Pharmacy World & Science

, Volume 32, Issue 5, pp 559–561 | Cite as

Acute renal failure when exenatide is co-administered with diuretics and angiotensin II blockers

  • Alfonso López-RuizEmail author
  • Cristina del Peso-Gilsanz
  • Amparo Meoro-Avilés
  • José Soriano-Palao
  • Alberto Andreu
  • Juan Cabezuelo
  • José L. Arias
Case Report


Case (description) the patient is a 20 years old male smoker, who was diagnosed with type 2 diabetes mellitus in 2006. Due to the inadequate response to the previously established treatment, the pharmacotherapy was modified by introducing exenatide (up to 10 μg, twice daily) instead of insulin glargine, but maintaining the treatment with the diuretic and angiotensin II receptor antagonist drugs. Two months later, the patient exhibited a very important intolerance to exenatide (continuous nausea, vomiting, and dehydration), finally leading to ischemic acute renal failure. When the angiotensin II receptor antagonist and exenatide were suspended, a very rapid recovery of renal function was observed. Conclusion ischemic acute renal failure is supposed to be the consequence of the extracellular volume contraction caused by exenatide (the result of continuous nausea and vomiting). This adverse effect could be caused by the co-administration of diuretics and angiotensin II receptor antagonists.


Adverse drug effect ADE Angiotensin II receptor antagonist Candesartan Combined therapy Diuretic Exenatide Hydrochlorothiazide Ischemic acute renal failure Renal function Type 2 diabetes mellitus 



The cooperation of the Diabetes Unit of the Reina Sofía University Hospital (Murcia, Spain), of the Medical Department of Eli Lilly & Co. (Spain), and of Mr. Martin Urbanek are gratefully acknowledged.


No funding was received for this study.

Conflicts of interest



  1. 1.
    Fineman MS, Bicsak TA, Shen LZ, Taylor K, Gaines E, Varns A, et al. Effect on glycemic control of exenatide (synthetic exendin-4) additive to existing metformin and/or sulfonylurea treatment in patients with type 2 diabetes. Diabetes Care. 2003;26:2370–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Kolterman OG, Buse JB, Fineman MS, Gaines E, Heintz S, Bicsak TA, et al. Synthetic exendin-4 (exenatide) significantly reduces postprandial and fasting glucose in subjects with type 2 diabetes. J Clin Endocrinol Metab. 2003;88:3082–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Norris SL, Lee N, Thakurta S, Chan BK. Exenatide efficacy and safety: a systematic review. Diabet Med. 2009;26:837–46.CrossRefPubMedGoogle Scholar
  4. 4.
    Glass LC, Qu Y, Lenox S, Kim D, Gates JR, Brodows R, et al. Effects of exenatide versus insulin analogues on weight change in subjects with type 2 diabetes: a pooled post-hoc analysis. Curr Med Res Opin. 2008;24:639–44.CrossRefPubMedGoogle Scholar
  5. 5.
    Kim D, MacConell L, Zhuang D, Kothare PA, Trautmann M, Fineman M, et al. Effects of once-weekly dosing of a long-acting release formulation of exenatide on glucose control and body weight in subjects with type 2 diabetes. Diabetes Care. 2007;30:1487–93.CrossRefPubMedGoogle Scholar
  6. 6.
    Edwards CM, Stanley SA, Davis R, Brynes AE, Frost GS, Seal LJ, et al. Exendin-4 reduces fasting and postprandial glucose and decreases energy intake in healthy volunteers. Am J Physiol Endocrinol Metab. 2001;281:E155–61.PubMedGoogle Scholar
  7. 7.
    Bunck MC, Diamant M, Cornér A, Eliasson B, Malloy JL, Shaginian RM, et al. One-year treatment with exenatide improves beta-cell function, compared with insulin glargine, in metformin-treated type 2 diabetic patients: a randomized, controlled trial. Diabetes Care. 2009;32:762–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Kendall DM, Cuddihy RM, Bergenstal RM. Clinical application of incretin-based therapy: therapeutic potential, patient selection and clinical use. Eur J Intern Med. 2009;20:S329–39.CrossRefPubMedGoogle Scholar
  9. 9.
    Weise WJ, Sivanandy MS, Block CA, Comi RJ. Exenatide-associated ischemic renal failure. Diabetes Care. 2009;32:E22–3.CrossRefPubMedGoogle Scholar
  10. 10.
    Johansen OE, Whitfield R. Exenatide may aggravate moderate diabetic renal impairment: a case report. Br J Clin Pharmacol. 2008;66:568–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Alfonso López-Ruiz
    • 1
    Email author
  • Cristina del Peso-Gilsanz
    • 1
  • Amparo Meoro-Avilés
    • 1
  • José Soriano-Palao
    • 1
  • Alberto Andreu
    • 1
  • Juan Cabezuelo
    • 1
  • José L. Arias
    • 2
  1. 1.Diabetes UnitReina Sofía University HospitalMurciaSpain
  2. 2.Department of Pharmacy and Pharmaceutical TechnologyUniversity of GranadaGranadaSpain

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