Antidiabetic Medication Comparison Chart

[Pages:4]Antidiabetic Medication Comparison Chart

Generic Name Brand name

Expected %

decrease in A1c*

Hypoglycemia in

monotherapy

Weight

Renal/GU

GI SX

CHF

CVD Bone Health

Other

Effect on

Site of

Cost

considerations blood glucose

action

$

Acarbose^ (Precose)

Miglitol(Glyset)

0.5-0.8 0.5-0.8

Neutral Neutral

Neutral Neutral

Neutral Neutral

Alpha-Glucosidase Inhibitors

Moderate Neutral Neutral Neutral

Take with first Post prandial bite of food

Intestines liver

100

Moderate Neutral Neutral Neutral

Take with first Post prandial Intestines

200

bite of food

liver

Biguanide

Metformin^

1-2

Neutral

Slight Cont. CKD stage

Moderate Neutral Benefit

Neutral Lactic acidosis

Fasting

Liver

4

(Foramet, Glucophage,

loss 3B, 4, 5 Crcl 45-60:

(if stable)

risk increases with increased

& Basal

Intestines muscles

Glucophage

monitor

age, CHF, and

XR, Glumetza,

Crcl 30-45:

hepatic

Riomet)

decrease dose and

insufficiency

monitor

Alogliptin

0.6

(Nesina)

Neutral

Neutral Dose adj. Crcl < 60

Dipeptidyl Peptidase IV (DPP-4) Inhibitors Neutral Neutral Neutral Neutral

Pancreatitis, Post prandial Pancreas,

340

liver disease

liver

Linagliptin (Tradjenta)

0.4

Neutral

Neutral

Neutral

Neutral Neutral Neutral Neutral

Pancreatitis, liver disease

Post prandial

Pancreas, liver

350

Saxagliptin (Onglyza,)

Sitaglitptin (Januvia)

0.4-0.5 0.5-0.8

Neutral Neutral

Neutral

Dose adj. Crcl < 50

Neutral Dose adj. Crcl < 50

Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral

Pancreatitis, liver disease

Post prandial

Pancreas, liver

350

Pancreatitis, Post prandial Pancreas,

360

liver disease

liver

Bromocriptine (Cycloset)

0.1

Neutral

Neutral

Neutral

Dopamine Agonists

Moderate Neutral Neutral Neutral

Hypotension

Unknown

Unknown

200

Expected A1c lowering based on monotherapy ^ Generic available Pricing based on

Adapted from AACE Comprehensive Diabetes Management Algorithm/Lex-Drug Antidiabetic Agents Comparison Tables

Diana G. Mercurio, RPh, CDE, CDOE, CVDOE

January 2017

Antidiabetic Medication Comparison Chart

Generic Name Brand name

Expected %

decrease in A1c*

Hypoglycemia in

Monotherapy

Weight

Renal/GU

GI SX

CHF

CVD

Bone

Other

Effect on

Site of

Cost

Health considerations blood glucose

action

$

Nateglinide^ (Starlix)

0.5-1.5

Mild

Slight gain

Repaglinide^ 0.5-1.5

Mild

Slight

(Prandin)

gain

Neutral Neutral

Meglitinide Derivatives

Moderate Neutral Neutral Neutral

Take with meals

Post prandial Pancreas

170

Hold if meal

skipped

Moderate Neutral Neutral Neutral

Take with

Post prandial Pancreas

300

meals

Hold if meal

skipped

Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors

Canagliflozin (Invokana)

0.771.03

Neutral

Loss

Urogenital inf. Caution if eGFR <

Neutral

Neutral

Neutral or? risk

? bone loss

Hypotension Maintain

Post prandial

Kidney

375

45

adequate

hydration

DKA warning

Dapagliflozin

0.77-

Neutral

Loss

Urogenital inf.

Neutral

Neutral

Neutral ? bone loss Hypotension Post prandial

Kidney

375

(Farxiga)

1.03

Caution if

or? risk

Maintain

eGFR < 60

adequate

hydration

DKA warning

Empagliflozin (Jardiance)

0.771.03

Neutral

Loss

Urogenital inf. Caution if

Neutral

Neutral

? Benefit

? bone loss

Hypotension Maintain

Post prandial

Kidney

360

eGFR < 45

adequate

hydration

DKA warning

Expected A1c lowering based on monotherapy

Adapted from AACE Comprehensive Diabetes Management Algorithm/Lex-Drug Antidiabetic Agents Comparison Tables

^ Generic available

Pricing based on

Diana G. Mercurio, RPh, CDE, CDOE, CVDOE

January 2017

Antidiabetic Medication Comparison Chart

Generic Name Brand name

Expected %

decrease in A1c*

Hypoglycemia in

Monotherapy

Weight

Renal/GU

GI SX

CHF

CVD

Bone

Other

Effect on

Site of

Cost

Health considerations blood glucose

action

$

Thiazolidinediones (TZDs)

Piolglitazone^ (Actos)

0.5-1.4

Rosiglitazone (Avandia)

0.5-1.4

Neutral Neutral

Gain

Can worsen fluid retention

Neutral

Moderate Monitor

Neutral May

Moderate fracture

Edema Bladder CA

reduce

risk

Up to 3

stroke

months for full

risk

effect

Gain

Can worsen fluid retention

Neutral

Moderate Neutral

Monitor

May

Moderate fracture

Edema Bladder CA

reduce

risk

Up to 3

stroke

months for full

risk

effect

Glimepiride^ (Amaryl)

Sulfonylureas (SU)

1-2

Moderate to Gain >risk of hypo and Neutral Slight risk

?

severe

fluid retention

increase

Neutral

Preferred SU option

Fasting &

Basal

Fasting &

Basal

Fasting &

Basal

Muscles

20

Body fat

Muscles

200

Body fat

Pancreas

10

Glipizide^ (Glucotrol

1-2

Moderate to severe

Gain

>risk of hypo and fluid retention

Neutral

Slight risk increase

?

Glucotrol XL)

Neutral

Preferred SU option

Fasting &

Basal

Pancreas

10

Glyburide^

1-2

Moderate to Gain > risk of hypo and Neutral Slight risk

?

(Diabeta,

severe

fluid retention

increase

Glynase,

Micronase)

Neutral

Avoid use in patients 65+

Fasting &

Basal

Pancreas

10

Expected A1c lowering based on monotherapy ^ Generic available Pricing based on

Adapted from AACE Comprehensive Diabetes Management Algorithm/Lex-Drug Antidiabetic Agents Comparison Tables

Diana G. Mercurio, RPh, CDE, CDOE, CVDOE

January 2017

Antidiabetic Medication Comparison Chart

Generic Name Brand name

Expected %

decrease in A1c*

Hypoglycemia in

Monotherapy

Weight

Renal/GU

GI SX

CHF

CVD

Bone

Other

Effect on

Site of

Cost

Health considerations blood glucose

action

$

Colesvelam (Welchol)

0.5

Albiglutide (Tanzeum)

0.6-1.3

Exenatide (Byetta, Bydureon)

0.5-1

Neutral

Neutral

Neutral

Bile Acid Sequestrant

Mild

Neutral Benefit

Neutral

Decrease LDL-C

Post prandial Intestines

600

Large size

Neutral Neutral

Glucagon-Like Peptide Receptor Agonists (GLP-1 RA)

Loss

No dose adj

Moderate Neutral Neutral Neutral

Pancreatitis Fasting, post Pancreas,

415

Use with Caution

?thyroid cancer

prandial

liver, intestines

Half-life 5 days:

may lose effect

by end of week

Loss Contraindicated Moderate Neutral Neutral Neutral Crcl ................
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