Oral and Noninsulin Injectable Antidiabetic Medications1, 2

ORAL AND NONINSULIN INJECTABLE ANTIDIABETIC MEDICATIONS1, 2

BRAND NAME GENERIC DOSING RANGE MECHANISM OF ACTION ADVERSE EFFECTS NAME BIGUANIDE Glucophage®, MetFORMIN  500-1000 mg twice  Decreases hepatic glucose production, decreasing  Diarrhea Glucophage® XR daily intestinal absorption of glucose  Gas  Total dose given once  Improves insulin sensitivity  Nausea daily for XR formulations  Abdominal Pain  Use cautiously in patients  Hold for with renal insufficiency dehydration or if undergoing contrast dye procedures SULFONYLUREA Amaryl® Glimeperide  1-8 mg once daily  Stimulates insulin release from pancreatic beta  Hypoglycemia Glucotrol®, GlipiZIDE  5-10 mg twice daily cells  Nausea Glucotrol XL®  Reduces glucose output from liver Diabeta®, GlyBURIDE  Micronized tablets: 1.5-  Insulin sensitivity increased at peripheral targets Micronase® 12 mg twice daily  Conventional tablets: 2.5- 20 mg twice daily THIAZOLIDINEDIONE Actos® Pioglitazone  15-45 mg once daily  Improve target response to insulin  Edema Avandia® Rosiglitazone  5-20 mg once daily  Weight gain  Osteoporosis  Macular edema MEGLITINIDE ANALOG Starlix® Nateglinide  60-120 mg 3 times daily  Stimulate insulin release from pancreatic beta  Hypoglycemia before meals cells Prandin® Repaglinide  0.5-4 mg taken with  Insulin release glucose-dependent meals DIPEPTIDYL PEPTIDASE IV (DPP-IV) INHIBITOR Nesina™ Alogliptin  25 mg once daily  Inhibit dipeptidyl peptidase IV (DPP-IV) enzyme  Pancreatitis Tradjenta™ Linagliptin  5 mg once daily prolonging active incretin levels  Hypoglycemia Onglyza™ Saxagliptin  2.5-5 mg once daily  Incretin increases insulin synthesis from Januvia™ Sitagliptin  25-100 mg once daily pancreatic beta cells and decreases glucagons levels ALAPHA-GLUCOSIDASE INHIBITOR Precose® Acarbose  25-100 mg three times  Delay digestion of ingest carbohydrates resulting  Abdominal pain daily at start of each meal in smaller rise in blood glucose levels following meals  Diarrhea Glyset® Miglitol  25-100 mg three times  Flatulence daily at start of each meal SODIUM-GLUCOSE CONTRANSPORTER 2 (SGLT2) INHIBITOR Invokana® Canagliflozin  100-300 mg once daily  Inhibit sodium-glucose transporter 2 (SGLT2) in  Female genital Farxiga™ Dapagliflozin  5-10 mg once daily proximal renal tubules reducing reabsorption of mycotic infections Jardiance® Empagliflozin  10-25 mg once daily filtered glucose from tubular lumen  Increased urination  Results in increased urinary excretion of glucose  Increased thirst  Dehydration  Possible worsening renal insufficency GLUCAGON-LIKE PEPTIDE (GLP-1) RECEPTOR AGONIST Tanzeum™ Albiglutide  30-50 mg once weekly  Increase glucose-dependent insulin secretion  Hypoglycemia subcutaneously  Decrease inappropriate glucagons secretion  Nausea Trulicity Dulaglutide  0.75-1.5 mg once weekly  Slow gastric emptying  Decreased appetite subcutaneously Byetta®, Bydureon® Exenatide  Immediate release: 5-10 (extended-release for mcg twice daily injectable subcutaneously within 60 suspension) minutes prior to a meal  Extended release: 2 mg once weekly subcutaneously Victoza® Liraglutide  0.6-1.8 mg once daily subcutaneously AMYLINOMIMETIC SymlinPen® Pramlintide  15-120 mcg prior to each  Used only in insulin requiring patients  Hypoglycemia major meal  Reduces postprandial glucose by prolonging gastric  Nausea subcutaneously emptying time and reducing postprandial glucagons secretion  Centrally-mediated effects on appetite suppression

References 1. Lexi-Comp, Inc. (Lexi-Drugs® ). Lexi-Comp, Inc.; October 17, 2014 2. Drug Facts and Comparisons. Facts & Comparisons [database online]. St. Louis, MO: Wolters Kluwer Health, Inc . Accessed October 17, 2014