Generic Name

Lixisenatide

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Classification

FDA Approved Indications

• Type 2 diabetes mellitus to improve glycemic control

Mechanism of Action

Lixisenatide is a GLP-1 receptor agonist that enhances glucose-dependent insulin secretion, suppresses elevated glucagon secretion, and slows gastric emptying, which helps to lower blood glucose levels.

Dosage and Administration

Adult: 10 mcg once daily within 1 hour before the first meal. May increase to 20 mcg once daily if additional glycemic control is needed.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; consider renal function and risk of gastrointestinal side effects.

Renal Impairment: No dosage adjustment needed for mild impairment; use caution in severe impairment.

Hepatic Impairment: No specific dosing recommendations available.

Pharmacokinetics

Absorption: Rapid absorption with peak plasma concentrations in approximately 1.5 hours.

Distribution: Wide distribution; protein binding is minimal.

Metabolism: Metabolized mainly via dipeptidyl peptidase-4 (DPP-4) enzymes and other proteolytic pathways.

Excretion: Primarily excreted via the kidneys.

Half Life: Approximately 3 hours.

Contraindications

• Hypersensitivity to lixisenatide or other components.
• Personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2.

Precautions

• Risk of pancreatitis; monitor for symptoms.
• Use with caution in patients with renal impairment.
• Potential for gastrointestinal symptoms; start at lower doses in sensitive patients.

Adverse Reactions - Common

• Nausea (Often)
• Vomiting (Less common)
• Diarrhea (Less common)
• Headache (Less common)

Adverse Reactions - Serious

• Pancreatitis (Rare)
• Hypoglycemia (especially when combined with insulin or sulfonylureas) (Uncommon)

Drug-Drug Interactions

• Insulin or sulfonylureas (risk of hypoglycemia)

Drug-Food Interactions

• No significant interactions generally reported

Drug-Herb Interactions

• Limited data; use caution with herbal products that affect glucose levels.

Nursing Implications

Patient/Family Teaching

• Take lixisenatide exactly as prescribed, preferably before the first meal.
• Recognize symptoms of pancreatitis (severe abdominal pain, nausea, vomiting).
• Report any signs of hypoglycemia, especially if using insulin or other hypoglycemics.
• Maintain regular blood glucose monitoring.

Special Considerations

Black Box Warnings:

• Thyroid C-cell tumors, including medullary thyroid carcinoma, have been observed in rodent studies; use only if the benefits outweigh the risks.

Genetic Factors: Patients with a personal or family history of medullary thyroid carcinoma or MEN 2 should not use.

Lab Test Interference: No known significant interference.

Overdose Management

Signs/Symptoms: Symptoms of hypoglycemia or gastrointestinal disturbances.

Treatment: Discontinue lixisenatide, manage hypoglycemia with glucose as needed, supportive care.

Storage and Handling

Storage: Store refrigerated at 2°C to 8°C (36°F to 46°F).

Stability: Unopened vials can be kept at room temperature up to 14 days; opened vials should be used promptly.