DƯỢC LÍ Goodman & Gilman's The Pharmacological Basis of Therapeutics 12th, 2010

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SECTION V
HORMONES AND HORMONE ANTAGONISTS
Table 43–9
Comparison of Agents Used for Treatment of Diabetes
MECHANISM HbA 1C
AGENT-SPECIFIC AGENT-SPECIFIC
OF ACTION EXAMPLES REDUCTION (%) a ADVANTAGES DISADVANTAGES CONTRAINDICATIONS
Oral
Biguanides c b Hepatic glucose Metformin 1-2 Weight neutral, Diarrhea, nausea, GFR<50 mL/min,
production Do not cause lactic acidosis CHF, radiographic
hypoglycemia,
contrast studies,
inexpensive
seriously ill patients,
acidosis
α–Glucosidase b GI glucose Acarbose, miglitol 0.5-0.8 Reduce postprandial GI flatulence, liver Renal/liver disease
inhibitors c absorption glycemia function tests
Dipeptidyl Prolong Saxagliptin, 0.5-1.0 Do not cause Reduce dose with
peptidase-4 endogenous sitagliptin, hypoglycemia renal disease
inhibitors c GLP-1 action vildagliptin
Insulin a Insulin See text and 1-2 Inexpensive Hypoglycemia, Renal/liver disease
secretagogues – secretion Table 43-8 weight gain
Sulfonylureas c
Insulin a Insulin See text and 1-2 Short onset of action, Hypoglycemia Renal/liver disease
secretagogues – secretion Table 43-8 lower postprandial
Non-sulfonylureas c
glucose
Thiazolidinediones c b Insulin resistance, Rosiglitazone, 0.5-1.4 Lower insulin Peripheral edema, CHF, liver disease
a glucose utilization pioglitazone requirements CHF, weight gain,
fractures, macular
edema. Rosiglitazone
may increase risk
of CV disease
Bile Acid Bind bile acids; Colesevelam 0.5 Constipation,
sequestrants c mechanism of dyspepsia, abdominal
glucose-lowering
pain, nausea,
not known
a triglycerides,
interfere with
absorption of other
drugs, intestinal
obstruction