Journal of Clinical Toxicology
Open Access

Abstract

Acute Exenatide Overdose

Christine Payen, Jean-Marc Thouret, Jacques Descotes and Thierry Vial

Exenatide, a glucagon-like peptide-1 (GPL-1) receptor agonist, was quite recently approved as adjunctive therapy to improve glycemia control in type 2 diabetes patients. There is very limited information on overdose consequences. We report 3 cases of exenatide overdose involving 2 suicidal self-injections associated with psychotropic intake and one medication error. Two patients rapidly experienced gastro-intestinal symptoms and none of them presented severe hypoglycemia, which is in accordance with the known biological activity of GLP-1 that acts in a glucose-dependent manner and does not inhibit glucagon release in case of hypoglycemia. Interestingly one patient, who ingested large amounts of psychotropic drugs together with self-injection of a large dose (600 μg) of exenatide, presented unexpected delayed onset of central nervous system (CNS) symptoms whereas no hypoglycemia was experienced and no neurological feature is anticipated from exenatide exposure. Physicians should be aware of exenatide property to inhibit gastric emptying which can delay symptoms of acute poisoning due to co-ingested drugs.