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Oral Hypoglycaemics

DrugBrand NameActionDosageCautions and Contra IndicationsWhen To Take
Biguanide
MetforminGlucophageDecreases Gluconeogenesis. Increases peripheral uptake of glucose500 mg. every 8 hours or 850mg every 12 hours maximum 3 g daily in divided doses.Renal failure, Hepatic impairment, heart failure, trauma, alcohol dependencewith or just after food
Glucophage SRAs above however evidence shows much lower GI side effect profile than regular Metformin.Once daily after main meal. 500mg tablets. 2g daily maximum dose.As aboveTaken with or after main meal of day
Sulphonylureas
Chlorpropramide (Check availability)36 hrs + auguments insulin secretion250 mgs. daily Max. 500 mgsEncourages weight gain hepatic and renal insufficiency avoid in the elderlyBest before breakfast
GlibenclamideDaonil24 - 38 hours as above5 mgs - 15 mgs dailyEncourages weight gain hepatic and renal insufficiency avoid in the elderlyBest before breakfast
GliclazideDiamicron24 hours - acts as above40mg - 80 mg daily up to 160 mg in a single dose higher doses divided max 320 mgs dailyMore suitable for the elderly or those with renal impairment, hepatic insufficiency still a cautionBefore breakfast or before meals
Gliclazide MRDiamicronModified release30mg - 120mg Gliclazide (30mg approximately equal in effect to 80mg standard gliclazide)
GlimepirideAmaryl24 hours1mg-4mg Usual max dose 4 mgHepatic monitoringBest before breakfast or first meal
GlipizideGlibenese Minodiab24Hrs20 mg daily, Minodiab 2.5 – 20mg Up to 15mg as single doseHepatic monitoringBest before breakfast or first meal
TolbutamideUp to 16 hours0.5mg - 1.5 mg daily, divided doses max.2 mg dailyProbably the most suitable choice for elderly or renal impairment.Before breakfast before evening meal
Other OHAs
AcarboseGlucobay6-12 hours Delays digestion and absorption of sugars and starch50 mg daily initially - Increase to 50 mg tds Max 200 mg tdsMay enhance hypoglycaemic effect of sulphonylureas/insulin, hepatic/renal impairment, irritable bowel syndromechew with first mouthful of food or swallow with a little liquid immediately before food
RepaglinideNovoNormRapid onset500 microgrammes – 4mg before each main meal (usually tds) max 16mgs dailypregnancy, renal/hepatic disorders, Type 1 diabetes, DKAless than 30 minutes before main meals
NateglinideStarlix Rapid3-4 hrs60mg – 180mg (usually tds)Type 1 diabetes, Severe Hepatic impairment, Pregnancy, Breast feeding, DKA.before each meal.
Thiazolidinediones
Pioglitazone/Metformin HClCompetactRefer to Actos and Metformin15mg/850mg 1 tablet twice dailyRefer to Actos and MetforminWith or just after food
RosiglitazoneAvandiaIncreases insulin sensitivityRecommended 4 mg once daily. Can increase to 8 mg after 8 weeks, as monotherapy or with metforminIn combination with insulin. Heart failure or history of heart failure. Hepatic impairment. Severe renal impairmentWith/without food - same time each day
Rosiglitazone/Metformin HClAvandametRefer to Avandia and Metformin1mg/500mg or 2mg/500mg 2mg/1000mg or 4mg/1000mg 1 tablet twice per dayRefer to Avandia and MetforminWith or just after food
PioglitazoneActosIncreases insulin sensitivity15,30 or 45mg mg once daily, Recommended 30 mg once daily, Dose may be increased up to a max 45mg Heart failure or history of heart failure. Hepatic impairment. Severe renal impairmentwith/without food
SitagliptinJanuviaDPP-4 Inhibitor, incretin enhancer100 mg Not for Type 1 or for diabetic ketoacidosisOnce daily With or without food