Buffered formulations of exendin (9-39)

1. A liquid pharmaceutical formulation comprising exendin (9-39) or a pharmaceutically acceptable salt thereof and a tonicity modifier in a physiologically acceptable buffer having a pH in the range of above 5.1 to 6, wherein the exendin (9-39) or the pharmaceutically acceptable salt thereof does not exhibit detectable aggregation in the formulation, and wherein the liquid pharmaceutical formulation, when administered to a human subject, has an improved pharmacokinetic profile as compared to a composition comprising the same dose of exendin (9-39) or a pharmaceutical acceptable salt thereof formulated in 0.9% normal saline.

2. The liquid pharmaceutical formulation of claim 1 , wherein the physiologically acceptable buffer comprises an acetate buffer or a citrate buffer.

3. The liquid pharmaceutical formulation of claim 1 , wherein the physiologically acceptable buffer comprises sodium acetate or sodium citrate.

4. The liquid pharmaceutical formulation of claim 1 , wherein the physiologically acceptable buffer comprises sodium acetate or sodium citrate at a concentration from about 5 mM to about 30 mM.

5. The liquid pharmaceutical formulation of claim 1 , wherein the physiologically acceptable buffer comprises sodium acetate at a concentration of about 10 mM.

6. The liquid pharmaceutical formulation of claim 1 , wherein the buffer has a pH in the range of 5.2 to 5.8.

7. The liquid pharmaceutical formulation of claim 6 , wherein the pH is about 5.5.

8. The liquid pharmaceutical formulation of claim 1 , wherein the tonicity modifier comprises mannitol, dextrose, glycerin, lactose, sucrose, or trehalose.

9. The liquid pharmaceutical formulation of claim 8 , wherein the tonicity modifier comprises mannitol.

10. The liquid pharmaceutical formulation of claim 8 , wherein the tonicity modifier is present in an amount from about 20 mg/ml to about 60 mg/ml.

11. The liquid pharmaceutical formulation of claim 10 , wherein the tonicity modifier is present in an amount that achieves an osmolality of 290 mOsm/kg.

12. The liquid pharmaceutical formulation of claim 1 , wherein the pharmaceutically acceptable salt of exendin (9-39) is exendin (9-39) acetate or exendin (9-39) trifluoroacetate.

13. The liquid pharmaceutical formulation of claim 1 , wherein the exendin (9-39) or the pharmaceutically acceptable salt thereof is at a concentration of about 10 mg/ml to about 120 mg/ml.

14. The liquid pharmaceutical formulation of claim 13 , wherein the exendin (9-39) or the pharmaceutically acceptable salt thereof is at a concentration of at least 15 mg/ml.

15. The liquid pharmaceutical formulation of claim 13 , wherein the exendin (9-39) or the pharmaceutically acceptable salt thereof is at a concentration of about 30 mg/ml.

16. The liquid pharmaceutical formulation of claim 13 , wherein the exendin (9-39) or the pharmaceutically acceptable salt thereof is at a concentration of about 60 mg/ml.

17. The liquid pharmaceutical composition of claim 1 , formulated for subcutaneous administration.

18. The liquid pharmaceutical formulation of claim 1 , wherein the liquid pharmaceutical formulation, when administered to a human subject, exhibits a higher C max for exendin (9-39) than a composition comprising the same dose of exendin (9-39) or a pharmaceutical acceptable salt thereof formulated in 0.9% normal saline.

19. The liquid pharmaceutical formulation of claim 1 , wherein the liquid pharmaceutical formulation, when administered to a human subject, exhibits a higher 12-hour AUC for exendin (9-39) than a composition comprising the same dose of exendin (9-39) or a pharmaceutical acceptable salt thereof formulated in 0.9% normal saline.

20. The liquid pharmaceutical formulation of claim 1 , wherein the liquid pharmaceutical formulation, when administered to a human subject, exhibits a higher trough plasma concentration for exendin (9-39) than a composition comprising the same dose of exendin (9-39) or a pharmaceutical acceptable salt thereof formulated in 0.9% normal saline.

21. A method of treating or preventing hyperinsulinemic hypoglycemia in a subject, comprising administering to the subject the liquid pharmaceutical formulation of claim 1 .

22. The method of claim 21 , wherein the subject has previously had an upper-gastrointestinal procedure.

23. The method of claim 22 , wherein the subject has previously had a bariatric procedure.

24. The method of any of claim 21 , wherein the method comprises subcutaneously administering to the subject the liquid pharmaceutical formulation comprising exendin (9-39) at a dosage of about 30 mg to about 75 mg once daily (QD).

25. The method of claim 21 , wherein the method comprises subcutaneously administering to the subject the liquid pharmaceutical formulation comprising exendin (9-39) at a dosage of about 30 mg, 45 mg, or 90 mg QD.

26. The method of claim 21 , wherein the method comprises subcutaneously administering to the subject the liquid pharmaceutical formulation comprising exendin (9-39) at a dosage of about 15 mg, 30 mg, or 45 mg twice daily (BID).

27. The liquid pharmaceutical formulation of claim 13 , wherein the exendin (9-39) or the pharmaceutically acceptable salt thereof is at a concentration of about 45 mg/ml.

28. The liquid pharmaceutical formulation of claim 13 , wherein the exendin (9-39) or the pharmaceutically acceptable salt thereof is at a concentration of about 90 mg/ml.

29. The method of claim 21 , wherein the method comprises subcutaneously administering to the subject the liquid pharmaceutical formulation comprising exendin (9-39) at a daily dosage of about 30 mg, 45 mg, or 90 mg.

30. The method of claim 29 , wherein the method comprises subcutaneously administering to the subject the liquid pharmaceutical formulation comprising exendin (9-39) once per day (QD) or twice per day (BID).