Exenatide

What is exenatide?

Exenatide (brand names Bydureon®, Byetta®) is a glucagon-like peptide-1 (GLP-1) receptor agonist used in addition to insulin to achieve better blood sugar control and to treat certain types of diabetes in cats.

It is used off label (extra label) in veterinary medicine. Many drugs are commonly prescribed for off-label use in veterinary medicine. “Off label” means the drug is being used in a way that has not been reviewed or approved by the U.S. Food and Drug Administration (FDA) or Health Canada. 

In these instances, follow your veterinarian’s directions and cautions very carefully, as they may be significantly different from those on the label.

How do I give my pet exenatide?

• Exenatide comes in immediate-release (IR) and extended-release (ER) injectable forms. The forms are NOT interchangeable.
• Injections are given subcutaneously (under the skin).
• Follow your veterinarian’s directions on how and where to give the injections.
• Ensure you are using the correct form as prescribed by your veterinarian.
• Any medications given orally (by mouth) should be given at least 1 hour before giving an exenatide injection.
• Give injection before feeding – do not give after a meal.
• Do not mix this medication with injectable insulin.
• Dispose of used sharps in a designated sharps container.
• Give this medication to your pet for the entire time prescribed by your veterinarian, even if it appears that your pet is feeling better.

This medication should take effect within 1 hour, though effects may not be noticeable right away. 

What if I miss giving my pet the medication?

Contact your veterinarian for recommendations. Do not give the pet two doses at once.

Are there any potential side effects from exenatide?

Exenatide may cause the following side effects:

• Diarrhea, vomiting
• Decreased appetite

The following reactions are rare, but if they occur, contact your veterinarian immediately:

• An allergic reaction such as irregular breathing, rash, fever, puffiness and swelling around the face
• Not eating or drinking, persistent vomiting or diarrhea
• Signs of hypoglycemia (low blood sugar) – unsteadiness, weakness, confusion, seizures, etc.

Drug sensitivities can develop over time with repeated exposure. Your pet may have no reaction after the first few doses, but may develop a sensitivity later. It is important to watch for signs of an allergic reaction over the entire course of treatment. 

Other side effects may occur. If you notice anything unusual, contact your veterinarian immediately. The immediate-release form is short-acting, which means the effects will last several hours. The extended-release form is moderate-acting, meaning that effects will last up to 1 week. Effects for both forms may last longer in pets with kidney or liver disease.

Are there any risk factors for this medication?

DO NOT USE exenatide in cats who:

• Are allergic to any component of the medication 
• Have type 1 diabetes or ketoacidosis
• Have severe kidney disease

USE WITH CAUTION in cats who:

• Have gastrointestinal disease (e.g., IBD), pancreatitis, and/or kidney disease
• Are sick or frail
• Are pregnant or nursing

Are there any drug interactions I should be aware of?

Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking before starting any new treatment. 

Certain medications should be USED WITH CAUTION when given with exenatide, including: 

• Acepromazine, chlorpromazine
• Albuterol, terbutaline
• Blood pressure medications (e.g., atenolol, propranolol, telmisartan)
• Certain classes of antibiotics (e.g., sulfonamides, fluoroquinolones)
• Certain behavior modification medications (MAOIs, fluoxetine, clonidine)
• Diuretics (e.g., furosemide)
• Fenofibrate
• Heart disease medications (e.g., digoxin, benazepril, enalapril)
• Hormones and related agents (e.g., testosterone, estrogens, progestins, leuprolide)
• Immunosuppressants (e.g., cyclosporine, prednisolone, dexamethasone)
• Other glycemic control medications (e.g., glipizide, metformin, diazoxide)
• Pentoxifylline
• Salicylates (e.g., aspirin)
• Warfarin

Is any monitoring needed with this medication?

• Your veterinarian will monitor blood glucose levels and/or urine glucose levels throughout treatment. Other blood work values and physical parameters (e.g., weight, hydration status, etc.) may be monitored throughout treatment.
• Your veterinarian may schedule follow-up visits for monitoring.
• At home, monitor urine output and monitor for any abnormal changes. If any occur, discontinue the medication and contact your veterinarian.

How do I store exenatide?

• Refrigerate at 36°F-46°F (2°C-8°C). Do not freeze.
• Follow manufacturer’s directions for product specific discard times.
• Keep medication out of reach of children and pets.

What should I do in case of emergency?

If you suspect an overdose or adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility. Report adverse effects to the FDA or Health Canada.