Makindo Medical Notes

💉 Administration: Each dose should be given by subcutaneous injection into the thigh, abdomen, or upper arm. Injection sites should be rotated to reduce risk of local irritation.

📘 About

• Always check the BNF for latest prescribing advice.
• Exenatide is a GLP-1 receptor agonist used as an add-on therapy for patients with T2DM who have inadequate glycaemic control despite maximally tolerated metformin and/or sulfonylurea therapy.
• It is available in both intermediate-release (twice daily) and modified-release (once weekly) formulations.

⚙️ Mode of Action

• GLP-1 analogue that mimics the incretin hormone.
• Stimulates glucose-dependent insulin secretion.
• Suppresses inappropriate glucagon secretion.
• Slows gastric emptying → promotes satiety and weight loss.

💊 Indications & Example Doses

• T2DM with metformin and/or sulfonylurea (± pioglitazone):
• Intermediate release: 5 micrograms SC BD for ≥1 month, then increase to 10 micrograms SC BD if required. Administer within 1 hour before two main meals (≥6 hours apart).
• Modified release: 2 mg SC once weekly, regardless of meals.
• T2DM with basal insulin (± metformin/pioglitazone):
• Intermediate release as above: start 5 micrograms SC BD, may increase to 10 micrograms BD.

🔄 Interactions

• Risk of hypoglycaemia when combined with sulfonylureas or insulin – dose reduction of these agents may be needed.
• Delays gastric emptying → may alter absorption of oral medicines (especially narrow therapeutic index drugs).

⚠️ Cautions

• Do not reduce insulin too rapidly when switching/adding therapy (risk of DKA).
• Weight loss can be problematic in frail or elderly patients.
• Stop if renal function deteriorates (risk of accumulation and adverse effects).
• Monitor for symptoms of pancreatitis (severe abdominal pain radiating to the back).

🚫 Contraindications

• Moderate to severe renal impairment (eGFR <30 mL/min/1.73m²).
• History of severe gastrointestinal disease (e.g., gastroparesis).

💥 Side Effects

• GI: Nausea, vomiting, diarrhoea, constipation, abdominal discomfort.
• Weight loss (can be beneficial but may be excessive in older adults).
• Hypoglycaemia (especially with sulfonylurea or insulin).
• Slows gastric emptying → can worsen gastroparesis.
• Rare: Pancreatitis, injection-site reactions.

📖 References

• BNF – Exenatide
• NICE NG28: Type 2 Diabetes in adults: management

📝 Revisions

• September 2025 – Expanded with renal cautions, pancreatitis risk, and UK NICE context.