Lixisenatide is an injectable medication primarily used to treat type 2 diabetes, belonging to a class of drugs known as incretin mimetics. It has shown promise not only in managing blood sugar levels but also as a potential aid in weight loss. This article provides a detailed overview of lixisenatide, its mechanism of action, usage guidelines, potential side effects, and its role in diabetes and weight management.
What is Lixisenatide?
Lixisenatide, known by the brand name Adlyxin, is a glucagon-like peptide-1 (GLP-1) receptor agonist. GLP-1 receptor agonists are glucose-lowering agents administered via subcutaneous injection, and they are associated with weight loss and a low risk of inducing hypoglycemia. It was first approved by the European Medicines Agency in February 2013 for the treatment of type 2 diabetes. The U.S. Food and Drug Administration (FDA) approved lixisenatide on July 27, 2016.
How Lixisenatide Works
Lixisenatide mimics the effects of the natural hormone GLP-1 in the body. This helps to control blood sugar levels through several mechanisms:
- Increases Insulin Production: Lixisenatide stimulates the pancreas to release more insulin when blood sugar levels are high. Insulin helps move sugar from the blood into other body tissues where it is used for energy.
- Slows Down Digestion: It reduces the amount of sugar released into the blood and slows down the digestion of food, preventing rapid spikes in blood sugar levels after meals.
- Reduces Glucagon Production: Lixisenatide reduces the production of glucagon, a hormone that raises blood sugar levels.
- Promotes Satiety: It helps you feel full sooner, potentially leading to reduced food intake.
Lixisenatide for Weight Loss
Clinical studies and meta-analyses have demonstrated that lixisenatide can contribute to weight loss. A meta-analysis of 23 articles showed a significant reduction in body weight (WMD: -0.97 kg, 95 % CI: -1.10, -0.83, p < 0.001) and BMI (WMD: -0.48 kg/m2, 95 % CI: -0.67, -0.29, P < 0.001) after subcutaneous administration of Lixisenatide. This makes it a therapeutic option for those suffering from weight gain caused by other anti-diabetic agents.
Dosage and Administration
Lixisenatide is administered via subcutaneous injection once a day, within 60 minutes (1 hour) before the first meal of the day, at approximately the same time each day. It can be injected into the upper leg, stomach area (abdomen), or upper arm. It is essential to rotate injection sites to avoid skin irritation.
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Your doctor will likely start you on a low dose of lixisenatide and then increase your dose after 14 days.
Instructions for Use
- Preparation: Always inspect the lixisenatide solution before injection. It should be clear, colorless, and free of particles. Do not use if it is colored, cloudy, thickened, or contains solid particles, or if the expiration date on the pen has passed. Allow the pen to warm to room temperature before using it if stored in the refrigerator.
- Injection: Inject the prescribed dose under the skin (subcutaneously) of your abdomen, thigh, or upper arm. Use a different site for each injection.
- Disposal: Never reuse needles and never share needles or pens. Always remove the needle right after you inject your dose. Throw away used needles in a puncture-resistant container. Ask your doctor or pharmacist how to dispose of the puncture-resistant container.
Important Considerations Before Taking Lixisenatide
Before starting lixisenatide, inform your doctor and pharmacist about any allergies to medications, foods, or substances. Also, disclose all prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking.
Medical Conditions
Tell your doctor if you have or have ever had:
- Severe stomach problems, including gastroparesis (slowed movement of food from the stomach to the small intestine) or problems digesting food.
- Pancreatitis (swelling of the pancreas) or problems with your pancreas.
- Gallbladder disease.
- Kidney disease.
- If you are pregnant, plan to become pregnant, or are breastfeeding.
Surgical Procedures
If you are having surgery, including dental surgery, inform the doctor or dentist that you are using lixisenatide injection.
Lifestyle Changes
Ask your doctor what to do if there is a large change in your diet, exercise, or weight; or if you get sick, develop an infection or fever, experience unusual stress, or are injured.
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Potential Side Effects
Like all medications, lixisenatide can cause side effects.
Common Side Effects
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Indigestion
- Bloating
- Headache
- Pain, itching, or redness at the injection site
These side effects are usually mild and may subside over time. However, if they persist or become bothersome, consult your healthcare provider.
Serious Side Effects
Some side effects can be serious and require immediate medical attention:
- Pancreatitis: Symptoms include ongoing pain that begins in the upper left or middle of the stomach but may spread to the back, with or without vomiting.
- Allergic Reactions: Signs include hives, rash, itching, pounding heartbeat, fainting or feeling dizzy, swelling of the eyes, face, mouth, tongue, throat, feet, ankles, or lower legs, difficulty swallowing or breathing, and hoarseness.
- Kidney Problems: Symptoms include decreased urination, very dry mouth or skin, or extreme thirst.
- Gallbladder Problems: Severe stomach pain, nausea, vomiting, fever.
Low Blood Sugar (Hypoglycemia)
Low blood sugar can occur when you use lixisenatide with other medicines that can lower blood sugar, such as insulin, metformin, or a sulfonylurea. It can also occur if you delay or miss a meal or snack, exercise more than usual, drink alcohol, or cannot eat because of nausea or vomiting.
Symptoms of low blood sugar include:
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- Anxiety
- Behavior change similar to being drunk
- Blurred vision
- Cold sweats
- Confusion
- Cool, pale skin
- Difficulty with thinking
- Drowsiness
- Excessive hunger
- A fast heartbeat
- Headache (continuing)
- Nausea
- Nervousness
- Nightmares
- Restless sleep
- Shakiness
- Slurred speech
- Unusual tiredness or weakness
If symptoms of low blood sugar occur, eat glucose tablets or gel, corn syrup, honey, or sugar cubes, or drink fruit juice, non-diet soft drink, or sugar dissolved in water to relieve the symptoms. Also, check your blood for low blood sugar.
High Blood Sugar (Hyperglycemia)
Hyperglycemia may occur if you do not take enough or skip a dose of your antidiabetic medicine, overeat or do not follow your meal plan, have a fever or infection, or do not exercise as much as usual.
Symptoms of high blood sugar include:
- Blurred vision
- Drowsiness
- Dry mouth
- Flushed, dry skin
- Fruit-like breath odor
- Increased urination (frequency and amount)
- Ketones in the urine
- Loss of appetite
- Stomachache
- Nausea or vomiting
- Tiredness
- Trouble breathing (rapid and deep)
- Unconsciousness
- Unusual thirst
If symptoms of high blood sugar occur, check your blood sugar level and then call your doctor for instructions.
Interactions with Other Medications
Lixisenatide can interact with several medications, affecting their absorption or efficacy. It is important to inform your healthcare provider of all medications you are taking, including:
- Acetaminophen: Lixisenatide may delay the absorption of acetaminophen.
- Oral Contraceptives: Lixisenatide may lower the amount of medicine in your blood from your birth control pills and they may not work as well to prevent pregnancy. Take them at least 1 hour before, or 11 hours after using lixisenatide injection.
- Antibiotics: Lixisenatide may delay the absorption of certain antibiotics. Take these medicines at least 1 hour before using lixisenatide. If you must take these medicines, take them with a meal or a snack.
- Other Diabetes Medications: Using lixisenatide with other medicines that can lower blood sugar, such as sulfonylurea or insulin, increases the risk of hypoglycemia. The dose of your sulfonylurea or insulin medicine may need to be lowered while you use lixisenatide.
- Warfarin
- Digoxin
Alcohol
Drinking alcohol may cause severe low blood sugar. Discuss alcohol consumption with your healthcare team.
Special Instructions
It is very important to carefully follow any instructions from your health care team about:
- Alcohol: Drinking alcohol may cause severe low blood sugar. Discuss this with your health care team.
- Other medicines: Do not take other medicines during the time you are using lixisenatide unless they have been discussed with your doctor. This especially includes nonprescription medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.
- Counseling: Other family members need to learn how to prevent side effects or help with side effects if they occur. Also, diabetic patients may need special counseling about diabetes medicine dosing changes that might occur because of lifestyle changes, such as changes in exercise and diet. Furthermore, counseling on contraception and pregnancy may be needed because of the problems that can occur during pregnancy in patients with diabetes.
- Travel: Keep a recent prescription and your medical history with you. Be prepared for an emergency as you would normally. Make allowances for changing time zones and keep your meal times as close as possible to your usual meal times.
- In case of emergency: There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that says that you have diabetes and a list of all of your medicines.
Storage and Disposal
- Store unused lixisenatide pens in the refrigerator (36°F to 46°F [2°C to 8°C]).
- Once a lixisenatide pen is in use, store it at room temperature (below 86°F [30°C]) with its cap on.
- Do not freeze. Do not use lixisenatide if it has been frozen.
- Dispose of lixisenatide pens in a puncture-resistant container after 14 days from its first use, even if there is some solution left in the pen.
Clinical Studies and Efficacy
A 24-week, randomized, double-blind, placebo-controlled study in 680 patients with inadequately controlled type 2 diabetes (HbA1c 7â10% [53â86 mmol/mol]) showed that lixisenatide significantly reduced mean HbA1c versus combined placebo. Lixisenatide morning injection significantly reduced 2-h postprandial glucose versus morning placebo. LS mean difference in fasting plasma glucose was significant in both morning and evening groups versus placebo. Mean body weight decreased to a similar extent in all groups.
Alternatives to Lixisenatide
Other medications that combine a long-acting insulin with a GLP-1 agonist include Soliqua and Xultophy. Soliqua is a combination of insulin glargine plus lixisenatide, and Lantus only contains insulin glargine. Xultophy brings together Tresiba (insulin degludec) and Victoza (liraglutide), while Soliqua combines Lantus (insulin glargine) with Adlyxin (lixisenatide).
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