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GLP-1 Receptor Agonist Pregnancy: Contraindicated — insufficient data. Use insulin in pregnancy.

Exenatide

Brand names: Byetta (twice daily), Bydureon (once weekly)

Adult dose

Dose: Byetta (twice daily): 5 micrograms SC BD for 4 weeks; increase to 10 micrograms SC BD. Bydureon (once weekly): 2mg SC once weekly
Route: Subcutaneous injection
Frequency: Byetta: BD (60 min before morning and evening meals); Bydureon: once weekly (any time, with or without food)
Max: Byetta 10 micrograms BD; Bydureon 2mg OW
Do not use if eGFR <30. GLP-1 RAs cause weight loss (3–5kg) — favoured in obese Type 2 DM. Withhold if pancreatitis suspected. Bydureon BCise pen is an auto-injector with pre-mixed suspension.

Paediatric dose

Route: Subcutaneous injection
Frequency: Twice daily
Max: Not applicable
Not licensed under 18 years. Seek specialist opinion.

Dose adjustments

Renal

eGFR 30–60: use with caution. eGFR <30: avoid.

Hepatic

No specific dose adjustment — limited hepatic metabolism.

Clinical pearls

  • GLP-1 RAs reduce HbA1c by 1–1.5% and cause 3–5kg weight loss — preferred in obese patients with Type 2 DM (NICE NG28)
  • Pancreatitis warning: advise patient to stop and seek medical attention if persistent severe abdominal pain occurs
  • Bydureon injection site: small palpable nodules may develop at injection sites — rotate sites and reassure patient
  • Exenatide now largely superseded by once-weekly semaglutide (superior HbA1c and weight reduction)

Contraindications

  • eGFR <30
  • Personal/family history of medullary thyroid carcinoma or MEN2 (theoretical — from rodent data)
  • Pancreatitis history (caution)
  • Type 1 DM
  • Hypersensitivity

Side effects

  • Nausea and vomiting (very common, usually transient)
  • Diarrhoea
  • Injection site nodules (Bydureon — subcutaneous deposits)
  • Pancreatitis (rare but serious)
  • Reduced appetite
  • Headache

Interactions

  • Oral medications — delayed gastric emptying may reduce absorption; take time-critical drugs (e.g. antibiotics, hormonal contraceptives) 1h before exenatide
  • Warfarin — monitor INR (delayed gastric emptying affects absorption timing)
  • Sulphonylureas — additive hypoglycaemia risk; reduce sulphonylurea dose

Monitoring

  • HbA1c 3–6 monthly
  • Weight and BMI
  • eGFR (baseline and periodic)
  • Lipase if abdominal pain
  • Injection site inspection

Reference: BNFc; BNF 90; NICE NG28 (Type 2 DM). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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