HYPOGLYCAEMIC AGENTS Oct ober 2010

Biguanide Name of Drug Metformin (Glucophage) Now available in tablet and powder form Dose 500 mg 850 mg 1000 mg Max Dose 1g TDS Typical Dose is 1g BD Time of Administration Once, twice or three times daily with food Side Effects GI upset B12 deficiency Precaution Renal impairment Cirrhotic liver disease Acute CCF Metabolic acidosis Lactic acidosis Contrast studies* Renal impairment Liver impairment

Sulphonylureas

Gliclazide MR (Diamicron MR, Diaglyc) Gliclazide (Diaclide, Diabrezide) Glimepiride (Amaryl)

30 mg 80 mg 1 2 3 4 5 mg mg mg mg mg

120 mg daily 160 mg BD 6 mg daily

Once daily - with breakfast Once / twice daily, with food - breakfast and evening meal Once daily - with breakfast

Hypoglycaemia GI upset

Glipizide (Glibenese)

Thiazolidinedione (TZD)

Glibenclamide (Daonil) Avoid in patients > 65 years Pioglitazone (Actos)

2.5 mg 5 mg 15 mg 30 mg 45 mg

20 mg daily (Doses >15 mg should be taken in divided doses) 15 mg daily 45 mg daily

Once / twice daily, with food - breakfast and evening meal Once / twice daily with food - breakfast and evening meal Once daily

Fluid retention Weight gain Anaemia

GLP-1 Analogue

Exenatide (Byetta) Liraglutide (Victoza)

DPP-4 Inhibitor

Sitagliptin (Januvia) - Caution with Digoxin Saxagliptin (Ongylza) Vildagliptin (Galvus) with Metformin Vildagliptin (Galvus) with Sulphonylurea Repaglinide (Novonorm)

Prandial glucose regulator

Nateglinide (Starlix)

Alpha-Glucosidase Inhibitor Combination tablets

Acarbose (Glucobay) Sitagliptin & Metformin (Janumet) Vildagliptin & Metformin (Eucreas) Pioglitazone & Metformin (Competact)

5 mcg 10 mcg 0.6 mgs Increase after 1/52 to 1.2 mg 100 mg 5 mg 50 mg 50 mg 0.5 mg 1 mg 2 mg 60 mg 120 mg 180 mg 50 mg 100 mg 50 mg / 850 mg 50 mg / 1000 mg 50 mg / 850 mg 50 mg / 1000 mg 15 mg / 850 mg

10 mcg BD 1.8 mg

Twice daily SC injection prior to breakfast & evening meal Once daily SC injection

Nausea Dizziness Pancreatitis

Hepatic impairment Renal impairment Macular oedema Osteoporosis Cardiovascular disorders Liver failure Renal impairment, Severe GI disease Cachexia Renal impairment Liver impairment

100 mg daily 5 mg daily 50 mgs BD 50 mg daily 16 mg daily

Once daily Twice daily Once daily - with breakfast Before each meal

Nausea Dizziness Headache Hypoglycaemia GI upset

Renal impairment Liver impairment

180 mg TDS

200 mg TDS 50 mg / 1000 mg BD 50 mg / 1000 mg BD 15 mg / 850 mg BD

1 - 3 times daily with food 1 tablet twice daily with breakfast and evening meal

GI upset See individual agents above

Little effect on reducing blood glucose levels See individual agents above

* Contrast studies Metformin should be stopped on day of contrast study if normal kidney function (48 hours before if abnormal kidney function ie Creatinine > 135 OR Egfr < 60ml/min) and only restarted 48 hours after study, if repeat U&E post contrast remains normal or unchanged.