Selecting a Treatment Regimen
Table 11. Hypoglycemic Agentsa Generic (Brand)
Dose
Glinides (short-acting secretagogues) )
Nateglinide (Starlix®
Repaglinide (Prandin®
)
Repaglinide + metformin (PrandiMet®
)
Miglitol (Glyset® Amylin Agonist
Pramlintide (Symlin®
)
Bile Acid Sequestrant )
Colesevelam (Welchol®
Bromocriptine mesylate (Cycloset®
) ),
Initial: 120 mg tid; 60 mg tid in elderly patients Max: 120 mg tid
Initial: Patients with HbA1c < 8% or elderly patients and 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
Initial: 1 mg/500 mg bid Max: 10 mg/2500 mg daily or 4 mg/1000 mg per meal
α-Glucosidase Inhibitors (start with low dose and titrate up slowly) Acarbose (Precose®
Initial: 25 mg tid ac Max: 100 mg tid ac
Initiate at 60 mcg and increase to a dosage of 120 mcg as tolerated. Reduce preprandial, rapid- or short-acting insulin, including premixed insulins, by 50%.
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 )
Initial dose is one tablet (0.8 mg) daily increased weekly by one 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 thereaſter; contraindicated in NYHA Class III or IV cardiac disease and functional capacity; monitor for edema. Pioglitazone (Actos®
Pioglitazone + metformin (Actoplus Met®
) Actoplus Met XR® , )
Initial: 15 or 30 mg daily Max: 45 mg daily
Initial: Actoplus Met® 15 mg/500 mg or 15 mg/850 mg daily or bid 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 (Duetact®
)
Initial: 30 mg/2 mg or 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 (continued)
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