1. Antihyperglycemic Agents and Renal Function
Yale JF, December 2015 version
Antihyperglycemic Agents and Renal Function
eGFR (mL/min/1.73 m2):
<15
15–29
30–59
60–89
≥ 90
CRF Stage 5 4 3 2 1
Alpha-glucosidase Inhibitors
Acarbose (Glucobay)
Not recommended 25
100 mg tid
Metformin (Glucophage) 30 60
Biguanides
500 mg bid
850 mg tid
Alogliptin (Nesina)
Not recommended 50
6.25 mg
12.5 mg 30
25 mg die 15
Linagliptin (Trajenta)
DPP-4 Inhibitors
5 mg
5 mg die
Saxagliptin (Onglyza) 50 15
2.5 mg
5 mg die
Sitagliptin (Januvia) 50 30
50 mg
25 mg
100 mg die
Albiglutide (Eperzan) 50
50 mg per week
Dulaglutide (Trulicity) 50
1.5 mg per week
GLP-1 Receptor Agonists
5 ug bid
10 ug bid die
Exenatide (Byetta) 30 50
5 ug bid
10 ug bid
Exenatide QW (Bydureon) 30 50
2 mg per week
Liraglutide (Victoza)** 50 30
1.8 mg die
1.8 mg die
Gliclazide (Diamicron) 15 30
hypos
MR 120 mg die ou 160 mg bid
Glimepiride (Amaryl) 15 30
hypos
4 mg bid
Insulin Secretagogues
Glyburide (Diabeta) 30 50
hypos
10 mg bid
Repaglinide (GlucoNorm)
4 mg tid
Canagliflozin (Invokana) 25
60*
100 mg 45
300 mg die
SGLT2 Inhibitors
Dapagliflozin (Forxiga) 60
10 mg die
Empagliflozin (Jardiance) 45
25 mg
60*
25 mg die
Pioglitazone (Actos) 30
heart failure
45 mg die
Thiazolidinediones
Rosiglitazone (Avandia) 30
heart failure
8 mg die
Insulins
Contraindicated
Not recommended
Caution and/or dose adjustment
Close monitoring of renal function
Safe
**Based on Saxenda product monograph Adapted from product monographs
* = Do not initiate if eGFR is less than 60 ml/min
Dose indicated is the maximum dose allowed for that eGFR