Diabetes Education Online - Diabetes Teaching Center at the University of San Francisco

 

Table of Medications

Use this table to look up the different medications that can be used to treat type 2 diabetes. Use the links below to find medications within the table quickly, or click the “Learn More” button to link to expanded information about the drug.

 

Table of oral medications, incretion-based therapy and amylin analog therapy:

Medicine FDA Approval Formulations
(color indicated for Brand products)		 Dosing Comments
(SE= side effects)

SULFONYLUREAS (SFUs): INSULIN RELEASING PILLS (SECRETAGOGUES) - increase insulin secretion from pancreas 2

Tolazamide

  • Tolinase®
  • various generics

1965

100 mg, 250 mg, 500 mg (white, scored) tablets

Initial: 100-250 mg daily

Range: 100-1000 mg

Dosed once or twice (if >500 mg) daily

SE: hypoglycemia, weight gain

Tolbutamide

  • Orinase®
  • various generics

1957

500 mg (white, scored) tablets

Initial: 1000-2000 mg daily

Range: 250-3000 mg

(seldom need >2000 mg/day)

Dosed two or three times daily

SE: hypoglycemia, weight gain

Preferred SFU for elderly

Must be taken 2-3 times daily

Glimepiride

  • Amaryl®

11/95

1 mg (pink), 2 mg (green), 4 mg (blue) tablets

Initial: 1-2 mg daily

Range: 1-8 mg

Dosed once daily

SE: hypoglycemia, weight gain

Need to take only once daily

Glipizide

  • Glucotrol®
  • Glucotrol XL®
  • various generics

5/84

4/94

5 mg, 10 mg (white, scored) tablets

XL: 2.5 mg (blue) 5 mg (white), 10 mg (white) tablets

Initial: 5 mg daily

Range: 2.5-40 mg1 (20 mg for XL)

Dosed once or twice (>15 mg) daily

SE: hypoglycemia, weight gain

Preferred SFU for elderly

XL = extended release/take once a day

Glyburide

  • Micronase®, DiaBeta®
  • various generics

5/84

1.25 mg (Diab-peach, Micronase-white), 2.5 mg (Diab-pink, Micronase-pink), 5 mg (Diab-green, Micronase-blue)

tablets (scored)

Initial: 2.5-5 mg daily

Range: 1.25-20 mg1

Dosed once or twice daily

SE: hypoglycemia, weight gain

Glyburide, micronized

  • Glynase PresTab®
  • various generics

3/92

1.5 mg (white), 3 mg (blue), 4.5 mg, 6 mg (yellow) micronized tablets (scored)

Initial: 1.5-3 mg daily

Range: 0.75-12 mg

Dosed once or twice (>6 mg) daily

SE: hypoglycemia, weight gain

GLINIDES: INSULIN RELEASING PILLS (SECRETAGOGUES) -
increase insulin secretion from pancreas

Repaglinide

  • Prandin®

12/97

0.5 mg (white), 1 mg (yellow), 2 mg (red) tablets

Initial: 1-2 mg daily

(0.5 mg if A1C <8%)

Range: 0.5-16 mg

Max dose per meal is 4 mg

SE: hypoglycemia

Safe for elderly

Duration of action is only 4 hours

Take within 15-30 minutes of meal

Nateglinide

  • Starlix®

12/00

60 mg (pink), 120 mg (yellow) tablets

Initial: 120 mg three times daily

Range: 60-120 mg three times daily

SE: hypoglycemia

Safe for elderly; Duration of action is only 2 hours

Take within 30 minutes of meal

BIGUANIDES: EUGLYCEMIC - decreases glucose release from liver and brings the glucose into the normal range

Metformin

  • Glucophage®

Extended release (ER):

Glucophage XR®

Fortamet®

Glumetza

Riomet® (liquid, 500 mg/5ml)

12/94

10/00

Glucophage: 500 mg (white to off-white), 850 mg (white to off-white), 1000 mg (white oval scored) tablets

Glucophage XR: 500 mg (white to off-white), 750 mg (pale red) tablets

Fortamet: 500 mg (white), 1000 mg (white) biconvex tablets

Glumetza: 500 mg (blue) oval tablets

Generic metformin ER: 500 mg, 750 mg (white to off-white) capsule shaped tablets

Initial: 500 mg twice daily or 850 mg once daily

Range: 500-2550 mg

Dosed two or three times daily

ER: Initial: 500 mg once daily

Range: 500-2000 mg

Dosed once daily

SE: Gastrointestinal symptoms (diarrhea, nausea, upset stomach), metallic taste (3%),

lactic acidosis (0.03 cases/1000 people)3,4

Take with meals (ER with evening meal)

Cannot use if have liver or kidney problems, take drug to treat heart failure, or drink alcohol excessively.

ALPHA-GLUCOSIDASE INHIBITOR: STARCH BLOCKER – EUGLYCEMIC -
delays digestion and absorption of carbohydrates, and brings the glucose into the normal range

Acarbose

  • Precose®

9/95

25 mg, 50 mg, 100 mg (white) tablets

Initial: 25 mg three times daily

Range: 75-300 mg

(max 150 mg if <60 kg)

Dosed three times daily

SE: flatulence

Take with first bite of meal

Start with low dose and slowly ­ to minimize GI intolerance.

THIAZOLIDINEDIONES: EUGLYCEMICS -
decrease insulin resistance and bring the glucose into the normal range

Rosiglitazone

  • Avandia®

5/99

2 mg (pink), 4 mg (orange),

8 mg (red-brown) tablets

Initial: 4 mg daily

Range: 4-8 mg

Dosed once or twice daily

SE: anemia, fluid retention, edema, weight gain, CHF5, bone loss in women. May cause CAD6

Cannot use if have liver problems

Requires liver monitoring 7

Pioglitazone

  • Actos®

7/99

15 mg, 30 mg, 45 mg (white to off-white) tablets

Initial: 15-30 mg daily

Range: 15-45 mg

Dosed once daily

SE: anemia, fluid retention, edema, weight gain, CHF5, bone loss in women.

Cannot use if have liver problems

Requires liver monitoring 7

COMBINATION ORAL PRODUCTS

Glyburide/Metformin

  • Glucovance®

7/00

1.25 mg/250 mg (pale yellow), 2.5 mg/500 mg (pale orange), 5 mg/500 mg (yellow) capsule shaped

Initial: 1.25 mg/250 mg once or twice daily

Range: up to – 20/2000 mg

Dosed once or twice daily

Same as above with glyburide & metformin

Glipizide/Metformin

  • Metaglip®

10/02

2.5 mg/250 mg (pink), 2.5mg/500 mg (white), 5mg/500 mg (pink) oval tablets

Initial: 2.5 mg/250 mg daily or 2.5mg/500 mg twice daily

Range: up to 20/2000 mg

Dosed once or twice daily

Same as above with glipizide and metformin

Rosiglitazone/Metformin

  • Avandamet®

10/02

2 mg/500 mg (pale pink), 2 mg/1000 mg (yellow), 4 mg/500 mg (orange), 4 mg/1000 mg (pink) oval tablets

Initial: 2 mg/5000 mg once or twice daily

Range: up to 8 mg/2000 mg; Dosed twice daily

Same as above with metformin and rosiglitazone

Pioglitazone/Metformin

  • ActoPlus Met®

8/05

15 mg/500 mg, 15 mg/850 mg (white to off-white) oblong tablets

Initial: 15 mg/500 mg or 15 mg/850 mg once or twice daily

Range: up to 45 mg/2550 mg

Dosed once or twice daily

Same as above with metformin and pioglitazone

Pioglitazone/Glimepiride

  • Duetact®

7/06

30 mg/2 mg, 30 mg/4 mg (white to off-white) tablets

Initial: 30 mg/2 mg or 30 mg/4 mg once daily

Range: max of one tablet daily

Dosed once daily

Same as above with pioglitazone and glimepiride

Rosiglitazone/Glimepiride

  • Avandryl®

11/05

4 mg/1 mg (yellow), 4 mg/2 mg (orange), 4 mg/4 mg (pink) rounded triangle tablets

Initial: 4 mg/1 mg or 4 mg/2 mg once daily

Range: up to 8 mg/4 mg

Dosed once daily

Same as above with rosiglitazone and glimepiride

INCRETIN-BASED THERAPIES: EUGLYCEMICS -
increases glucagon secretion, reduces glucose release from liver after meals, delays food emptying from stomach (exenatide only) and promotes satiety (exenatide only), and bring the glucose into the normal range

Exenatide (GLP-1 analog)

  • Byetta®

4/05

5 mcg per dose and 10 mcg per dose pen devices

Injected under the skin (subcutaneous/SQ)

Initial: 5 mcg SQ twice daily

Range: up to 10 mcg SQ twice daily

Dosed twice daily

SE: nausea, headache, hypoglycemia (when used with insulin secretagogues), may cause pancreatitis

May cause mild weight loss

Sitagliptin (DPP-4 inhibitor)

  • Januvia®

11/06

25 mg (pink), 50 mg (light beige), 100 mg (beige) tablets

Initial: 100 mg daily

Range: 25-100 mg daily

Dosed once daily

SE: runny nose, upper respiratory infection

Lower doses used if renal problems

AMYLIN ANALOG THERAPY: EUGLYCEMIC -
increases glucagon secretion, reduces glucose release from liver after meals, delays food emptying from stomach, promotes satiety, and bring the glucose into the normal range

Pramlintide (Amylin analog)

  • Symlin®

7/05

Vial – solution contains 6 mcg per 0.01 cc (equivalent to 1 unit on a U100 insulin syringe)

Injected under the skin (subcutaneous/SQ)

Initial: 60 mcg SQ before meals (15 mcg for type 1 diabetes)

Range: up to 120 mcg SQ before meals (30-60 mcg for type 1 diabetes)

Dosed before meals

SE: nausea, headache, hypoglycemia (when used with insulin secretagogues or insulin),

May cause mild weight loss
  1. “Clinical” maximum daily dose for glyburide is 10 mg and glipizide is 20 mg; higher doses are not likely to be more effective and may be associated with increased side effects.
  2. SFUs, repaglinide, and nateglinide and hypoglycemia:  increased risk of hypoglycemia when meals are skipped. Avoid skipping meals.
  3. Lactic acidosis symptoms: feeling very weak, tired or uncomfortable; unusual muscle pain, trouble breathing, unusual or unexpected stomach discomfort, feeling cold, feeling dizzy or lightheaded, or suddenly developing a slow or irregular heartbeat.
  4. Radiologic tests using iodinated contrast media: stop metformin at the time of or prior to the procedure, and withhold for 48 hours after procedure and restart after kidney function has been re-evaluated and found to be normal.
  5. Congestive Heart Failure (CHF)
  6. Coronary Artery Disease (CAD)
  7. Liver toxicity symptoms: unexplained nausea, vomiting, abdominal pain, fatigue, anorexia, or dark urine.

**Oral agents [other than SFUs, repaglinide, and nateglinide] are EUGLYCEMICS & do not cause hypoglycemia when used alone. However, when used with SFUs, repaglinide, nateglinide, or insulin, hypoglycemia may occur

Table is prepared with information from package inserts of the various medications and opinion of the UCSF Diabetes Teaching Center.

This table is not meant to be all inclusive and contains important educational information, as viewed by the UCSF Diabetes Teaching Center

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