Selecting a Treatment Regimen
Table 11. Hypoglycemic Agentsa Generic (Brand)
Dose
Biguanides (start with initial dose and titrate up slowly) , Riomet®
Metformin (Glucophage®
Metformin extended release (Glucophage XR® Glumetza®
, Fortamet® ,
DPP-4 Inhibitors )
Linagliptin (Tradjenta™
Saxagliptin (Onglyza®
)
Saxagliptin + metformin (Kombiglyze™
XR)
Sitagliptin (Januvia®
)
Sitagliptin + metformin (Janumet®
)
Exenatide Injection (Byetta®
) 5 mg daily
2.5-5 mg daily Assess renal function and limit dose to 2.5 mg daily if ClCr
≤ 50 mL/min.
Initial: Individualize Max: 5 mg/2000 mg
Initial: 100 mg daily If ClCr
Max: 100 mg daily
Incretin Mimetics (GLP-1 agonist) )
50 mg daily. If ClCr dosage to 25 mg daily.
Initial: 50 mg/500 mg bid Max: 50 mg/1000 mg bid
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] Injection (Victoza®
) 2nd ) Glucotrol XL® )
Glyburide (DiaBeta®
) ,
Initial: 0.6 mg subcut daily Max: 1.8 mg daily
-Generation SUs (half max dose typically provides most of benefit) Glimepiride (Amaryl® Glipizide (Glucotrol®
Initial: 1 or 2 mg daily
Glipizide/metformin (Metaglip®
Glyburide + metformin (Glucovance®
, Micronase® )
20 )
Initial: 5 mg daily (2.5 mg daily in elderly) Max: 40 mg in 2 divided doses
Initial: 2.5 mg/250 mg once a day Max: 20 mg/2000 mg
Initial: 1.25 mg to 5 mg daily Max: 20 mg in 1 or 2 divided doses daily or bid
Initial: 1.25 mg/250 mg daily or bid Max: 20 mg/2000 mg divided daily
Max: 8 mg daily is 30 to 50 mL/min/1.73 m2 is < 30 mL/min/1.73 m2
, reduce dosage to , reduce
) 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
