Exenatide

Identification

Summary

Exenatide is a GLP-1 agonist used in the management of type 2 diabetes mellitus.

Brand Names

Bydureon, Byetta

Generic Name

Exenatide

DrugBank Accession Number

DB01276

Background

Exenatide is a glucagon-like peptide-1 (GLP-1) analog⁸. It activates the GLP-1 receptor and increases insulin secretion, decreases glucagon secretion, and slows gastric emptying to improve glycemic control⁸. Exenatide was given FDA approval on April 28, 2005⁴. It is available as immediate- and extended-release formulations.^7,8 Bydureon, the brand name product of extended-release exenatide in an injectable suspension, was discontinued in 2021. Bydureon BCise, an auto-injector extended-release formulation, remains available.⁹

Type

Biotech

Groups

Approved, Investigational

Biologic Classification

Protein Based Therapies
Hormones

Protein Structure

Protein Chemical Formula

C₁₈₄H₂₈₂N₅₀O₆₀S

Protein Average Weight

4186.6 Da

Sequences

>Exenatide
HGEGTFTSDLSKQMEEEAVRLFIEWLKNGGPSSGAPPPS

Download FASTA Format

Synonyms

• Exenatida
• Exenatide
• Exenatide synthetic
• Exendin 4
• Exendin-4
• Synthetic exendin-4

External IDs

• AC 2993
• AC-002993
• AC-2993
• AC-2993A
• AC-2993LAR
• AC002993
• AC2993
• AC2993A
• DA-3091
• ITCA-650
• LY-2148568
• LY2148568

Pharmacology

Indication

Exenatide is indicated as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes. An extended-release formulation is available which is indicated in patients ≥10 years old,¹⁰ while the immediate-acting formulation is approved only for adult patients.⁸

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Associated Conditions

• Type 2 Diabetes Mellitus

Contraindications & Blackbox Warnings

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Pharmacodynamics

When patients take exenatide the body's natural response to glucose is modulated^Label. More insulin and less glucagon are released in response to glucose, though in cases of hypoglycemia a normal amount of glucagon is released^Label. Exenatide also slows gastric emptying, leading to a slower and prolonged release of glucose into the systemic circulation^Label. Together these effects prevent hyper and hypoglycemia^Label.

Mechanism of action

Exenatide is a human glucacon-like peptide-1(GLP-1) receptor agonist^Label. By activating this receptor, insulin secretion is increased and glucagon secretion is decreased in a glucose dependant manner^Label. Exenatide also slows gastric emptying and decreases food intake^Label. These effects work synergistically to improve glycemic control by reducing the likelihood of hyper and hypoglycemia^Label.

Target	Actions	Organism
AGlucagon-like peptide 1 receptor	agonist	Humans

Absorption

Exenatide reaches a peak plasma concentration in 2.1 hours^Label. Because exenatide is administerd subcutaneously, the bioavailability is 1¹.

Volume of distribution

28.3L^Label.

Protein binding

Protein binding of exenatide has not been determined⁵.

Metabolism

Exenatide is filtered through the glomerulus before being degraded to smaller peptides and amino acids by dipeptidyl peptidase-4, metalloproteases, endopeptidase 24-11, amino proteases, and serine proteases^Label,3. It is currently believed that the metalloproteases are responsible for most of the degradation of exenatide³. Exenatide is metabolised to small peptides <3 amino acids in length by enzymes in the kidney².

Route of elimination

Exenatide is mainly eliminated by glomerular filtration followed by proteolysis before finally being eliminated in the urine^Label,2.

Half-life

2.4 hours^Label

Clearance

9.1 L/hour^Label.

Adverse Effects

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Toxicity

In animal studies, exenatide was associated with fetal deformities of ribs and vertebrae as well as slowed growth^Label. In humans, uncontrolled hyperglycemia can be associated with an up to 25% risk of miscarriage^Label. No human studies in pregnancy have been performed with exenatide and so exenatide should only be prescribed in pregnancy if the benefit to the mother and fetus outweigh the risks^Label. In mice, exenatide is excreted in the milk at a concentration 2.5% of the plasma concentration though this data may not be applicable to humans^Label. The effect of exenatide on breastfed infants is also unknown and so the risk and benefit of breastfeeding while taking exenatide must be weighed^Label. There is no data for the use of exenatide in pediatric patients^Label. Geriatric patients do not have different results for safety and efficacy of exenatide though caution should still be used in this group as they are at higher risk of renal impairment or other comorbidities that may affect the liklihood of adverse effects^Label. No dosage adjustments are necessary for patients with creatinine clearance ≥50mL/min, though prescribing to patients with creatinine clearance 30-50mL/min should be done cautiously^Label. Exenatide is not recommended for patients with creatinine clearance <30mL/min^Label. Hepatic impairment is not expected to affect clearance of exenatide though no studies have been performed to confirm this^Label.

Pathways

Not Available

Pharmacogenomic Effects/ADRs

Not Available

Interactions

Drug Interactions

This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.

• Approved
• Vet approved
• Nutraceutical
• Illicit
• Withdrawn
• Investigational
• Experimental
• All Drugs

Drug	Interaction
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Acarbose	The risk or severity of hypoglycemia can be increased when Acarbose is combined with Exenatide.
Acebutolol	The therapeutic efficacy of Exenatide can be increased when used in combination with Acebutolol.
Acenocoumarol	Exenatide can cause an increase in the absorption of Acenocoumarol resulting in an increased serum concentration and potentially a worsening of adverse effects.
Acetazolamide	The therapeutic efficacy of Exenatide can be increased when used in combination with Acetazolamide.
Acetohexamide	Exenatide may increase the hypoglycemic activities of Acetohexamide.
Acetyl sulfisoxazole	The therapeutic efficacy of Exenatide can be increased when used in combination with Acetyl sulfisoxazole.
Acetylsalicylic acid	The risk or severity of hypoglycemia can be increased when Acetylsalicylic acid is combined with Exenatide.
Albiglutide	The risk or severity of hypoglycemia can be increased when Exenatide is combined with Albiglutide.
Alclometasone	The risk or severity of hyperglycemia can be increased when Alclometasone is combined with Exenatide.
Alogliptin	The risk or severity of hypoglycemia can be increased when Exenatide is combined with Alogliptin.

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Food Interactions

• Take before a meal. Inject subcutaneously within 60 minutes before morning and evening meals.

Products

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Brand Name Prescription Products

Name	Dosage	Strength	Route	Labeller	Marketing Start	Marketing End	Region	Image
Bydureon	Injection, powder, for suspension, extended release; Kit	2 mg / dose	Subcutaneous	Astra Zeneca	2016-02-16	2022-04-01
Bydureon	Injection	2 mg	Subcutaneous	Astra Zeneca Ab	2020-12-21	Not applicable
Bydureon	Kit	2 mg/0.65mL	Subcutaneous	Amylin Pharmaceuticals, Llc.	2012-01-27	2018-01-31
Bydureon	Injection, powder, for suspension, extended release	2 mg	Subcutaneous	Astra Zeneca Ab	2016-09-08	Not applicable
Bydureon	Injection, powder, for suspension; Kit	2 mg/0.65mL	Subcutaneous	AstraZeneca Pharmaceuticals LP	2015-02-01	2020-11-30
Bydureon	Injection, powder, for suspension, extended release	2 mg	Subcutaneous	Astra Zeneca Ab	2016-09-08	Not applicable
Bydureon	Kit	2 mg/0.65mL	Subcutaneous	Amylin Pharmaceuticals, Llc.	2012-01-27	2018-01-31
Bydureon	Injection, suspension, extended release	2 mg/0.65mL	Subcutaneous	AstraZeneca Pharmaceuticals LP	2014-09-08	2023-04-30
Bydureon	Injection, powder, for suspension, extended release	2 mg	Subcutaneous	Astra Zeneca Ab	2016-09-08	Not applicable
Bydureon	Injection	2 mg	Subcutaneous	Astra Zeneca Ab	2020-12-21	Not applicable

Mixture Products

Name	Ingredients	Dosage	Route	Labeller	Marketing Start	Marketing End	Region	Image
BYDUREON	Exenatide (2.000 mg) + Carboxymethylcellulose sodium (19.000 mg) + Sodium hydroxide (0.360 mg)	Suspension	Subcutaneous	Astra Zeneca, S. A. De C. V.	2017-02-04	Not applicable

Categories

ATC Codes

A10BJ01 — Exenatide

• A10BJ — Glucagon-like peptide-1 (GLP-1) analogues
• A10B — BLOOD GLUCOSE LOWERING DRUGS, EXCL. INSULINS
• A10 — DRUGS USED IN DIABETES
• A — ALIMENTARY TRACT AND METABOLISM

Drug Categories

• Alimentary Tract and Metabolism
• Amino Acids, Peptides, and Proteins
• Anti-Obesity Agents
• Biological Factors
• Blood Glucose Lowering Agents
• Bodily Secretions
• Drugs Used in Diabetes
• Fluids and Secretions
• GLP-1 Agonists
• Glucagon-Like Peptide 1
• Glucagon-like peptide-1 (GLP-1) analogues
• Hormones
• Hormones, Hormone Substitutes, and Hormone Antagonists
• Hypoglycemia-Associated Agents
• Incretin Mimetics
• Incretins
• Peptides
• Toxins, Biological
• Venoms

Chemical TaxonomyProvided by Classyfire

Description

Not Available

Kingdom

Organic Compounds

Super Class

Organic Acids

Class

Carboxylic Acids and Derivatives

Sub Class

Amino Acids, Peptides, and Analogues

Direct Parent

Peptides

Alternative Parents

Not Available

Substituents

Not Available

Molecular Framework

Not Available

External Descriptors

Not Available

Affected organisms

• Humans and other mammals

Chemical Identifiers

UNII

9P1872D4OL

CAS number

141758-74-9

References

Synthesis Reference

Matthieu Giraud, Anne-Sophie Droz, Stephane Varray, El Djouhar Rekai, Marie-Helene Brichard, Daniel Latassa, Christine Devijver, Pascal Gilles, Jeanne-Marie Cauvin, Fernando Albericio, Marta Paradis Bas, "PROCESS FOR THE PRODUCTION OF EXENATIDE AND OF AN EXENATIDE ANALOGUE." U.S. Patent US20110046349, issued February 24, 2011.

US20110046349

General References

1. Gao W, Jusko WJ: Target-mediated pharmacokinetic and pharmacodynamic model of exendin-4 in rats, monkeys, and humans. Drug Metab Dispos. 2012 May;40(5):990-7. doi: 10.1124/dmd.111.042291. Epub 2012 Feb 15. [Article]
2. Copley K, McCowen K, Hiles R, Nielsen LL, Young A, Parkes DG: Investigation of exenatide elimination and its in vivo and in vitro degradation. Curr Drug Metab. 2006 May;7(4):367-74. [Article]
3. Liao S, Liang Y, Zhang Z, Li J, Wang J, Wang X, Dou G, Zhang Z, Liu K: In vitro metabolic stability of exendin-4: pharmacokinetics and identification of cleavage products. PLoS One. 2015 Feb 27;10(2):e0116805. doi: 10.1371/journal.pone.0116805. eCollection 2015. [Article]
4. FDA Drug Approval Package: Exenatide [Link]
5. FDA Pharmacology Review: Exenatide [Link]
6. FDA Approved Drug Products: Bydureon (exenatide extended-release) suspension for subcutaneous injection [Link]
7. FDA Approved Drug Products: Bydureon BCise (exenatide extended-release) suspension for subcutaneous injection [Link]
8. FDA Approved Drug Products: Byetta (exenatide) for subcutaneous injection [Link]
9. OptumRx: Bydureon (exenatide) Pen – Product discontinuation [Link]
10. FDA Approved Drug Products: BYDUREON (exenatide) extended-release injectable suspension for subcutaneous use (December 2022) [Link]

External Links

KEGG Drug

D04121

PubChem Substance

46509017

RxNav

60548

ChEMBL

CHEMBL414357

Therapeutic Targets Database

DAP001038

PharmGKB

PA164749238

RxList

RxList Drug Page

Drugs.com

Drugs.com Drug Page

Wikipedia

Exenatide

FDA label

Download (1.34 MB)

MSDS

Download (22.2 KB)

Clinical Trials

Clinical Trials

Phase	Status	Purpose	Conditions	Count
4	Active Not Recruiting	Treatment	Diabetes	1
4	Completed	Basic Science	Diabetes / Impaired Glucose Tolerance	1
4	Completed	Basic Science	Type 2 Diabetes Mellitus	2
4	Completed	Diagnostic	Healthy Subjects (HS)	1
4	Completed	Prevention	Diabetic Nephropathy	1
4	Completed	Treatment	Acute Coronary Syndrome (ACS) / Hyperglycemia / Myocardial Infarction	1
4	Completed	Treatment	Atherosclerosis / Diabetes / Restenosis	1
4	Completed	Treatment	Congestive Heart Failure (CHF) / Type 2 Diabetes Mellitus	1
4	Completed	Treatment	Disorder of Glucose Regulation / Overweight and Obesity / Polycystic Ovarian Syndrome (PCOS)	1
4	Completed	Treatment	Fatty Liver, Non-alcoholic Fatty Liver Disease, NAFLD	1

Pharmacoeconomics

Manufacturers

Not Available

Packagers

• Amylin Pharmaceuticals
• Baxter International Inc.
• CP Pharmaceuticals Ltd.
• Eli Lilly & Co.
• Physicians Total Care Inc.

Dosage Forms

Form	Route	Strength
Solution	Parenteral	250.000 mcg
Injection	Subcutaneous	2 mg
Injection, powder, for suspension, extended release; kit	Subcutaneous	2 mg / dose
Injection, powder, for suspension; kit	Subcutaneous	2 mg/0.65mL
Injection, suspension	Parenteral; Subcutaneous	2 MG
Injection, suspension	Subcutaneous	2 MG
Injection, suspension, extended release	Subcutaneous	2 mg/0.65mL
Kit	Subcutaneous	2 mg/0.65mL
Suspension	Subcutaneous	2.000 mg
Powder	Subcutaneous	2 mg
Injection, suspension, extended release	Subcutaneous	2 mg/0.85mL
Suspension, extended release	Subcutaneous	2 mg / dose
Injection, powder, for suspension, extended release	Subcutaneous	2 mg
Suspension	Subcutaneous	2 mg
Injection, powder, for suspension	Subcutaneous	2 mg
Injection	Subcutaneous
Injection	Subcutaneous	250 ug/1mL
Injection, solution	Parenteral; Subcutaneous	10 MICROGRAMMI
Injection, solution	Parenteral; Subcutaneous	5 MICROGRAMMI
Injection, solution	Subcutaneous	10 micrograms
Injection, solution	Subcutaneous	5 micrograms
Solution	Subcutaneous	10 mcg / act
Solution	Subcutaneous	5 mcg / act
Solution	Subcutaneous	10 μg/40μL
Solution	Subcutaneous	5 μg/20μL
Injection, powder, for solution
Solution	Subcutaneous	250 mcg
Powder		1 g/1g

Prices

Unit description	Cost	Unit
Byetta 10 MCG Pen 10 mcg/0.04ml Solution 2.4ml Pen	324.23USD	pen
Byetta 5 mcg dose pen inj	316.76USD	ml
Byetta 5 MCG Pen 5 mcg/0.02ml Solution 1.2ml Pen	276.57USD	pen

DrugBank does not sell nor buy drugs. Pricing information is supplied for informational purposes only.

Patents

Patent Number	Pediatric Extension	Approved	Expires (estimated)	Region
US8216180	Yes	2012-07-10	2028-07-12
US8439864	Yes	2013-05-14	2028-09-25
US6667061	Yes	2003-12-23	2020-11-25
US6495164	No	2002-12-17	2020-05-25
US5424286	No	1995-06-13	2016-12-01
US6858576	No	2005-02-22	2017-01-06
US6872700	No	2005-03-29	2020-01-14
US6956026	No	2005-10-18	2018-01-07
US7741269	No	2010-06-22	2018-01-07
US7297761	No	2007-11-20	2017-10-15
US7521423	No	2009-04-21	2017-10-15
US6902744	No	2005-06-07	2020-01-14
US9238076	Yes	2016-01-19	2024-10-15
US8906851	Yes	2014-12-09	2027-02-18
US7612176	Yes	2009-11-03	2025-10-13
US8431685	Yes	2013-04-30	2025-10-13
US8461105	Yes	2013-06-11	2025-10-13
US8329648	Yes	2012-12-11	2027-02-18
US7456254	Yes	2008-11-25	2025-12-30
US7563871	Yes	2009-07-21	2024-10-15
US6824822	Yes	2004-11-30	2023-04-09
US6479065	No	2002-11-12	2020-08-10
US7223440	Yes	2007-05-29	2022-03-03
US8685934	No	2014-04-01	2030-05-26
US8501698	Yes	2013-08-06	2027-12-20
US6414126	No	2002-07-02	2020-10-04
US6515117	Yes	2003-02-04	2026-04-04
US6936590	No	2005-08-30	2020-10-04
US9198925	No	2015-12-01	2020-10-04
US7919598	No	2011-04-05	2029-12-16
US8361972	Yes	2013-01-29	2028-09-21
US8716251	No	2014-05-06	2028-03-21
US7851502	No	2010-12-14	2028-08-19
US8221786	No	2012-07-17	2028-03-21
US9320853	Yes	2016-04-26	2028-09-25
US8827963	Yes	2014-09-09	2029-08-04
US8712615	No	2014-04-29	2030-01-18
US8998876	Yes	2015-04-07	2030-07-07
US8758292	Yes	2014-06-24	2028-05-12
US8690837	Yes	2014-04-08	2029-11-19
US8895033	Yes	2014-11-25	2031-04-04
US8721615	Yes	2014-05-13	2030-07-18
US9884092	Yes	2018-02-06	2027-02-18

Properties

State

Solid

Experimental Properties

Property	Value	Source
isoelectric point	4.86	https://www.karger.com/Article/FullText/492409

Targets

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insights and accelerate drug research.

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Details1. Glucagon-like peptide 1 receptor

Kind

Protein

Organism

Humans

Pharmacological action

Yes

Actions

Agonist

General Function

Transmembrane signaling receptor activity

Specific Function

This is a receptor for glucagon-like peptide 1. The activity of this receptor is mediated by G proteins which activate adenylyl cyclase.

Gene Name

GLP1R

Uniprot ID

P43220

Uniprot Name

Glucagon-like peptide 1 receptor

Molecular Weight

53025.22 Da

References

1. Briones M, Bajaj M: Exenatide: a GLP-1 receptor agonist as novel therapy for Type 2 diabetes mellitus. Expert Opin Pharmacother. 2006 Jun;7(8):1055-64. [Article]
2. Hargrove DM, Kendall ES, Reynolds JM, Lwin AN, Herich JP, Smith PA, Gedulin BR, Flanagan SD, Jodka CM, Hoyt JA, McCowen KM, Parkes DG, Anderson CM: Biological activity of AC3174, a peptide analog of exendin-4. Regul Pept. 2007 Jun 7;141(1-3):113-9. Epub 2007 Jan 11. [Article]
3. Wajchenberg BL: beta-cell failure in diabetes and preservation by clinical treatment. Endocr Rev. 2007 Apr;28(2):187-218. Epub 2007 Mar 12. [Article]
4. Mack CM, Moore CX, Jodka CM, Bhavsar S, Wilson JK, Hoyt JA, Roan JL, Vu C, Laugero KD, Parkes DG, Young AA: Antiobesity action of peripheral exenatide (exendin-4) in rodents: effects on food intake, body weight, metabolic status and side-effect measures. Int J Obes (Lond). 2006 Sep;30(9):1332-40. Epub 2006 Mar 14. [Article]
5. Geelhoed-Duijvestijn PH: Incretins: a new treatment option for type 2 diabetes? Neth J Med. 2007 Feb;65(2):60-4. [Article]
6. Mann RJ, Nasr NE, Sinfield JK, Paci E, Donnelly D: The major determinant of exendin-4/glucagon-like peptide 1 differential affinity at the rat glucagon-like peptide 1 receptor N-terminal domain is a hydrogen bond from SER-32 of exendin-4. Br J Pharmacol. 2010 Aug;160(8):1973-84. doi: 10.1111/j.1476-5381.2010.00834.x. [Article]
7. Degn KB, Brock B, Juhl CB, Djurhuus CB, Grubert J, Kim D, Han J, Taylor K, Fineman M, Schmitz O: Effect of intravenous infusion of exenatide (synthetic exendin-4) on glucose-dependent insulin secretion and counterregulation during hypoglycemia. Diabetes. 2004 Sep;53(9):2397-403. [Article]
8. Diamant M, Bunck MC, Heine RJ: [Analogs of glucagon-like peptide-1 (GLP-1): an old concept as a new treatment of patients with diabetes mellitus type 2]. Ned Tijdschr Geneeskd. 2004 Sep 25;148(39):1912-7. [Article]
9. Kolterman OG, Kim DD, Shen L, Ruggles JA, Nielsen LL, Fineman MS, Baron AD: Pharmacokinetics, pharmacodynamics, and safety of exenatide in patients with type 2 diabetes mellitus. Am J Health Syst Pharm. 2005 Jan 15;62(2):173-81. [Article]
10. Barnett AH: Exenatide. Drugs Today (Barc). 2005 Sep;41(9):563-78. [Article]
11. Lebovitz HE: Therapeutic options in development for management of diabetes: pharmacologic agents and new technologies. Endocr Pract. 2006 Jan-Feb;12 Suppl 1:142-7. [Article]
12. Chen X, Ji ZL, Chen YZ: TTD: Therapeutic Target Database. Nucleic Acids Res. 2002 Jan 1;30(1):412-5. [Article]
13. Xue X, Ren Z, Zhang A, Yang Q, Zhang W, Liu F: Efficacy and safety of once-weekly glucagon-like peptide-1 receptor agonists compared with exenatide and liraglutide in type 2 diabetes: a systemic review of randomised controlled trials. Int J Clin Pract. 2016 Aug;70(8):649-56. doi: 10.1111/ijcp.12847. Epub 2016 Jul 25. [Article]
14. Nadkarni P, Chepurny OG, Holz GG: Regulation of glucose homeostasis by GLP-1. Prog Mol Biol Transl Sci. 2014;121:23-65. doi: 10.1016/B978-0-12-800101-1.00002-8. [Article]
15. Lorenz M, Lawson F, Owens D, Raccah D, Roy-Duval C, Lehmann A, Perfetti R, Blonde L: Differential effects of glucagon-like peptide-1 receptor agonists on heart rate. Cardiovasc Diabetol. 2017 Jan 13;16(1):6. doi: 10.1186/s12933-016-0490-6. [Article]
16. Htike ZZ, Zaccardi F, Papamargaritis D, Webb DR, Khunti K, Davies MJ: Efficacy and safety of glucagon-like peptide-1 receptor agonists in type 2 diabetes: A systematic review and mixed-treatment comparison analysis. Diabetes Obes Metab. 2017 Apr;19(4):524-536. doi: 10.1111/dom.12849. Epub 2017 Feb 17. [Article]
17. Prasad-Reddy L, Isaacs D: A clinical review of GLP-1 receptor agonists: efficacy and safety in diabetes and beyond. Drugs Context. 2015 Jul 9;4:212283. doi: 10.7573/dic.212283. eCollection 2015. [Article]
18. Gallwitz B: Novel Therapeutic Approaches in Diabetes. Endocr Dev. 2016;31:43-56. doi: 10.1159/000439372. Epub 2016 Jan 19. [Article]

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Drug created at May 16, 2007 20:43 / Updated at February 10, 2023 08:55