Oral Diabetes Medications - Diabetes Educational Services

Oral Diabetes MedicationsClass/Main Action Name(s) Daily Dose Range ConsiderationsBiguanidesDecrease hepatic glucoseoutput.American Diabetes Associationrecommends start at diagnosisof type 2.SulfonylureasStimulates sustained insulinrelease.DPP – 4 Inhibitors“Incretin Enhancers” Prolongsaction of gut hormones =increased insulin secretion,delayed gastric emptying.metformin (Glucophage)Extended Release-XR(Glucophage XR)(Glumetza)(Fortamet)glyburide:(Micronase, Diabeta)(Glynase)glipizide:(Glucotrol*)(Glucotrol XL)glimepiride (Amaryl)sitagliptin (Januvia)saxagliptin (Onglyza)linagliptin (Tradjenta)alogliptin (Nesina)500–2500 mg(usually BID w/meal)(1x daily w/dinner)500–2000 mg500–2000 mg500–2500 mg1.25–20 mg0.75–12 mg2.5–40 mg2.5–20 mg1.0–8 mg100 mg daily(eliminated via kidney*)Up to 5 mg daily(eliminated via kidney*, feces)5 mg daily(eliminated via feces)25 mg once daily(eliminated via kidney)More medications on back. Note: These meds are for people with Type 2 diabetes andshould not be used during pregnancy. Content is for educational purposes only: please consultprescribing information for details.Take caution if creat>1.4 women, >1.5 men,CHF on meds, >80 yrs, binge drinker, liverdisease, during IV dye study, illness. Eliminatedvia kidney. Side effects include nausea, B12deficiency, bloating, diarrhea. Take w/ meals.Lowers A1c 1.0% – 2.0%.Can take once or twice daily. Side effectsinclude hypoglycemia and weight gain.Eliminated via kidney.*Take Glucotrol on an empty stomach.Take Glucotrol XL with first meal.Lowers A1c 1.0%–2.0%.*If creatinine elevated, see pkg insert fordosing info. No wt gain or hypoglycemia. Sideeffects include nasopharyngitis, headacheand upper-respiratory tract infection. Reportsigns of pancreatitis (abdominal pain, nausea,vomiting).Lowers A1c 0.6%–0.8%.Rev. 02/2013Diabetes PocketCard www.DiabetesEd.net

Class/Main Action Name(s) Daily Dose Range ConsiderationsMeglitinidesStimulates rapid insulin“burst.”Thiazolidinediones“TZDs”Increase insulin sensitivity.Dopamine ReceptorAgonistsResets circadian rhythm.Glucosidase InhibitorsDelay carb absorption.Combination medicationsObserve precautions of eachcomponent drug.repaglinide (Prandin)nateglinide (Starlix)0.5–4 mg w/meals(metabolized in liver)60–120 mg w/meals(eliminated via kidney)Take before meals. Side effects may includehypoglycemia and weight gain.Lowers A1c 1.0%–2.0%.pioglitazone (Actos) 15–45 mg daily Black Box Warning: TZDs may cause or worsen CHF.Monitor for edema and weight gain. Increased peripheralrosiglitazone (Avandia)restricted access*bromocriptine mesylate—Quick Release “QR” (Cycloset)acarbose (Precose)miglitol (Glyset)Glucovance: Glucophage + GlyburideMetaglip: Metformin + GlipizideKazano: Alogliptin + MetforminOseni: Alogliptin + Actos4–8 mg daily1.6 to 4.8 mg a day(each tab 0.8 mg)25–100 mg w/meals;300 mg max daily dosefracture risk.No new pts to be started on Avandia as single orcombo med. Actos may increase risk of bladdercancer.Lowers A1c 0.5%–1.0%Take within 2 hrs of waking. Start at one tab daily, increase0.8 mg each wk as tolerated. Side effects: nausea,headache, fatigue, hypotension, syncope, somnolence.Lowers A1c 0.6%–0.9%.Start with low dose, increase at 4-8 wk intervals todecrease GI effects. Caution with liver or kidney problems.Lowers A1c 0.5%–1.0%.Actoplus Met: Actos + MetforminDuetact: Actos + AmarylJanumet: Januvia + MetforminKombiglyze XR: Onglyza + Metformin XRJuvisync: Januvia + ZocorDiabetes Educational Services • 530/893-8635Beverly Dyck Thomassian RN, MPH, BC-ADM, CDEDiabetes PocketCard www.DiabetesEd.net