Type 2 meds chart 0805.indd

Your Complete Oral Type 2 Meds Reference Guide from Diabetes Health magazine
Drug Class and How It Works
Brand and Generic Name
Manufacturer
Usual Starting Dose
Sulfonylureas: The fi rst three types of
Amaryl (glimepiride)
1 to 2 mg once a day, taken with the fi rst meal oral diabetes medications listed here—the sulfonylureas, the meglitinides and the phenylalanine derivatives—act Diabinese (chlorpropamide)
by causing the pancreas to secrete more insulin. Because of this action of increasing insulin production, which in turn has the potential to cause DiaBeta (glyburide)
2.5 or 5 mg a day, taken at the fi rst meal of the day. For those more sensitive to hypoglycemic agents, called hypoglycemic agents or insulin secretagogues.
Micronase (glyburide)
2.5 or 5 mg a day, taken at the fi rst meal of the day.
For those more sensitive to hypoglycemic agents, Glynase (glyburide)
1.5 mg a day, taken at the fi rst meal of the day.
For those more sensitive to hypoglycemic agents, Glucotrol (glipizide)
5 mg a day, taken before the fi rst meal of the day. For the elderly and those with liver disease, the Glucotrol XL extended-
2.5 or 5 mg a day, taken at the fi rst meal of the day Prandin (repaglinide)
Available in 0.5 mg, 1 mg and 2 mg tablets.
U Meglitinides: Hypoglycemic agents or
If you’ve never taken an oral hypoglycemic agent insulin secretagogues; see the entry for and your A1C is less than 8%, the starting dose is 0.5 mg before each meal. If you’ve previously been treated with an oral hypoglycemic agent and your A1C is greater than 8%, the starting dose is 1 Phenylalanine Derivatives:
Starlix (nateglinide)
The recommended starting dose is 120 mg three times daily before meals. In patients who are near their A1C Glucophage* (metformin)
Generally, signifi cant eff ects are not seen with Biguanides: These drugs work
doses below 1,500 mg a day, but starting with lower doses and gradually increasing is a recommended Metformin* (generic) Teva
to minimize gastrointestinal reactions.
The suggested starting dose is one 500 mg tablet taken with both the morning and evening meals, or one 850 mg tablet taken once a day with the 500 mg (5 ml) twice a day with meals or 850 mg Glucophage XR*
The usual starting dose is 500 mg or 750 mg, taken *Lactic acidosis—a rare but very serious (often fatal) complication—has been associated with the use of Glucophage (metformin). However, the reported incidence of lactic acidosis in people taking this medication is very low. Lactic acidosis happens more often in people with kidney problems. Signs of lactic acidosis are feeling very weak, tired or uncomfortable; experiencing unusual muscle pain, trouble breathing or unusual stomach discomfort; feeling cold, dizzy or lightheaded; suddenly developing a slow or irregular heartbeat. Contact your physician if your medical condition suddenly changes. Copyright Kings Publishing, Inc. All rights reserved / August 2005 / Diabetes Health Maximum Daily Dose
Side Eff ects and Special Considerations Average Cost**
All sulfonylureas can cause hypoglycemia and weight gain. May cause sun sensitivity. Sulfonylureas are not approved for use during pregnancy or lactation.
Diabinese is very long-acting (72 hours). Caution advised for use by the elderly and those with kidney disease. Diabinese may cause a fl ushing (reddened face) reaction with alcohol use. May cause low blood sodium problems.
divided and given twice a day before meals. 20 mg. Doses of 15 mg or more should be divided and given twice a day before meals. 12 mg. Doses of more than 6 mg a day should be divided and given twice a day before meals.
Take 30 minutes before a meal for greater eff ectiveness. May be taken with a meal. Do not divide, crush or chew these tablets. Prandin may be used by people with kidney disease. Prandin and Starlix work faster than sulfonylureas and have a shorter duration of action.
They may cause hypoglycemia, but this is less likely than with sulfonylureas. Prandin and Starlix also cause less weight gain than sulfonylureas. Do not take a dose if you are skipping a meal. Do not take Prandin or Starlix in combination with sulfonylureas. Prandin or Starlix maybe used in combination with metformin. Not approved for use 2,500 to 2,550 mg per day. Maximum eff ective Metformin rarely causes hypoglycemia when used alone. Metformin does not cause weight gain and does improve triglycerides. Gastrointestinal disturbances such as diarrhea, nausea, vomiting, abdominal bloating and fl atulence occur in up to one-third of users. Minimize side eff ects by taking with food. Do not use if kidney disease or active liver disease is present. Use caution with people 80 years old and older, or if heart failure is present. Do not use during medical tests that involve IV contrast drugs. Do not use for people who are going to have surgery. Do not use for people with signifi cant alcohol intake. Not approved for use during pregnancy or lactation.
2550 mg (25.5 ml) in divided doses with meals Dosage increases should be made in increments See the entry for Glucophage/metformin. In some clinical trials, Glucophage XR lost the of 500 mg or 750 mg weekly, up to a maximum triglyceride-lowering benefi t. Do not divide, crush or chew these tablets. of 2,000 mg or 2,250 mg taken once daily with the evening meal.
Chart prepared by Brian Gates, PharmD; Cindy Onufer, RN, MA, BC-ADM, CDE;
Stephen Setter, PharmD, CGP, DVM, CDE
Copyright Kings Publishing, Inc. All rights reserved / August 2005 / Diabetes Health Your Complete Oral Type 2 Meds Reference Guide from Diabetes Health magazine
Drug Class and How It Works
Brand and Generic Name
Manufacturer
Usual Starting Dose
Alpha-Glucosidase Inhibitors: These drugs
Precose (acarbose)
25 mg (half a 50-mg tablet), taken orally three work in the intestines to slow the digestion of times a day at the start of each main meal some carbohydrates so that after-meal blood glucose Glyset (miglitol)
Avandia (rosiglitazone
Thiazolidinediones (glitazones, “TZDs”):
These drugs help the muscle cells respond to insulin and use glucose more eff ectively.
Actos (pioglitazone)
15 mg once daily, Taken with or without food **Prices provided by Walgreens pharmacy in South San Francisco, California.
Copyright Kings Publishing, Inc. All rights reserved / August 2005 / Diabetes Health Maximum Daily Dose
Side Eff ects and Special Considerations Average Cost**
Abdominal pain, fl atulence and diarrhea tend to return to pretreatment levels as therapy continues. Take with the fi rst bite of food for maximum eff ectiveness. Not approved for use during pregnancy or lactation. When these medications are used in combination with insulin, meglitinides or sulfonylureas, hypoglycemia may occur and must be treated with pure glucose (tablets or gel) or milk since Precose and Glyset delay the absorption of other carbohydrates.
Blood tests to check for serious liver problems should be conducted before therapy, and periodically thereafter as determined by a physician. TZDs rarely cause hypoglycemia when used alone. Not approved for use during pregnancy or lactation. TZDs generally take four weeks or more to become eff ective. Avandia is approved for use with insulin in doses of 4 mg per day or less, but not at the 8 mg per day dose. Must be used carefully in people with congestive heart failure. Possibility of fl uid retention; contact your physician if this occurs.
Actos must be used carefully in people with congestive heart failure. Actos is approved for use with insulin in doses of 30 mg per day or less, but not at the 45 mg per day dose. Possibility of fl uid retention when used alone or with insulin; contact your physician if this occurs. See also Copyright Kings Publishing, Inc. All rights reserved / August 2005 / Diabetes Health

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