New drugs: Exenatide – an injectable diabetic agent and Denosumab – a monoclonal antibody for postmenopausal osteoporosis
Exanatide (Byetta):
the first injectable synthetic analogue of the incretin hormone glucagon-like peptide-1 (GLP-1)
note that the glyptins inhibit incretin breakdown and are thus incretin “enhancers” not “mimics”
PBS approved for type 2 diabetics as an addition to the combination of metformin and sulphonylurea to help lower HbA1c below 7% or as dual Rx for those who cannot tolerate metformin or a sulphonylurea.
dose:
is given bd s/c within 1 hour BEFORE meals starting at 5 mcg per dose which should be at least 6 hours apart
after 1 month, dose can be increased to 10mcg bd
main adverse effects are:
nausea (50% initially)
vomiting
risk of hypoglycaemia (this risk is similar to use of insulin and mainly a risk with sulphonylurea combination)
pancreatitis – PH of pancreatitis is a C/I!
renal impairment
development of antibodies which in some may limit its effect (~3% of the 50% of patients who develop antibodies)
the actions include:
increase glucose-dependent insulin secretion
suppress inappropriate glucagon secretion
delay gastric emptying and thus delays glucose absorption
reduces appetite and may contribute to a 1-2kg weight loss
Denosumab (Prolia):
an alternative for Rx of postmenopausal osteoporosis
a human IgG2 monoclonal antibody that targets the RANKL (receptor activator of nuclear factor kappa B ligand).
this inhibition prevents the formation, function and survival of osteoclasts and thus decreases bone resorption and bone l...
Source: Oz E Medicine - emergency medicine in Australia - Category: Emergency Medicine Authors: Gary Tags: new drugs Source Type: blogs
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