A new drug has been launched for the treatment of type 2 diabetes. Exenatide (Byetta®) is a subcutaneous injection indicated for use in combination with metformin and/or sulphonylureas in patients not achieving adequate glycaemic control.
A dose of 5 micrograms is recommended for the first month to improve tolerability before moving onto the 10 microgram dose. The injection is given twice daily up to a maximum of 60 minutes before eating.
Exenatide is not recommended for use in pregnancy or breast feeding. It should be used cautiously in patients with moderate renal impairment. Patients with severe renal impairment or end stage renal disease should not take this drug. Safety and efficacy have not been evaluated in patients aged below 18 years of above 75 years.
Hypoglycaemia, nausea, vomiting and diarrhoea are listed as very common side effects (occurring in more than 10% of patients). Common side effects (occurring in 1-10% of patients) include headache, dizziness, dyspepsia, abdominal pains, gastro-oesophageal reflux disease and abdominal distension.
Further prescribing information is contained in the Summary of Product Characteristics.
Action: A place in therapy for exenatide is yet to be established but it would appear to be very limited. In patients uncontrolled on one oral agent there is the option of adding another oral agent from the range available. When all oral agents have been exhausted this product does not appear to offer any advantages over insulin.