Scientific context only. Not medical advice, not a recommendation to use.
At a glance
Synthetic version of exendin-4, originally isolated from the saliva of the Gila monster (Heloderma suspectum). First GLP-1receptoragonist, FDA-approved 2005 as Byetta. Weekly depot form Bydureon approved 2012.
Researched for
Glycaemic control in type 2 diabetesAdjunctive use in obesity (off-label)
Official status
US: Prescription
FDA-approved 2005 as Byetta (twice daily) and 2012 as Bydureon (weekly depot). Distribution of Bydureon BCise began 2017. Prescription-only.
Exenatide is a 39-amino-acid peptide with about 53% sequence homology to human GLP-1. A glycine substitution at position 2 prevents dipeptidyl-peptidase-IV cleavage and extends the half-life from native GLP-1 (minutes) to about 2.4 hours. GLP-1 receptor activation glucose-dependently stimulates insulin secretion, inhibits glucagon and delays gastric emptying.
02
Evidence at a glance
Reading note. The distribution shows on which evidence tier each observation sits. Strong colours mark stronger evidence — weaker tiers are deliberately visible, not hidden.
3 observations · single evidence tier
Human RCT
3
03
What the studies show
Human RCT
Mensch
Kendall DM. et al. 2005
HbA1c reduction versus placebo in type 2 diabetes over 30 weeks documented in the AMIGO trials
What does NOT follow: Effect size varies by concomitant therapy; smaller effect than semaglutide in head-to-head comparisons.
Human RCT
Mensch
Reduction of body weight as a secondary endpoint reported in several registration trials
What does NOT follow: Secondary endpoint; no efficacy demonstrated in non-diabetic obesity populations.
Human RCT
Mensch
Holman RR. et al. 2017
Neutral cardiovascular effect in the EXSCEL trial (weekly depot form over median 3.2 years)
What does NOT follow: No significant MACE reduction in contrast to liraglutide (LEADER) and semaglutide (SUSTAIN-6, SELECT). Likely due to pharmacokinetic differences.
04
Where studies disagree
Open question
Does exenatide reduce cardiovascular events?
POSITION A
EXSCEL showed numerical but not statistically significant MACE reduction.
POSITION B
Other GLP-1 RAs (liraglutide, semaglutide, dulaglutide) showed significant MACE reductions in comparable CVOTs.
CURRENT STATE · It is debated whether pharmacokinetic differences (plasma peaks vs constant levels) explain the divergent finding.
05
Pharmacokinetics
Theoretical concentration curve at a half-life of 2.4 h. Pure pharmacokinetic model — not a dosing recommendation.
Which routes of administration the available studies describe — neutral reporting, not a usage guide.
Subcutaneous
In AMIGO and EXSCEL administered exclusively subcutaneously (immediate-release twice daily, depot weekly).
07
Known adverse events from studies
Factual reporting of what studies observed. Not a safety statement for individual use.
Human RCT
Nausea
Most frequent documented event; mostly transient in the first 8 weeks.
≈40 % in AMIGO-Studien
Human RCT
Acute pancreatitis (rare)
Class effect of GLP-1 RAs; discussed in FDA adverse-event databases in the early post-approval years. EXSCEL found no significant increase.
selten
07b
Interactions & combinations
Documented interactions and contraindications from studies, prescribing information and guidelines. Where no data exists, this is stated.
Reporting of risks, NOT a combination guide. The absence of an entry does not mean „safe to combine“ but „not sufficiently studied“.
No documented interactions recorded
We have not yet found robustly documented interactions for this peptide. This does NOT mean none exist — the data is limited.
08
Risks & hygiene aspects in the literature
What regulatory and scientific literature reports on risks, sterility and identity in non-pharmaceutical sources — descriptive, not a hygiene guide.
Thyroid C-cell carcinoma (boxed warning)
Bydureon carries a boxed warning based on tumours in rat studies. Clinical relevance in humans is not confirmed.
11
Legal status by country
Country
Status
Note
Checked
United States
Prescription
FDA-approved 2005 as Byetta (twice daily) and 2012 as Bydureon (weekly depot). Distribution of Bydureon BCise began 2017. Prescription-only.
2026-05-22
Germany
Prescription
EMA-approved since 2006 (Byetta) and 2011 (Bydureon). Prescription-only in Germany.
2026-05-22
12
Reconstitution calculator
Pure mg/mL maths — works like a calculator. Not a usage recommendation.
Peptides ship as a dry powder. Once dissolved in a liquid (reconstitution), this calculator answers a single question: how much substance is in one millilitre of solution afterwards?
1Enter the vial's substance amount (printed on the label).
2Enter how much solvent you add.
3Result = concentration in mg per mL.
Printed on the label
/
Liquid you add
=
2.50
mg / mL
5 mg in 2 mL gives 2.50 mg/mL — each millilitre contains 2.50 mg of substance.
Liraglutide once a day versus exenatide twice a day for type 2 diabetes: a 26-week randomised, parallel-group, multinational, open-label trial (LEAD-6)