Diabetes Drugs

MOA - stumlate pancreatic secretion of insulin in a glucose-INDEPENDENT manner

dec. FPG > PPG

HbA1c - 1-2%

AE: Hypoglycemia - wt gain - SIADH - HYPERinsulemia

brand - Dymelor

Brand - Diabinese

Brand - Tolinase

Brand - Orinase

Brand - Amaryl

Max. Dose - 8mg/day

Brand - Glucatrol (XL)

App. Max Dose = 40 mg/day

XL Max Dose = 20 mg/day

• DI: INC. Hypogylcemia = salicylates, SMP_TMZ, miconazole
• DEC. Hypoglycemia = Cholestyramine, rifampin

• Brand - Diabeta & Micronase
• Micronized - Glynase

AMD - 20 mg/day

Glynase - AMD - 12 mg/day

MOA - Stimulate insulin secretion in a glucose-DEPENDENT manner

OMIT dose if miss a meal

AE: Hypoglycemia, Wt. gain, Inc. LFT, safe for pts in renal/hepatic failure

Brand - Starlix

PPG

HbA1c - 0.6-0.8%

Dose: 120mg/day TID

NO dose titration

Brand - Prandin

PPG

HbA1c - 1.5%

• Dose - Max (16mg/day)
• A1c <8% = 0.5mg before meals
• >8% 1-2mg before meals

MED - 2 mg w each meal

Brand - Glucophage (XR) & Fortamet

• MOA - Reduce hepatic glucose production
• Reduce Intestinal absorption of glucose
• Inc. peripheral glucose uptake (Improves insulin sensitivity)

HbA1c = 1-2%

FPG

• AE & CI = Unstable w/ CHF
• -NO wt gain, hyperinsulemia or hypoglycemia
• -Lactic Acidosis = Scr >1.5 (males) >1.4 (females)
• -Malabsorption of B12 and Folate
• -STOP before radiology and do not resume for 48 hrs

MOA -Delay digestion of carbs and absorption of glucose => reduce PPG

Take with first bite of meals

HbA1c - 0.5-0.8%

• - High incidence of GI SE
• - Increase in LFTs (Acarbose)
• - Not metabolized and cleared by kidney (Miglitol)
• - IF hypoglycemia - GLUCOSE TABS

Brand - Precose

• Indication - adjunct to diet or in combo. w sulfonylureas, metformin, or insulin.
• - Inc. LFTs occur at doses > 150mg/day

CI - Pts with Scr > 2.0 mg/dL

Brand - Glyset

Indication - Adjunct to diet or in comno with sulfonylureas

Not metabolized and cleared by kidney

• MOA - Dec. insulin resistence by stimulation PPAR-Gamma
• - Dec. hepatic gluconeogensis
• HbA1c = 0.5-1.4%
• FPG, PPG

• - up to 3 months to see full effect
• - NOT for T1DM
• AE - wt gain, Edema, Dec. Hct and Hb, hepatotoxicity - FRACTURES in women

Brand - Avandia

dose = 4-8 mg

• - Does NOT inhibit any major CYP enzyme
• Gemfibrozil - (Dec. dose)
• - Do NOT give w Insulin or Nitrates
• - BBW - Inc. myocardial events
• - Inc. TG and LDL

Brand - Actose

• dose = 15-15 mg
• - can inc. HDL

• DI- Inducer of CYP3A4
• - ketoconazole inc. [ ]
• - Dec. plasma conc. of BC
• - Gemfibrozil - (dec. dose)

• MOA - Increase insulin --> glucose-DEPENDENT
• - Decrease glucagon

Brand - Januvia

• HbA1c - 0.6-1%
• PPG
• - 100mg QD
• AE: Wt neutral, Steven Johnsons Syndrome (rash)
• Adjust dose in renal failure

• Indication = >18 YO w T2DM
• Brand - Onglyza

• HbA1c - 0.5%
• PPG

• -Metabolized by CYP3A 4/5
• - Dose on renal funcation
• - NO CI'S

• MOA = Incretin Mimetic
• Brand - Byetta

• HbA1c - 0.5-1%
• PPG

• AE - wt loss, hypoglycemia, Pancreatitis, do NOT sub. for insulin, Dec. absorption of oral drugs
• CI - ESRD or CrCl < 30ml/dL

• MOA - GLP-1 Analogue
• Brand - Victoza

• HbA1c - 1%
• dec. FPG & PPG

• NOT 1st line Tx
• WARNING - thyroid c-cell tumors
• - Pancreatitis

• MOA - Synthetic analogue of human Amylin
• Brand - Symlin

• **Tx for BOTH Type 1/2 DM pts
• HbA1c - 0.5-0.7%
• PPG

• - NEVER mix with insulin
• - NO Hypoglycemia (when used alone)
• - Not for pts w poor compliance