Selecting a Treatment Regimen
Table 11. Hypoglycemic Agentsa
Generic (Brand)
Dose
Biguanides (start with initial dose and titrate up slowly)
Metformin
(Glucophage® , Riomet®)
Metformin extended
release
(Glucophage XR® ,
Glumetza® , Fortamet®)
DPP-4 Inhibitors
Initial: 500 mg bid or 850 mg daily in the morning
Max: 2550 mg in 3 divided doses
Initial: 500 mg daily in the evening
Max: 2000 mg daily
Linagliptin
(Tradjenta™)
Saxagliptin
(Onglyza®)
5 mg daily
2.5-5 mg daily
Assess renal function and limit dose to 2.5 mg daily if
ClCr ≤ 50 mL/min.
Saxagliptin + metformin Initial: Individualize
(Kombiglyze™ XR)
Max: 5 mg/2000 mg
Sitagliptin
(Januvia®)
Initial: 100 mg daily
If ClCr is 30 to 50 mL/min/1.73 m2, reduce dosage to
50 mg daily. If ClCr is < 30 mL/min/1.73 m2, reduce
dosage to 25 mg daily.
Max: 100 mg daily
Sitagliptin + metformin Initial: 50 mg/500 mg bid
(Janumet®)
Max: 50 mg/1000 mg bid
Incretin Mimetics (GLP-1 agonist)
Exenatide Injection
(Byetta®)
Indicated as monotherapy or as adjunct treatment to improve
glycemic control in patients with T2DM who take metformin,
an SU, or a combination of both, but who have not
achieved adequate glycemic control. Initiated at 5 mcg per dose
administered bid given subcut within 60 minutes before morning
and evening meals. Dosage can be increased to 10 mcg bid ac after
1 month of therapy.
Liraglutide [rDNA origin] Initial: 0.6 mg subcut daily
Injection (Victoza®)
Max: 1.8 mg daily
2nd-Generation SUs (half max dose typically provides most of benefit)
Glimepiride (Amaryl ®)
Initial: 1 or 2 mg daily
Glipizide (Glucotrol ®,
Glucotrol XL®)
Initial: 5 mg daily (2.5 mg daily in elderly)
Max: 40 mg in 2 divided doses
Glipizide/metformin
(Metaglip®)
Initial: 2.5 mg/250 mg once a day
Max: 20 mg/2000 mg
Glyburide
(DiaBeta®, Micronase®)
Initial: 1.25 mg to 5 mg daily
Max: 20 mg in 1 or 2 divided doses daily or bid
Glyburide + metformin
(Glucovance®)
Initial: 1.25 mg/250 mg daily or bid
Max: 20 mg/2000 mg divided daily
20
Max: 8 mg daily
