Do not use lixisenatide if you:

• are allergic to lixisenatide or any ingredients of the medication
• are pregnant
• are breast-feeding
• have type 1 diabetes
• have diabetic ketoacidosis (accumulation of ketones in blood and urine)

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

The side effects listed below are not experienced by everyone who takes 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
• back or muscle pain
• bloating
• constipation
• cough
• decreased appetite
• diarrhea
• dizziness
• dry mouth
• excessive sweating
• flu-like illness (fever, tiredness, body aches)
• gas
• hair loss
• headache
• heartburn
• motion sickness
• nausea
• nervousness
• pain, swelling, burning, or bruising at the place of injection
• rash
• runny, stuffy nose or sneezing
• tiredness
• tremor
• upset stomach
• vomiting
• weakness

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

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

• blurred vision
• dehydration from prolonged nausea, vomiting, or diarrhea
• dizziness, especially when standing
• slow, fast, or irregular heartbeat
• muscle pain
• signs of kidney problems (e.g., increased urination at night, decreased urine production, blood in the urine)
• signs of low blood glucose (e.g., anxiety, blurred vision, confusion, difficulty concentrating, difficulty speaking, dizziness, drowsiness, fast heartbeat, feeling jittery, headache, hunger, irritability, nausea, nervousness, numbness or tingling of the lips or tongue, sweating, tiredness, trembling, weakness)
• symptoms of a urinary tract infection (e.g., pain when urinating, urinating more often than usual, low back or flank pain, strong odour)

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

• severe hypoglycemia (e.g., disorientation, loss of consciousness, seizures)
• signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
• symptoms of a serious allergic reaction (e.g., swelling of the face or throat, difficulty breathing, wheezing, or itchy skin rash)
• unconsciousness

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.

Antibiotics: Lixisenatide may slow the absorption of antibiotics from your stomach. If you are taking antibiotics, you should take your dose of antibiotic at least 1 hour before your dose of lixisenatide.

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.

Heart problems: Lixisenatide 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 function: The safety and effectiveness of using this medication have not been studied for people with reduced kidney function. People taking similar medications have reported kidney problems. Dehydration may increase this risk. Ensure that you are drinking enough water to prevent dehydration if you experience nausea or vomiting with this medication. If you have reduced kidney function or kidney disease, 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.

Low blood glucose (hypoglycemia): People who use lixisenatide and are also taking a sulfonylurea (e.g., glyburide, gliclazide) or insulin to control high blood sugar are more at risk of experiencing hypoglycemia (low blood sugar). 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): Lixisenatide may cause pancreatitis. If you experience symptoms of pancreatitis such as severe and persistent abdominal pain that may move to the back with or without vomiting, contact your doctor immediately. If you have previously had pancreatitis, 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.

Risk of thyroid cancer: In rare cases, people have developed thyroid cancer while using medications similar to lixisenatide. People with a personal or family history of thyroid cancer or people who have multiple endocrine neoplasia syndrome type 2 (a disease where people have tumours in more than one gland in their body) should not use this medication.

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.

Pregnancy: Lixisenatide has not been studied for use by pregnant women and should not be used during pregnancy. If you become pregnant while using this medication, contact your doctor immediately.

Breast-feeding: It is not known if lixisenatide 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.

Seniors: Seniors may be more likely to experience side effects associated with lixisenatide.

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

• acetaminophen
• acetylsalicylic acid (ASA)
• androgens (e.g., testosterone)
• antibiotics
• atorvastatin
• atypical antipsychotics (e.g., clozapine, olanzapine, quetiapine, risperidone)
• basiliximab
• birth control pills
• buserelin
• chloroquine
• corticosteroids (e.g., budesonide, hydrocortisone, prednisone)
• diabetes medications (e.g., chlorpropamide,  glyburide, insulin, metformin, rosiglitazone)
• disopyramide
• diuretics ("water pills"; e.g., furosemide, hydrochlorothiazide, indapamide)
• epinephrine
• estrogens (e.g., conjugated estrogen, estradiol, ethinyl estradiol)
• everolimus
• glucagon
• goserelin
• hepatitis C antivirals (e.g., elbasvir, grazoprevir, ledipasvir, sofosbuvir, velpatasvir)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• hydroxychloroquine
• lanreotide
• mifepristone
• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
• niacin
• octreotide
• pasireotide
• pegvisomant
• progestins (e.g., dienogest, levonorgestrel, medroxyprogesterone, norethindrone)
• protein kinase inhibitors (e.g., ceritinib, dabrafenib, nilotinib, sunitinib)
• quinolone antibiotics (e.g., ciprofloxacin, norfloxacin, ofloxacin)
• quinine
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
• sirolimus
• somatropin
• sulfonamide antibiotics ("sulfas"; e.g., sulfisoxazole, sulfamethoxazole)
• tacrolimus
• vorinostat
• warfarin

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.