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Concerns

Sulfonylureas

Meglitinides

Biguanides

Thiazolidinediones (Glitazones)

Alpha-glucoside inhibitors

Dipeptidyl peptidase-4 (DPP-4) inhibitors

Amylin analogues

Dopamine-2-agonists

GLP-1 receptor agonists

Bile acid sequestrants

SGLT-2 inhibitors

Combination medications

Sulfonylureas:

Action: Stimulate beta cells to increase insulin secretion; may result in hypoglycemia.

First Generation Agents:

  • Chlorpropamide (Diabinese®).

Second Generation Agents:

  • Gliclazide (not licensed in the U.S.)
  • Glipizide (Glucotrol®)
  • Glimepiride (Amaryl®)
  • Glyburide (DiaBeta®, Micronase®, Glynase®)
  • Micronase, (Orinase®)
  • Tolazamide (Tolinase®)

Meglitinides (glinides):

Action: Stimulate beta cells to increase insulin secretion; may result in hypoglycemia.

Agents:

  • Repaglinide (Prandin®)
  • Nateglinide (Starlix®)

Biguanides:

Action: Prevent glycogenolysis; rarely associated with hypoglycemia.

Agents:

  • Metformin (Glucophage®, Glucophage XR®, GlumetzaTM, Riomet®, Fortamet®)

Thiazolidinediones (Glitazones):

Action: Increase tissue sensitivity to insulin; rarely associated with hypoglycemia.

Agents:

  • Pioglitazone (Actos®)
  • Rosiglitazone (Avandia®)

Alpha-glucosidase inhibitors:

Action: Slow the digestion and uptake of carbohydrates; lower the postprandial peaks.

Agents:

  • Acarbose (Precose®)
  • Miglitol (Glyset®)
  • Voglibose (Not licensed in the U.S. or Europe)

Dipeptidyl peptidase-4 (DPP-4) inhibitors:

Action: Increases the active levels of incretin hormones, which result in triggering the pancreas to increase insulin and signaling the liver to stop producing glucose.

Agents:

  • Alogliptin (Not licensed in the U.S. or Europe)
  • Linagliptin (Tradjenta®)
  • Saxagliptin (OnglyzaTM)
  • Sitagliptin (Januvia®)
  • Vildagliptin (Galvus)

Amylin analogues:

Action: Slow the digestion and uptake of carbohydrates; lower the postprandial peaks.

Agents:

  • Pramlintide (Symlin®) Injectable

Dopamine-2-agonists:

Action: May reverse metabolic alterations associated with insulin resistance and obesity by resetting hypothalamic circadian organization of monoamine neuronal activities.

Agents:

  • Bromocriptine (Cycloset®)

GLP-1 receptor agonists:

Action: Stimulate the release of insulin in response to high sugar levels after a meal.

Agents:

  • Exenatide (Byetta®) Injectable
  • Liraglutide (Victoza®) Injectable

Bile acid sequestrants:

Action: May reduce hepatic glucose production, and possibly increase incretin levels.

Agents:

  • Colesevelam (WelcholTM)

SGLT-2 inhibitors:

Action: Block the re-uptake of glucose in the renal tubules promoting glucose loss in the urine; little risk of hypoglycemia.

Agents:

  • canagliflozin (Invokana®)

Combination medications:

Agents:

  • Glipizide and metformin (Metaglip®)
  • Glyburide and metformin (Glucovance®)
  • Pioglitazone and glimepiride (Duetact®)
  • Pioglitazone and metformin (Actoplus Met®)
  • Repaglinide and metformin (PrandiMetTM)
  • Rosiglitazone and glimepiride (Avandaryl®)
  • Rosiglitazone and metformin (Advanmet®)
  • Sitagliptin and metformin (Janumet®)

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