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Clinical Chart: A Review of Sulfonylureas, Biguanides, and DPP-4 Inhibitors

Drug Class Drugs Dose Common Adverse Effects Major Drug Interactions Counseling

Biguanides

Metformin

(Fortamet, Glucophage, Glucophage XR, Riomet, Glumetza)

 

500-2500 mg PO QDay

 

-Cobalamin deficiency

Diarrhea

-Flatulence

-Indigestion

-Malabsorption syndrome

-Nausea

-Vomiting

-Asthenia

-Headache

-Lactic acidosis (rare)

 

-Contraindicated with any drug that can cause or increase the risk of lactic acidosis

– CIMETIDINE

-FLUOROQUINOLONES

– ZONISAMIDE

– DOFETILIDE

– TOPIRAMATE

– DICHLORPHENAMIDE

– ACETAZOLAMIDE

 

-diarrhea, dyspepsia, flatulence, nausea, vomiting, hyper- or hypoglycemia, or asthenia

lactic acidosis

– take with meals and XR tablets with the evening meal

-adequate hydration

– avoid alcohol

Sulfonylureas 

Glipizide (Glucotrol, Glucotrol XL)

Glimepiride

(Amaryl)

Glyburide (Diabeta, Micronase)

Chlorpropamide

(Diabinese)

 

IR: 5-40 mg PO QDay

XR: 5-20 mg QDay or BID

 

 

 

 

 

 

1-8 mg PO QDay

 

 

 

 

 

 

 

 

Initial: 2.5-5 mg PO QDay

Maintenance: 1.25-20 mg PO QDay

Micronized

Initial: 1.5-3 mg PO QDay

Maintenance:

0.75-12 mg PO QDay or BID

 

Initial: 250 mg PO QDay maintenance: 100-500 mg PO QDay MAX 750 mg/day

-Hypoglycemia (less than 3% )

Constipation, Diarrhea, Flatulence, Nausea

Asthenia,

-Dizziness, Feeling nervous, Headache, Tremor

-SJS

Hypoglycemia (adults, 4% to 19.7%)

– Nausea

– Asthenia, Dizziness, Headache

-SJS

-Epigastric fullness, Heartburn, Nausea

– Hypoglycemia

 

 

 

 

 

 

 

 

 

 

 

-Hypoglycemia

Diarrhea, Hunger, Loss of appetite, Nausea, Vomiting

 

FLUOROQUINOLONES

DISOPYRAMIDE

ACARBOSE

– VORICONAZOLE

 

 

 

 

 

 

 

-may cause dizziness

-may cause skin rash, diarrhea, nausea and HA

-monitor hypo- or hyperglycemia

-take tablet 30 mins before meal

-avoid alcohol

 

– glyburide may cause cutaneous hypersensitivity, blurred vision, heartburn, or nausea

 

DPP-4 Inhibitors 

Sitagliptin

(Januvia)

 

 

 

 

 

 

 

 

 

 

 

 

 

Saxagliptin

(Onglyza)

 

 

 

 

 

 

 

 

Linagliptin

(Tradjenta)

 

 

 

Alogliptin

(Nesina)

 

 

 

100 mg PO QDay

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.5 or 5 mg PO QDay with or without food

 

 

 

 

 

 

5 mg PO QDay

 

 

 

25 mg PO QDay with or without food

-Hypoglycemia (0.6% – 12.2% )

-Headache

Nasopharyngitis ,Upper respiratory infection

– pancreatitis

 

 

 

 

 

 

 

 

Peripheral edema (1.2% to 8.1% )

Hypoglycemia (4-18.5%), Headache

Urinary tract infectious disease

Nasopharyngitis , URTI

 

 

Minimal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Minimal

 

 

 

 

 

 

 

 

 

RIFAMPIN

PHENYTOIN

PHENOBARBITAL

RIFABUTIN

CARBAMAZEPINE

 

None

 

-may cause HA, nasopharyngitis, or URTI

– monitor for s/s of hypoglycemia

-stress may require dosage adjustments

– report s/s of pancreatitis

(i.e, nausea, vomiting, anorexia, and persistent severe abdominal pain)

-if a dose of saxagliptin and linagliptin are missed, skip the missed dose and take the next dose.

– Pancreatic cancer

-Linagliptin may cause arthralgia and back pain

Last modified January 2014 by Christian Muenyi

Christian Muenyi, Pharm.D., M.S. (12 Posts)

Christian Muenyi is a research scientist. After obtaining his Masters of Science in Organic Chemistry, he developed novel extraction techniques that have yielded new discoveries in anti-oxidation and anti-microbial science. He obtained his Pharm.D. from the University of Tennessee Health Science Center.


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