Class & Generic | Dosing | MOA | Efficacy & Target | ADRs | Clinical Pearls |
DPP-4 inhibitors:
sitagliptan
saxagliptan
linagliptan
alogliptin | Daily | Inhibits GLP-1 breakdown | <1
Postprandial | HA
Nasopharyngitis
Peripheral edema
Pancreatitis | Take w/ or w/out food
High cost
C/I: Hx of pancreatitis |
SGLT-2 inhibitors:
canagliflozin
dapagliflozin
empagliflozin | Daily | Increase urinary Glu excretion by blocking reabsorption in proximal convoluted tubule | <1 | Genital mycotic infections
UTIs
Hypotension
Bone Fractures | Increases urination
Expensive
C/I: severe renal impairment |
GLP-1 agonists:
exenatide
liraglutide
albiglutide
dulaglutide | Weekly-BID | Increase insulin secretion; Decrease glucogon secretion; Reduce gastric emptying; Promote satiety | <1
Postprandial | GI
Pancreatitis
Medullary thyroid tumors | Injectable
Expensive
Liraglutide indicated for weight loss
C/I: Hx of pancreatitis, renal inpairment |
Amylin analog:
pramlintide | TID | Decrease glucagon secretion; Slow gastric emptying; Promote satiety | <1
Postprandial | GI
HA
Hypoglycemia | Administered w/insulin (injectable)
Expensive
Weight loss
C/I: hypoglycemia unawareness, gastroparesis |
Bile Acid Binding Resin:
colesevelam | Daily-BID | Unclear; Reduce hepatic gluconeogenesis or intestinal Glu absorption | <1
Postprandial | GI | Expensive
C/I: bowel obstruction, TGs >500 |
Dopamine agonist:
bromocriptine | Daily | Unclear: Affect circadian activities the reduce caloric intake and storage | <1
Fasting | GI
HA
DZ | Can decrease antipsychotic effectiveness
Expensive
C/I: syncopal migraine, breastfeeding, uncontrolled HTM |
Biguanide:
metformin | Daily-BID | Decrease hepatic Glu production; Decrease intestinal Glu absorption; Increase insulin sensitivity | >1
Fasting | GI
Lactic acidosis (BBW)
B12 deficiency | Take w/food for GI
Hold 48 hrs for contrast
C/I: GFR <30, metabolic acidosis, HF |
Sulfonylureas:
glyburide
glipizide
glimepiride | Daily-BID | Increase insulin secretion | >1
Fasting & postprandial | Hypoglycemia
Weight gain | Skip dose if meal is skipped
C/I: hypoglycemia unawareness, renal dysfunction, T1DM
Glipizide for renal dysfunction |
Meglitinides:
repaglinide
nateglinide | TID | Increase insulin secretion | ~1
Postprandial | Hypoglycemia
Weight gain
URTIs | Skip dose if meal is skipped
C/I: repaglinide + gemfibrozil, T1DM |
TZDs:
pioglitazone
rosiglitazone | Daily | Increase insulin sensitivity | >1
Fasting & postprandial | Fluid retention
Weight gain
Increase lipids
Fracture risk
Bladder cancer (pioglitazone) | Slow onset
C/I: Class III/IV HF, LFTs >3x ULN |
alpha-Glucosidase inhibitors:
acarbose
miglitol | TID | Slows intestinal carb digestion/absorption | <1
Postprandial | GI | Take w/1st bite of food
Use Glu to treat hypoglycemia
C/I: IBD, colonic ulcerations, intestinal obstructions, cirrhosis (acarbose) |