Acarbose effect decreased with concomitant administration of diuretics steroids

Acarbose effect decreased with concomitant

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Acarbose effect decreased with concomitant administration of diuretics, steroids, thyroid products, estrogens, phenytoin, calcium channel blockers Digestive enzymes decreases effect of miglitol and acarbose F. Dosing Dosed TID and taken with the first bite of each large meal Due to side effects both drugs must be started low and titrated to max dose Maximum response occurs by 6 months G. Monitoring When used in combination with a hypoglycemic agent, patients must be taught the importance of treating hypoglycemia with dextrose since these agents will block the absorption of more complex sugars like sucrose Liver function tests for acarbose H. Place in therapy Monotherapy or combination therapy in the treatment of Type 2 DM o ↓ A1C 0.5-1% Advantages: weight neutral, targets postprandial hyperglycemia (good for patients with erratic eating habits), no hypoglycemia, can be used in patients with sulfa allergy, Disadvantages: GI side effects, dosed with meals Combination Products Examples Glyburide and Metformin (Glucovance ® ) Glipizide and Metformin (Metaglip ) Pioglitazone and metformin (Actoplusmet ®) Sitagliptan and metformin (Janumet ® ) Place in Therapy May help ↑ compliance in patients who take the individual medications in dosages that are available in the combination products May be more expensive Incretin Mimetics Exenatide (Byetta ® and Bydureon ® ), Liraglutide (Victoza ® ), dulaglutide (Trulicity ® ), semaglutide (Ozempic ® and Rybelsus ® ) A. Mechanism of Action 17
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 Incretin hormones (GLP-1, GIP) are produced by the small intestine in response to food that act to stimulate insulin secretion  Exenatide is a GLP-1 analog that stimulates the production of insulin in response to high blood glucose levels, inhibits the release of glucagons after meals, increases satiety (which decreases food intake), and slows the rate of gastric emptying  Does not impair the body’s reaction to hypoglycemia  May aid in preservation and formation of pancreatic beta cells B. Adverse Effects  Nausea (44%), vomiting, diarrhea, dyspepsia  Dizziness, headache Hypoglycemia when used with sulfonylurea C. Precautions / Contraindications  Not a substitute for insulin in Type 1 patients  Can cause hypoglycemia when used with sulfonylureas – empirically reduce dose of oral med when starting exenatide  Do not use in patients with severe renal impairment (CrCl <30mL/min) or end- stage renal disease  Do not use in patients with severe GI disease or gastroparesis  Post marketing reports of pancreatitis, so use caution if history of pancreatitis D. Drug-Drug Interactions  Alters rate and extent of absorption of oral medications  Meds requiring peak concentrations (oral contraceptives, antibiotics) – take 1 hour before or at least 2 hours after exenatide E. Dosing  Byetta Initial – 5 mcg SQ BID within 60 minutes of the morning & evening meal, after 1 month increase to 10mcg SQ BID if desired o Decrease sulfonylurea dose when initiating exenatide Bydureon – 2mg SQ once weekly Victoza initial – 0.6mg SQ daily for 1 week, increase to 1.2mg SQ daily for 1 week
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