McKenna's Pharmacology for Nursing, 2e

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P A R T 6  Drugs acting on the endocrine system

TABLE 38.3

DRUGS IN FOCUS Other oral hypoglycaemic agents

Drug name

Dosage/route

Usual indications

Sulfonylureas

2.5 mg PO increased by 2.5 mg/week to maximum of 20 mg/day

Adjunct to diet for the management of type 2 diabetes; adjunct to insulin for management in certain type 2 diabetics, reducing the insulin dose and decreasing the risk of hypoglycaemia Adjunct to diet for the management of type 2 diabetes Adjunct to diet for the management of type 2 diabetes; adjunct to insulin for management in certain type 2 diabetics, reducing the insulin dose and decreasing the risk of hypoglycaemia Adjunct to diet for the management of type 2 diabetes; adjunct to insulin for management in certain type 2 diabetics, reducing the insulin dose and decreasing the risk of hypoglycaemia

glibenclamide (Daonil, Glimel)

gliclazide (Diamicron, Glyade) glimepiride (Amaryl)

40–160 mg PO daily adjusted according to responses 1–4 mg/day PO; lower doses with geriatric people

glipizide (Melizide, Minidiab)

5 mg PO daily, titrate based on response; do not exceed 15 mg/day; use lower doses with geriatric and hepatic-impaired people; extended release: 5 mg/day, adjust to a maximum of 20 mg/day

Other oral hypoglycaemic agents Alpha-glucosidase inhibitors acarbose (Glucobay)

100 mg PO t.d.s. at the start of each meal

Adjunct to diet to lower blood glucose in type 2 diabetics; in combination with sulfonylureas to control blood sugar in people whose diabetes cannot be controlled with either drug alone

Biguanide

500–850 mg/day PO in divided doses; reduce dose in geriatric and renal-impaired people; maximum dose: 2550 mg/day Children 10–16 years: 500 mg/day PO with a maximum dose of 2000 mg/day; do not use extended release form

Adjunct to diet to lower blood glucose in type 2 diabetes

metformin (Diaformin, Glucophage)

Dipeptidyl peptidase-4 (DPP-4) inhibitors alogliptin (Nesina)

25 mg/day PO

Adjunct to diet and exercise to improve glucose control in people with type 2 diabetes Adjunct to diet and exercise to improve glucose control in people with type 2 diabetes as monotherapy or combined with metformin, pioglitazone or other agents Adjunct to metformin, a thiazolidinedione or sulfonylurea Adjunct to diet and exercise to improve glucose control in people with type 2 diabetes, as monotherapy or combined with metformin, pioglitazone or other agents Adjunct to diet and exercise to improve glucose control in individuals with type 2 diabetes, as monotherapy or combined

linagliptin (Trajenta)

5 mg/day PO

saxagliptin (Onglyza)

5 mg/day PO

sitagliptin (Januvia)

100 mg/day PO

vildagliptin (Galvumet, Galvus)

individualised up to 100 mg/day

Glucagon-like peptide 1 liraglutide (Victoza)

0.6–1.8 mg/day by SC injection

Adjunct to diet and exercise to improve glucose control in people with type 2 diabetes, as monotherapy or combined with other agents