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

2. I.
BIGUANIDES

3. 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.

4. 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).

5. 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

6. 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.

7. iodine contrast agents
Interactions
alchohol
iodine contrast agents

8. Pregnancy and lactation
Not recommended in pregnancy and lactation!

9. SULPHONAMIDES, UREA DERIVATES
II.
SULPHONAMIDES, UREA DERIVATES

10. 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.

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

12. 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.

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

14. ALPHA GLUCOSIDASE INHIBITORS
III.
ALPHA GLUCOSIDASE INHIBITORS

15. 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).

16. IV.
THIAZOLIDINEDIONES

17. 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.

18. New antidiabetic drugs

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Literature
HALMED MEDIATELY