Oral antidiabetic drugs (for primary care physician) Domina Petric, MD

I. BIGUANIDES

Metformin It is indicated for adults, adolescents and children more than 10 years old. It is indicated for treatment of diabetes mellitus type 2 (DMT2) when exercise and diet are not sufficient. It is especially indicated for the patients with excessive body weigh.

Metformin Start dose is 500 mg to 850 mg two or three times a day, during the meal or after the meal. Dose can be increased up to maximum dose of 3 g a day divided in two or three doses, if necessary. Metformin can be used in combination with insulin (children, adults) or with other antidiabetic drugs and/or insulin (adults).

Contraindications hypersensitivity diabetic ketoacidosis kidney failure (ClCr<60 mL/min) dehidration severe infections shock heart or respiratory insufficiency recent myocardial infarction liver insufficiency acute alchohol intoxication alchoholism

Rare, but severe complication of metformin accumulation. Lactacidosis Rare, but severe complication of metformin accumulation. Caution is necessary: kidney or liver failure, alchoholics, hypoxia, starving, poorly controled diabetes.

iodine contrast agents Interactions alchohol iodine contrast agents

Pregnancy and lactation Not recommended in pregnancy and lactation!

SULPHONAMIDES, UREA DERIVATES II. SULPHONAMIDES, UREA DERIVATES

Glibenclamide Indicated for DMT2 (insulin independent type of diabetes) patients in monotherapy or in combination with metformin. Start dose is 1,75 mg up to 3,5 mg per os a day. Maximum dose is 10,5 mg per os a day. Drug is taken with full glass of water before meal. In case of higher doses, the total dose is divided in ratio 2:1 = in the morning : in the evening.

Contraindications hypersensitivity insulin dependent diabetes diabetic ketoacidosis diabetic coma severe kidney or liver damage treatment with bosentan pregnancy lactation

Not recommended during pregnancy and lactation. Gliquidone Very good for middle aged or older patients. Start dose is 15 mg per os a day during lunch. Maximum dose is 120 mg per os a day divided in two or three doses. It is not recommended for children and adolescents. Contraindications are: hypersensitivity insulin dependent diabetes diabetic coma severe liver damage infections before surgical procedures Not recommended during pregnancy and lactation.

GLICLAZIDE GLIMEPIRID .... Other sulphonamides GLICLAZIDE GLIMEPIRID ....

ALPHA GLUCOSIDASE INHIBITORS III. ALPHA GLUCOSIDASE INHIBITORS

Acarbose Indicated for DMT2 patients that are not well regulated with metformin or can not take it (or other drugs). Start dose is 50 mg per os three times a day. Maintenance dose is 100 mg per os three times a day. Maximum dose is 200 mg per os three times a day. The drug is taken with the glass of water before meal or during the meal, chewed. Not recommended for children under the age of 18. Contraindications are hypersensitivity, inflammatory bowel disease, bowel obstruction, severe liver or kidney damage (ClCr<25 mL/min).

IV. THIAZOLIDINEDIONES

Pioglitazone It is indicated for DMT2 patients as second or third line therapy: Monotherapy: adults that can not take metformin. Double peroral therapy: with metformin (in adults when metformin as monotherapy is not sufficient) OR with sulphonylureas (when metformin is contraindicated). Triple peroral therapy: with metformin and sulphonylureas OR with insulin therapy. Start dose is 15 mg or 30 mg per os once a day. Maximum dose is 45 mg. Contraindications are hypersensitivity, heart failure (NYHA I to IV), liver damage, diabetic ketoacidosis, macroscopic haematuria, actual or history of urinary bladder carcinoma.

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