November 3, 2013

The GLP-1 Agonists

Victoza (liraglutide [rDNA origin] injection)

I dislike starting this with a warning, but it is important and valid for this medication. Just because a celebrity chef (Paula Deen) promotes this medication does not make it safe and I suspect there will be more warnings in the future.

Warning Liraglutide injection may increase the risk that you will develop tumors of the thyroid gland, including medullary thyroid carcinoma (MTC; a type of thyroid cancer), which may cause death if it is not treated at an early stage. If you develop thyroid cancer, your thyroid gland may need to be surgically removed. Tell your doctor if you or anyone in your family has or has ever had thyroid cancer, medullary thyroid carcinoma, or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2; condition that causes tumors in more than one gland in the body). If so, your doctor will probably tell you not to use Liraglutide injection. If you experience any of the following symptoms, call your doctor immediately: lump or swelling in the neck; hoarseness; difficulty swallowing; or shortness of breath.

Keep all appointments with your doctor and the laboratory. Your doctor may order certain tests to check your body's response to Liraglutide injection.

Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with Liraglutide injection and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website ( or the manufacturer's website to obtain the Medication Guide.

Talk to your doctor about the risks of using Liraglutide injection.

I strongly urge you to read this link (a PDF file) or the suggested links above in the warning so that you can familiarize yourself about Victoza. There are many special instructions that need to followed for proper use and avoiding problems with Victoza. Victoza is manufactured by Novo Nordisk.

Amylin Mimetic (Symlin) (pramlintide acetate)

This medication is not for people with type 2 diabetes taking oral medications. It is only for people already taking insulin. There are several warnings you must take seriously. Symlin cannot be used in place of insulin. You must use a separate syringe to inject Symlin. Symlin may reduce the amount of insulin you need to use. Non-compliance is a problem for those taking Symlin.

Symlin does help keep your blood glucose at lower levels after you eat by helping your liver not put glucose into your blood stream. It may also prevent hunger, causing you to eat less and has the potential to assist in losing weight.

You should not take Symlin and need to talk with your doctor if you can't tell when you are having low blood glucose, a condition called hypoglycemia unawareness, you have recently had severe low blood glucose, you have stomach problems caused by diabetes-related nerve damage, and the standard if you are pregnant, planning to get pregnant, or breastfeeding. Symlin has not been studied for use in children. There may be times when you should not take your usual dose of Symlin and this includes if you're having surgery and you’re sick and can’t eat. Also, discuss with your doctor about other times not to take Symlin.

Symlin can cause the following side effects and you should be prepared for them. They include - nausea and vomiting-most often when you first start taking Symlin, swelling, redness, or itching of the skin where Symlin is injected, headache, decreased appetite, stomach pain and indigestion, tiredness, and dizziness. Symlin does not cause low blood glucose by itself; however, your risk of having low blood glucose is higher because Symlin is always taken along with insulin.

Symlin is manufactured by Amylin Pharmaceuticals, Inc.

Incretin Mimetic Byetta and Bydureon (extended-release for injectable suspension) (exenatide)

Byetta and Bydureon are very much like Symlin, but you need to add that both help slow digestion by moving the food slowly through your stomach. Both are not to be used in place of insulin; however, people on oral medications or not on any medications may use it if appropriate.

You should not take Byetta or Bydureon and need to talk with your doctor if you have severe stomach or digestive problems, you have any symptoms of kidney disease or are on dialysis, you are pregnant, planning to get pregnant, or breastfeeding, and you have type 1 diabetes. Both have not been studied for use in children.

The possible side effects Byetta and Bydureon can cause are - nausea and vomiting-most often when you first start taking them, headache, diarrhea, and dizziness. Byetta and Bydureon also can cause an acid stomach or make you feel nervous.

If you are planning to take either, you need to know about problems with your kidneys
and talk with your doctor right away if you notice any of the following - changes in the color of your urine, how often you urinate, or the amount you urinate. swelling of your hands or feet, tiredness, changes in your appetite or digestion, and a dull ache in your mid to lower back. Byetta and Bydureon do not cause low blood glucose by itself, but your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose, or insulin. Your doctor may advise you to take a lower dose of your other diabetes medicines while you are taking Byetta or Bydureon.

Byetta and Bydureon are manufactured by Amylin Pharmaceuticals, LLC and AstraZeneca Pharmaceuticals LP.

These GLP-1 agonists are all under suspicion of causing pancreatitis and pancreatic cancer, but presently the FDA is not convinced and seems to be waiting for additional adverse events.

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