Other DPP4 inhibitors: Saxagliptin (Onglyza) Linagliptin (Tradjenta) Combinations with metformin are simvastatin are available
SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS Prototype: Canagliflozin (Invokana) Expected HbA1C reduction 0.7% to 1% Mechanism of Action Increase glucose excretion in the urine by inhibiting sodium-glucose co-transporter 2 (SGLT2) in the kidney Reabsorption of filtered glucose is reduced Uses Type 2 diabetes, lowers blood pressure, risk of hypoglycemia is low May be able to reduce the amount of insulin used (insulin sparing) Adverse Effects Urinary tract infections, increased urination Genital yeast infections, weight loss May cause dehydration and hypotension, use caution in older individuals Hyperkalemia Slightly increases LDL 4.5-8% Hypersensitivity reaction, rare occurrences of ketoacidosis No long term studies on macrovascular outcomes and cost is $$$ ($9/day) Major Drug Interactions Rifampin is and inducer and can decrease the levels of canagliflozin Increases digoxin levels Can be combined with metformin and sulfonylureas Administration, Assessment and Evaluation Take with the first meal of the day Assess for genital fungal infection and urinary tract infections Monitor blood pressure for hypotension Should not be initiated in patients with an eGFR less than 45 mL/min/1.73 m 2 Pregnancy Category C Pediatrics Safety and effectiveness in pediatric patients under 18 years of age have not been established Other SGLT2 Inhibitors Dapagliflozin (Farxiga-far-SEE-guh) Empagliflozin (Jardiance)
SULFONYLUREAS (SU) Prototype: Glipizide (Glucotrol, Glucotrol ER) Expected HbA1C reduction 1% to 1.5% Mechanism of Action Stimulates insulin release from the pancreas Uses Type 2 diabetes Adverse Effects Hypoglycemia Possible increased risk of sudden cardiac death Weight gain Disulfiram-like reaction when taken with ETOH Should not be used in patients with G6PD deficiency Major Drug Interactions Hypoglycemic action of sulfonylureas may be potentiated by nonsteroidal anti-inflammatory agents, some azoles, cimetidine, and other drugs that are highly protein bound, salicylates, sulfonamides, chloramphenicol, probenecid, warfarin, monoamine oxidase inhibitors, Beta blockers can mask the symptoms of hypoglycemia Administration Assessment and Evaluation Take with first meal Assess for hypoglycemia Pregnancy Category C Pediatrics Safety and effectiveness in children has not been studied Other Sulfonylureas Glyburide (DiaBeta, Micronase) Glimepiride (Amaryl) Older first generation SU are rarely used (chlorpropamide, tolazamide, and tolbutamide)
MEGLITINIDES Prototype: Repaglinide (Prandin) Expected HbA1C 0.5% to 1% Mechanism of Action Stimulates pancreatic insulin release (must have beta cell function for drug to work) Amount of insulin released is related to blood glucose level-hypoglycemia may be less than SU Uses Type 2 diabetes Adverse Effects Hypoglycemia (worse in patients with renal or liver impairment) Slight increase in serum uric acid Dizziness, nausea, and diarrhea Major Drug Interactions
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- Spring '14
- adverse effects, Major drug interactions