Names and pronunciation
(lix′i-sen′a-tide) Adlyxin
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Drug reference
(lix′i-sen′a-tide) Adlyxin
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Func. class.: Antidiabetic agent
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Chem. class.: GLP-1 receptor agonist
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ACTION: An incretin mimetic; a gluca- gon-like peptide-1 (GLP-1) receptor ago- nist; binds and activates the GLP-1 receptor. GLP-1 is an important, gut-derived, glucose homeostasis regulator that is released after the oral ingestion of carbohydrates or fats
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USES: Treatment of type 2 diabetes mel- litus in combination with diet and exercise
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CONTRAINDICATIONS: Angio- edema Precautions: Alcoholism, breastfeeding, children, cholelithiasis, diabetic ketoaci- dosis, gastroparesis, hypoglycemia, pan- creatitis, pregnancy, renal failure, renal impairment, risk of serious hypersensi- tivity reactions or anaphylaxis, type 1 diabetes mellitus
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SIDE EFFECTS GI: Nausea, vomiting, diarrhea, constipa- tion, abdominal pain, dyspepsia, pancre atitis (rare) CNS: Dizziness, headache MISC: Antibody formation, hypoglyce- mia, injection site reactions, hypoten- sion; anaphylactoid reaction, broncho spasm, renal failure, laryngeal edema
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INTERACTIONS Increase: hypoglycemia—antidiabetes, sulfonylureas Decrease: effect of hormonal contracep- tives, oral antiinfectives, atorvastatin, to be taken 1 hr before
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DOSAGE AND ROUTES • Adult: SUBCUT Initially, 10 mcg/day within 1 hr before the morning meal. If a dose is missed, give within 1 hr before the next meal. Continue 10 mcg/day × 14 days; on day 15, increase the dose to the mainte- nance dose of 20 mcg/day, max 20 mcg/day Renal dose • Adult: eGFR 60 to 89 mL/min/1.73 m2: no dosage adjustment needed; eGFR 30 to 59 mL/min/1.73 m2: no change; moni tor closely for adverse reactions; eGFR < 15 mL/min/1.73 m2: do not use
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Available forms: Solution for injection 10 mcg, 20 mcg prefilled pen starter pack, maintenance pack
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Administer: SUBCUT route • May be used as monotherapy or with other antidiabetic medications. Dose ad- justment of metformin or a thiazolidinedi- one is not usually required. A reduction in the dose of a sulfonylurea may be needed to reduce the risk of hypoglycemia • Give subcut injection only. Do not give IV/IM • Visually inspect for particulate matter and discoloration before use; do not use if unusually viscous, cloudy, discolored, or if particles are present • Available as a prefilled pen. Each pen must be activated before the first use • Administer daily within 1 hr before the first meal of the day, preferably the same meal each day. If a dose is missed, give within 1 hr before the next meal • Inject subcut into the thigh, abdomen, or upper arm • Rotate sites with each injection to pre- vent lipodystrophy • Storage: Protect pen from light and keep in its original packaging; discard pen 14 days after its first use
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Assess: • Diabetes: fasting blood glucose, A1c level during treatment to determine dia- betic control • Pancreatitis: severe abdominal pain with or without nausea and vomiting, product should be discontinued immedi ately • Renal disease: monitor BUN, creati nine in mild renal disease; do not use in severe renal disease • Hypoglycemia/hyperglycemia: reaction can occur soon after meals; for severe hypoglycemia, give IV D50W, IV dextrose solution
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Evaluate: • Therapeutic response: decreasing polydipsia, polyuria, polyphagia, clear sensorium, improving A1c, weight
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • How to prepare and use the pen; in- clude a practice injection • About the signs and symptoms of hypo- glycemia/hyperglycemia and what to do about each; to have emergency glucagon kit available at all times, to carry glucose source (sugar, candy) • That product must be taken on a con- tinuing basis; not to discontinue without prescriber’s approval • That diabetes is a lifelong condition; that product will not cure condition; to carry emergency ID with condition, products taken, prescriber’s phone num- ber and name • To continue weight control, dietary restrictions, exercise, hygiene • That regular lab testing and A1c will be necessary • Pancreatitis: to seek medical care immediately if severe abdominal pain occurs with or without nausea, vomit ing • Pregnancy: to notify prescriber if pregnant or planning to become preg- nant; if taking oral contraceptives, to take at least 1 hr before this product See Appendix B
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PHARMACOKINETICS Eliminated through glomerular filtration and proteolytic degradation, terminal half-life 1-3 hr; peak 1-3.5 hr; elimina- tion prolonged in renal disease, with mild (CCr 60 to 89 mL/min), moderate (CCr 30 to 59 mL/min), and severe renal impairment (CCr 15 to 29 mL/min) was increased by approximately 34%, 69%, and 124%, respectively; use with caution in renal disease
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• Adult: SUBCUT Initially, 10 mcg/day within 1 hr before the morning meal. If a dose is missed, give within 1 hr before the next meal. Continue 10 mcg/day × 14 days; on day 15, increase the dose to the mainte- nance dose of 20 mcg/day, max 20 mcg/day Renal dose
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• Adult: eGFR 60 to 89 mL/min/1.73 m2: no dosage adjustment needed; eGFR 30 to 59 mL/min/1.73 m2: no change; moni tor closely for adverse reactions; eGFR < 15 mL/min/1.73 m2: do not use
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