diabetes medication chart

download diabetes medication chart

of 21

  • date post

    29-Oct-2014
  • Category

    Documents

  • view

    142
  • download

    1

Embed Size (px)

description

diabetes medication chart

Transcript of diabetes medication chart

DIABETES MEDICATION COMPARISON CHART GENERIC/ NAMES BRAND DOSAGE KINETIC FORMS S DRUG INTERACTION S SIDE EFFECTS COMMENTS DOSAGE RANGE

SULFONYLUREAS - stimulate insulin release from cell; increase peripheral glucose utilization ( sensitivity of insulin receptor) reduce hepatic gluconeogenesis Glimepiride (Amaryl) Glipizide (Glucotrol) Glipizide XL (Glucotrol XL) 2.5,5,10 mg 1,2,4mg D=24h P=2-3h -Blockers NSAIDs Niacin Hypoglycemia: most seen w/ chlorpropamide & elderly)

Reduce dose if

hypoglycemia or renal/hepatic dysfxn

I: 1-2mg/d

Mt: 1-4mg/d Mx: 8mg/d I: 5mg/d Mt: 5-20mg/d Mx: 40mg/d I: 5mg/d

5,10mg

P=1.5-2h Rifampin ( D=12-24h effect)

glyburide (caution in Wt gain, (caution in obese) ; 1 choice option for lean patientst

Dose titration q1-2 weeks

MAO

Require consistent food intake to avoid hypoglycemia

P=612h

inhibitors

Probenecid Salicylates

Mt: 5-10mg/d Mx: 20mg/d

D=24hr

Glyburide

(Diabeta) Glyburide micronized (Glynase Prestab)

1.25, 2.5, 5mg

P=2-4h

D=12-24h Diuretics

Ethanol Azole

HA, Dizziness

Sulfa skin reaction (rash/photosensitivit y

Effects on Cholesterol and weight:

I: 1.25-2.5mg qd Mt: 5mg bid Mx: 10mg bid I: 1.5-3.0 mg/d Mt: 6-10mg/d Mx: 12mg/d

1.5, 3, 5, P= 26mg 3H

antifungals Chloramphe

No effect on Cholesterol May increase weight

D=12-24h nicol

BIGUANIDES - increase insulin sensitivity and cellular glucose uptake & utilization; reduce hepatic glucose production Metformin (MF) 500, 850, P=3h

D=8-12h cimetidine Effect

EtOH and

in

~1%) GI side effects 1-3%;

hypoglycemia by itself

Does not cause

I: 250-500mg/s Mx: 2500mg/s I: 2.5/250mg

Mt: 500-1000mg/d

Glucophage 1000mg Metaglip

MF + Glipizide 2.5/250mg P=1-3h Decreased 2.5/500mg D=See 5/500mg Metformin nicotinic

To avoid GI S/E, Start low & titrate up Anemia

60mL/min;

Caution if ClCr Elderly dose may be

effects:

Q2-4wk

required

Mt: 5-10/1000mg/d Mx: 20/2000mg

acid, & Glipizide

MF +

Rosiglitazone ,2,4mg Avandamet 2mg, 4mg MF Ext. 500,

500mg/1 Similar tocorticosteroid MF & e s, estrogens, isoniazid, thyroid 1000mg/ Rosiglitazon phenytoin, given

malabsorption)

6-8: 100(due to B12

dysfx/CHF or hepatic disease (lactic Avoid if SrCr acidosis 1:10,000)

Avoid if severe renal

I: 4/1000mg/d

Mt: 4-8/1000mg Mx: 8/2000mg

separately products P= 4-8 h Increased D= Up to effects: 24hr digoxin,

>1.5,men; >1.4, women

Release(NF) Glucophage XR

750mg

Metformin is DOC for

I: 500mg qd

furosemide,

obese!

Mt: 500-1000mg qd Mx: 2000mg qd

MF+

Glyburide

1.25/250 P= 2.75h ranitidine, mg, g,

D=10-12h triamterene

Effects on Cholesterol and weight:

I: 1.25/250mg w/meal qd Mx: 10/2000mg

Glucovance 2.5/500m 5/500mg

LDL, HDL, and TG.

Metformin improves In combination with Increase or decrease

other agents may

weight. carbohydrates

GLUCOSIDASE INHIBITORS - inhibit -glucosidase in brush border of small intestine; prevent hydrolysis & delay digestion of

Acarbose

(Precose)

50mg

100mg

Mealtime dosing ; may take l

Thiazides diuretics

and other Corticostero ids

GI

intolerance: flatulence >41% >28%

Administer with first bite of each meal Does not cause

I:

M: 50mg tid

25mg tid

hypoglycemia by itself

Max: 100mg tid

severa weeks to work

Estrogens Phenytoin Thyroid CCB's products

diarrhea

Liver enzymes=3% w/Acarbose; monitor

>21%

abdominal pain (Caution: may accumulate in chronic renal failure) Maximal effect takes weeks; ROLE: useful in pts with PPBG;

dose q4-8 weeks.

Minim ally ed absorb

SU, MF

Effects on Cholesterol and Weight:

Miglitol

(Glyset)

25,mg 50mg, 100mg

Well absorbed

May decrease TG and Weight I: Neutral on LDL and HDL

M: 100mg tid

25mg tid

THIAZOLIDINEDIONES (TZDs) - insulin sensitizers: hepatic output of glucose & peripheral insulin uptake; ~ 4 weeks before effec (adjust dose at ~3 months) Pioglitazone (Actos) 15, 30, 45mg Onset~ several weeks

Cholestyra mine

Edema (4.8%)

Does not cause hypoglycemia by itself

I: 15-30mg qd Mx: 45mg qd

Rosiglitazone 2, 4, (Avandia) 8mg

Max effect in absorption~ 8-16 weeks70%

HA, fatigue, diarrhea Wt gain URI

Resumption of ovulation in women (increased risk of pregnancy)

anovulatory premenopausal

I: 4mg qd

Mx: 8mg qd

Hepatic

CYP2C8 inhibitors and inducers

Mild anemia

Monitor AST/ALT yr

Use with caution in patients with elevated AST/ALT Pioglitazone may have more + lipid effect Avoid in patients with NYHA class 3 or 4 heart failure Role: Alone + MF; SU; Insulin (but HF risk)

q2mo in 1

st

Effects on Cholesterol and Weight:

Both TZDs improve HDL and

MEGLITINIDES- short-acting insulin secretagogue; bind to cell to stimulate insulin release at different site than SUs; (adjust dose at ~7 days) Nateglinide (Starlix) 60, O= CYP3A4 effect Hypoglycemi a

120mg