Selecting a Treatment Regimen
Table 11. Hypoglycemic Agentsa (continued)
Generic (Brand)
Dose
Glinides (short-acting secretagogues)
Nateglinide
Initial: 120 mg tid; 60 mg tid in elderly patients
(Starlix®)
Max: 120 mg tid
Repaglinide
Initial: Patients with HbA1c < 8% or elderly patients and
(Prandin®)
patients not previously treated with hypoglycemic
agents: 0.5 mg tid ac
Patients with HbA1c > 8%: 1 to 2 mg tid ac
Max: 16 mg daily
Repaglinide + metformin Initial: 1 mg/500 mg bid
(PrandiMet®)
Max: 10 mg/2500 mg daily or 4 mg/1000 mg per meal
α-Glucosidase Inhibitors (start with low dose and titrate up slowly)
Initial: 25 mg tid ac
Acarbose (Precose®),
Max: 100 mg tid ac
Miglitol (Glyset®)
Amylin Agonist
Pramlintide
Initiate at 60 mcg and increase to a dosage of 120 mcg as
(Symlin®)
tolerated. Reduce preprandial, rapid- or short-acting insulin,
including premixed insulins, by 50%.
Bile Acid Sequestrant
Colesevelam
(Welchol ®)
Six 625 mg tablets daily or 3 tablets bid
Oral suspension: one 3.75 gram packet daily or one 1.875 gram
packet bid
Dopamine Receptor Agonist
Bromocriptine mesylate Initial dose is one tablet (0.8 mg) daily increased weekly by one
(Cycloset®)
tablet until maximal tolerated daily dose of 1.6 to 4.8 mg is achieved.
TZDs
Note: Liver function tests at baseline with periodic monitoring thereafter; contraindicated in
NYHA Class III or IV cardiac disease and functional capacity; monitor for edema.
Pioglitazone
Initial: 15 or 30 mg daily
(Actos®)
Max: 45 mg daily
Pioglitazone + metformin Initial: Actoplus Met®
®
(Actoplus Met ,
15 mg/500 mg or 15 mg/850 mg daily or bid
Actoplus Met XR®)
Actoplus Met XR®
15 mg/1000 mg or 30 mg/1000 mg daily
Max: Actoplus Met®
45 mg/2550 mg in divided doses
Actoplus Met XR®
45 mg/2000 mg daily
Pioglitazone + glimepiride Initial: 30 mg/2 mg or
(Duetact®)
30 mg/4 mg daily with first meal (based on daily
dose of pioglitazone and/or glimepiride or other SU
previously prescribed)
Max: 45 mg/8 mg daily
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