Drug Guide
Lixisenatide
Classification
Therapeutic: Antidiabetic agent
Pharmacological: Glucagon-like peptide-1 (GLP-1) receptor agonist
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
Assessment: Monitor blood glucose levels regularly, assess for symptoms of pancreatitis, renal function.
Diagnoses:
- Risk for hypoglycemia
- Impaired tissue perfusion related to hypoglycemia
Implementation: Administer once daily before the first meal; educate patients on gastrointestinal side effects and pancreatitis symptoms.
Evaluation: Assess blood glucose control, monitor for side effects, verify weight and hydration status.
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.