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Home , Biguanide, Miglitol

Oral for the Management of Mechanism of Duration of Drug Name Classification Daily Dosing Side Effects Action Action 1.25, 2.5, 5mg tabs, Glyburide , nausea, Dosing: 2.5-20 mg (Micronase, 12-24 Hours heartburn, weight gain, (Glynase: 3-12mg) Diabeta, Glynase) diarrhea with meal 5, 10 mg tabs, Dosing: 2.5-40 mg Hypoglycemia, nausea, 10-18 Hours (Glucotrol) Stimulating 1/2 hour before weight gain, diarrhea secretion from the meals (decrease A1c pancreas Hypoglycemia, 1.0 - 2.0%) 2.5, 5, 10 mg tabs, Glipizide XL dizziness, headache, Dosing: 2.5-20 mg 24 Hours (Glucotrol XL) weight gain, diarrhea, with or without meal flatulence 1, 2, 4 mg tabs, Hypoglycemia, Dosing: 1-8 mg with 16-24 Hours (Amaryl) dizziness, nausea meal Stimulates insulin 0.5, 1, 2 mg tabs Prandin secretion to reduce Dosing: Daily max 16 Hypoglycemia, 2-6 Hours () (decrease A1c peaks in glucose mg, Take before each headache, weight gain 1.0 - 2.0%) after meal meal Stimulates rapid 60, 120 mg tabs, Starlix insulin secretion to Dosing: 60-180 mg Hypoglycemia, D-Phenylalanine About 1.5 Hours () reduce peaks in with meal, Daily max diarrhea, dizziness glucose after meal 540 mg

6-12 Hours, Diarrhea, nausea, 500, 850, 1000 mg Effective within a vomiting, abdominal tabs, Dosing 500- day or two, with (Glucophage) bloating, flatulence, Decreases liver 2250 mg with meals maximum effect anorexia, lactic acidosis (decrease A1c glucose production within 2 weeks (rare). Kidney test 1.0 - 2.0%) initially and at least 500-2000 mg, Metformin annually Dosing: Once daily 24 Hours (Glucophate XR) with evening meal Alpha-Glucosidase GI sx (may decrease Inhibitor 50, 100 mg tabs, Delays the digestion with time): diarrhea, (Precose), Dosing: 25-300 mg Less than 4 Hours of abdominal pain, (Glyset) (decrease A1c with first bite of food flatulence 1.0 - 2.0%) Works gradually Edema, weight gain, when initiated, dilutional anemia. Liver (decrease A1c minimal effect first function tests initially Increases insulin 15, 30 mg tabs, Actos ( 0.5 - 1.0%) week with and periodically sensitivity in muscle Dosing: 15-45mg HCL) increasing effect up thereafter and fat with or without food to 12-16 weeks; >3- 4 weeks duration

3/5/2018 Diabetes Oral Drug List 1 of 5 Oral Medication for the Management of Diabetes Mechanism of Duration of Drug Name Classification Daily Dosing Side Effects Action Action

**Avandia Increases insulin 2, 4, 8 mg tabs, ( sensitivity in muscle Dosing: 4-8 mg with Maleate) and fat or without food

URI, stuffy nose or sore Sulfonylurea Stimulating insulin 100 mg once daily as throat, headache. Not secretion from the monotherapy or as with type 1 or pregnant (decrease A1c pancreas combination with women. A dosage Januvia 1.0 - 2.0%) 24 Hours other oral agents; reduction is with or without food, recommended for renal Eliminated via kidney insufficiency (see PI for recommendation)

5 mg once daily. With or without food URI, stuffy nose or sore Tradjenta as monotherapy or 24 Hours throat, muscle pain and () with Metformin, Slows the headache Amaryl or Actos. inactivation of Eliminated via feces incretin hormones in the intestines. DPP-4 Inhibitor Increases insulin URI, UTI, headache, release and fluid retention (if with (decrease A1c 2.5 or 5 mg once decreases glucagon TZD's), hypoglycemia (if 0.6 - 0.8%) daily, with or without levels in the with SU), food; can be used Onglyza circulation, glucose hypersensitivity events; alone or with other 24 Hours () dependent, slows decreased dose with oral agents. gastric emptying renal impariment. Eliminated via feces, Decrease dose for pt kidneys using CYP3 A4/5 (ketoconazole)

25 mg once daily URI, UTI, headache, with or without food; fluid retention (if with can be used alone or TZD's), hypoglycemia (if with other oral with SU), agents. Eliminated hypersensitivity events; Nesina () via kidney 24+ Hours decreased dose with renal impariment; Heptatic effects possible so check LFT's before intiating

3/5/2018 Diabetes Oral Drug List 2 of 5 Oral Medication for the Management of Diabetes Mechanism of Duration of Drug Name Classification Daily Dosing Side Effects Action Action

100 mg daily before the first meal of the day (dose reduction Vaginal yeast recommended if GFR infections, UTI's, Invokana SGLT2 increases to 300 mg increased urination. () Sulfonylurea (Sodium glucose co- Stimulating insulin if needed for Less common is thirst, secretion from the (decreasetransporter A1c improved BG control. Peak 1-2 hours after nausea and pancreas 1.0inhibitor) - 2.0%) All SGLT2 decrease If GFR <45, stop given, half-life 10.6 - constipation. Warnings: renal glucose Invokana 13.1 hours with 300 hypotension (decrease A1c reabsorption and mg dose impariment of renal 0.7 - 1.5% increases urine respectively, function,elevated glocose excretion 5, 10 mg once daily reaches steady potassium, with or without food Farxiga SGLT2 can be used and lower weight state in body after 4- hypoglycemia if with If GFR <60, stop (Dapagliflozin) w/ Metformin, 1-3 lbs 5 days of taking insulin or SU's. insulin, DPP-4, Farxiga Avocid if drug hypersensitivity, GLP1, SU, glinides, bladder cancer increased LDL, genital TZD, α-glucosides mycotic infections. 10, 25 mg once daily Drug interactions: Jardiance with or without food Rifampin Digoxin () Do not start Jardiance if GFR <45

Hypoglycemia, 1.25/250 mg, Stimulates insulin diarrhea, nausea, Glucovance 2.5/500 mg, 5.0/500 Sulfonylurea and release and dizziness, lactic acidosis (Glyburide and mg 12 Hours Biguanide decreases liver (rare). Kidney test Metformin) Dosing: max 20/2000 glucose production initially and at least mg. Take with meals annaully

Edema, weight gain, 1/500 mg, dilutional anemia, 2/500 mg, diarrhea, nausea, 4/500 mg, Insulin sensitizer and vomiting, abdominal, Thiazolidinedione 2/1000 mg, **Avandamet decreases liver >3-4 Weeks bloating, anorexia, and Biguanide 4/1000 mg glucose production lactic acidosis. Kidney Dosing: max 8/2000 and liver function tests mg daily. Take with initially and periodically meals. thereafter

2.5/250 mg, Diarrhea, abdominal Decreases liver 2.5/500 mg, pain, dizziness, Biguanide and glucose production 5/5200 mg, hypoglycemia, lactic Metaglip 6-18 Hours Sulfonylurea and stimulates Dosing: Max per day: acidosis (rare). Kidney insuline production 20/2000 mg. Take test intially and at least with meals annually

3/5/2018 Diabetes Oral Drug List 3 of 5 Oral Medication for the Management of Diabetes Mechanism of Duration of Drug Name Classification Daily Dosing Side Effects Action Action

Edema, anemia, weight 50/500 mg, gain, hypoglycemiak **Avandaryl Insulin sensitizer and 50/1000 mg; Thiazolidinedione dizziness, nausea. Liver (Avandia and stimulates insulin Max dose: 100/2000 >3-4 Weeks and Sulfonylurea function test initially Amaryl) secretion mg. and periodically Sulfonylurea Twice daily with food Stimulating insulin thereafter secretion from the (decrease A1c pancreas 1.0 - 2.0%) Januvia side effects plus diarrhea, nausea, 50/500 mg, vomiting, abdominal 50/1000 mg; discomfort, indigestion, Janumet Max dose: 100/2000 24 Hours flatulence, lactic mg daily, acidosis (rare). Kidney Januvia actions plus Twice daily with food decreasing liver test intially and at least glucose production annually

DPP-4 Inhibitor and 100/1000 mg, Janumet XR 50/500 mg, Biguanide Januvia and Metformin ( and 50/1000 mg, 24 Hours ER side effects Metformin ER) Max dose: 100/2000 mg daily 5/500 mg, 2.5/1000 mg, Kombiglyze Onglyza actions 5/1000 mg, Onglyza side effects (Saxagliptin and pluse decreasing liver Max dose: 5/2000 24 Hours plus Metformin side Metformin ER) glucose production mg daily, with effects evening meal 2.5/1000 mg,

10/25 mg, Renal impariment. Glyxambi 25/5 mg, Do not initiate if eGFR SGLT2 and DPP-4 Same as individual (Jardiance and see SGLT2 and DPP-4 once daily in the <45 mL/min/1.73m2 d/c Inhibitor drugs Tradjenta) morning with or if eGFR drops to without food <45mL/min/1.73m2

5/1000 mg not to exceed XigduOXR (Farxiga SGLT2 and see SGLT2 and Same as individual Contraindicated CrCl 2:10/2000 mg, and Metformin) Biguanide Biguanide drugs <60 mL or ESRD once daily in the morning with food

3/5/2018 Diabetes Oral Drug List 4 of 5 Oral Medication for the Management of Diabetes Mechanism of Duration of Drug Name Classification Daily Dosing Side Effects Action Action

5/5020 mg, Do not initiate if eGFR 5/1000 mg, <45 mL/min/1.73m2 d/c 12.5/500 mg, if eGFR drops to Synjardy (Jardiance SGLT2 and see SGLT2 and 12.5/1000 mg (max Same as individual <45mL/min/1.73m2 and Metformin) Biguanide Biguanide dose), drugs Do not initiate or Sulfonylurea Stimulating insulin twice daily with food. continue if Cr > 1.5 secretion from the Increase dose mg/dL M) or ≥1.4 (decrease A1c pancreas gradually mg/dL (F) 1.0 - 2.0%)

2.5/500 mg, 2.5/850 mg, 2.5/1000 mg, Max dose: 2.5/1000 mg twice daily. Jentadueto Tradjenta actions DDP-4 Inhibitor and Should be given Tradjenta and (Tradjenta and plus decreasing liver 24 Hours Biduanide twice daily with Metformin side effects Metformin) glucose production meals, with gradual dose escalation to reduce gastrointestinal side effects of Metformin.

Insulin sensitizer and 30/2 mg, Duetact (Actos and Thiazolidinedione Actos and Amaryl side stimulates insulin 30/4 mg, > 3-4 Weeks Amaryl) and Sulfonylurea effects secretion Once daily 12.5/500 mg, 12.5/1000 mg, twice daily, not to exceed Kazano (Alogliptin DPP-4 Inhibitor and Algoliptin and Algoliptin and 25/2000 mg. 24 Hours and Metformin) Biguanide Metformin actions Metformin side effects Titrate gradually to prevent GI side effects possible with Metformin 12.5/15 mg 12.5/30 mg 12.5/45 mg Oseni (Alogliptin DPP-4 Inhibitor and Alogliptin and Actos 25/15 mn Aloglitpin and Actos > 3-4 Weeks and Actos) Thiazolidinedione actions 25/30 mg side effects 24/45 mg once daily with or without food

3/5/2018 Diabetes Oral Drug List 5 of 5