Exenatide (INN, marketed as Byetta) is one of a new class of medications (incretin mimetics) approved for the treatment of diabetes mellitus type 2. It is not approved for use in diabetes mellitus type 1. Exenatide is administered as a subcutaneous injection (under the skin) of the abdomen, thigh, or arm, 30 to 60 minutes before the first and last meal of the day. Byetta package insert Accessed September 6, 2008.

The main side effects of exenatide use are gastrointestinal in nature, including acid or sour stomach, belching, diarrhea, heartburn, indigestion, nausea, and vomiting; exenatide is therefore not meant for people with severe gastrointestinal disease. Other side effects include dizziness, headache, and feeling jittery. Drugs.com Accessed September 6, 2008. Drug interactions listed on the package insert include delayed or reduced concentrations of Lovastatin, Acetaminophen (Tylenol), and Digoxin, although this has not been proven to alter the effectiveness of these other medications.

In response to post-marketing reports of acute pancreatitis in patients using exenatide, the United States Food and Drug Administration added a warning to the labeling of Byetta in 2007.2007 Safety Alerts for Drugs, Biologics, Medical Devices, and Dietary Supplements, from the U.S. Food and Drug Administration. Accessed August 28 2008. In August 2008, four additional deaths from pancreatitis in users of exenatide were reported to the FDA; while no definite relationship had been established, the FDA was reportedly considering additional changes to the drug's labeling.Diabetes Drug Tied to New Deaths. Published in the New York Times on August 26 2008; accessed August 28 2008.

Chemistry and Pharmacology

Exenatide is manufactured and marketed by Amylin Pharmaceuticals and Eli Lilly and Company. Exenatide is a synthetic version of exendin-4, a hormone found in the saliva of the Gila monster. It displays biological properties similar to human glucagon-like peptide-1 (GLP-1), a regulator of glucose metabolism and insulin secretion. According to the package insert, BYETTA enhances glucose-dependent insulin secretion by the pancreatic beta-cell, suppresses inappropriately elevated glucagon secretion, and slows gastric emptying.. although the mechanism of action is still under study.

Exenatide is a 39-amino-acid peptide an insulin secretagogue with glucoregulatory effects. Exenatide was approved by the U.S. Food and Drug Administration on April 28 2005 for patients whose diabetes was not well-controlled on other oral medication.CDER Drug and Biologic Approvals for Calendar Year 2005, from the U.S. Food and Drug Administration. Accessed August 28 2008. The medication is injected subcutaneously twice per day using a pre-filled pen device. The abdomen is a common injection site, after the area is cleaned with an alcohol pad. A new pen must first be tested to see if the medicine is flowing