To improve efficacy and simplify medications regimens, three of these diabetes drugs are now combined. These medications combine Metformin plus Glyburide or Glucotrol and met-formin plus Avandia. (48)
Class/Main Action
 |
Name(s)
|
Daily Dose Range
|
Considerations
|
Sulfonylureas
Stimulate sustained Insulin Release |
Glyburide:
(Micronase, DiaBeta)
(Glynase)
Glipizide:
(Glucotrol*)
(Glucotrol XL)
Glimepiride (Amaryl) |
1.25 - 20 mg
0.75 - 12 mg
2.5 - 40mg
2.5 - 20 mg
1.0 - 8mg |
All sulfonylureas can cause weight gain and hypoglycemia.
*Glucotrol should be taken on empty stomach. |
Meglitinides
Stimulates insulin "burst" |
Repaglinide (Prandin) |
0.5 - 4 mg a.c.
16mg max daily dose |
Take before each meal. Side effects may include hypoglycemia / wt gain. |
D-Phenylalanine
Stimulates rapid insulin "burst" |
Nateglinide (Starlix) |
60 - 120mg mg a.c. |
Take before each meal. Side effects may include hypoglycemia / wt gain. |
Biguanides
Decrease hepatic glucose output |
Metformin
(Glucophage)
Glucophage XR
(extended release) |
500 - 2500mg
500 - 2000mg once daily |
Take caution if creat > 1.4 women, > 1.5 men, CHF on meds, > 80 yrs, binge drinker, liver disease, during IV dye study |
Thiazolidinediones "glitazones"
Increase insulin sensitivity |
Rosiglitazone
(Avandia)
Pioglitazone (Actos) |
4 - 8 mg
15 - 45mg |
Baseline liver labs. Can cause edema and weight gain. Caution in patients with heart failure or receiving insulin therapy. |
Glucosidase Inhibitors
Delay carb absorption |
Acarbose (Precose)
Miglitol (Glyset) |
75 - 300mg
based on wt. |
Start w/ low dose, increase slowly to decrease GI effects. Caution with liver or kidney problems. |
| Combination Medications |
Glucovance
Avandamet
Metaglip |
Combine the following medications:
Glucovance: metformin and glyburide
Avandamet: rosiglitazone and metformin
Metaglip: metformin and glipizide |
Intervention
