Drug Action
Binds to, and activates, the GLP-1 (glucagon-like peptide-1) receptor to increase insulin secretion, suppresses glucagon secretion, and slows gastric emptying.
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Drug reference
Binds to, and activates, the GLP-1 (glucagon-like peptide-1) receptor to increase insulin secretion, suppresses glucagon secretion, and slows gastric emptying.
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Type 2 diabetes mellitus in combination with oral antidiabetic drugs (e.g. metformin, pioglitazone, or a sulfonylurea) or basal insulin, or both, when adequate glycaemic control has not been achieved with these drugs ▶BY SUBCUTANEOUS INJECTION ▶Adult: Initially 10 micrograms once daily for 14 days, then increased to 20 micrograms once daily, dose to be taken within 1 hour before the first meal of the day or the evening meal
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DUE TO INTERACTIONS ▶Dose of concomitant sulfonylurea or insulin may need to be reduced.
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Ketoacidosis. severe gastro- intestinal disease
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History of pancreatitis
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Scottish Medicines Consortium (SMC) decisions The Scottish Medicines Consortium has advised (September 2013) that lixisenatide (Lyxumia ®) is accepted for restricted use within NHS Scotland for the treatment of type 2 diabetes in combination with oral antidiabetic drugs or basal insulin (or both), when adequate glycaemic control has not been achieved with these drugs, together with diet and exercise; use is restricted to patients for whom a GLP-1 agonist is appropriate, as an alternative to an existing GLP-1 agonist (exenatide or liraglutide).
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MHRA/CHM ADVICE: GLP-1 RECEPTOR AGONISTS: REPORTS OF DIABETIC KETOACIDOSIS WHEN CONCOMITANT INSULIN WAS RAPIDLY REDUCED OR DISCONTINUED (JUNE 2019) Serious and life-threatening cases of diabetic ketoacidosis have been reported in patients with type 2 diabetes mellitus on a combination of insulin and the glucagon-like peptide-1 (GLP-1) receptor agonist exenatide, liraglutide, or dulaglutide, particularly after discontinuation or rapid dose reduction of concomitant insulin. The MHRA has not currently received any UK reports of diabetic ketoacidosis with the GLP-1 receptor agonists lixisenatide and semaglutide but this risk cannot be excluded. Healthcare professionals are advised that any dose reduction of insulin should be done in a stepwise manner with careful blood glucose self- monitoring, particularly when GLP-1 receptor agonist therapy is initiated. Patients should be informed of the risk factors for and signs and symptoms of diabetic ketoacidosis, and advised to seek immediate medical attention if these develop.
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→Appendix 1: lixisenatide
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▶Common or very common Back pain. cystitis. diarrhoea. dizziness. drowsiness. dyspepsia. headache. increased risk of infection. nausea. vomiting ▶Uncommon Urticaria ▶Frequency not known Pancreatitis acute SIDE-EFFECTS, FURTHER INFORMATION Manufacturer advises discontinue if symptoms of acute pancreatitis occur, such as persistent, severe abdominal pain.
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Women of child- bearing age should use effective contraception.
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Avoid—toxicity in animal studies.
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Avoid—no information available.
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Use with caution if eGFR 30–50 mL/minute/1.73 m2. Avoid if eGFR less than 30 mL/minute/1.73 m2—no information available.
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There can be variation in the licensing of different medicines containing the same drug. Solution for injection CAUTIONARY AND ADVISORY LABELS 10 ▶Lyxumia (Sanofi) Lixisenatide 50 microgram per 1 ml Lyxumia 10micrograms/0.2ml solution for injection 3ml pre-filled pens | 1 pre-filled disposable injection P £31.67 DT = £31.67 Lixisenatide 100 microgram per 1 ml Lyxumia 20micrograms/0.2ml solution for injection 3ml pre-filled pens | 2 pre-filled disposable injection P £57.93 DT = £57.93 Combinations available: Insulin glargine with lixisenatide, p. 757
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Some oral medications should be taken at least 1 hour before or 4 hours after lixisenatide injection—consult product literature for details. Missed doses If a dose is missed, inject within 1 hour before the next meal—do not administer after a meal.
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Initially 10 micrograms once daily for 14 days,
First-line fragment. Read the complete Indications and Dose section above.
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