Adverse Effects

Question 1

Albiglutide (Tanzeum)(GLP1)

Answer 1

Nausea/Vomiting – start low and don’t titrate until ready
 Hypoglycemia
 Pancreatitis – some fatalities
 Black box waring for Liraglutide and Bydureon
o Risk of Thyroid C-cell tumor
o Dose/duration dependent in rats
o CI: personal/family history of medullary thyroid
carcinoma MTC or multiple endocrine neoplasia
syndrome 2 (MEN2)
 Avoid if cancer in throat area – unless sure not thyroid

Question 2

Canagliflozin (Invokana)(SGLT2)

Answer 2

UTI – due to sugar in urine
 Female and male genital fungal infections
 ↑ urination – sugar pulls water into urine
 Hypoglycemia
 Hypotension
 Hyperkalemia
 ↑ cholesterol
 DKA – triggered by illness, ↓ food/water intake, ↓ insulin dose
 Bone fracture and ↓ BMD in Canagliflozin
o First one, prescribed most, may be class effect

Question 3

Dapagliflozin (Farxiga)(SGLT2)

Answer 3

UTI – due to sugar in urine
 Female and male genital fungal infections
 ↑ urination – sugar pulls water into urine
 Hypoglycemia
 Hypotension
 Hyperkalemia
 ↑ cholesterol
 DKA – triggered by illness, ↓ food/water intake, ↓ insulin dose
 Bone fracture and ↓ BMD in Canagliflozin
o First one, prescribed most, may be class effect

Question 4

Glipizide (Glutrol)(sulf)

Answer 4

Hypoglycemia – used cautiously if:
o Renal/hepatic insufficiency
o Elderly
o Concurrent hypoglycemic drugs
o Malnourished – no sugars but extra insulin o Irregular dietary intake
o Alcoholics
 Weight gain
 GI upset
 Allergic skin reactions/photosensitivity – “sulfa”
 Hematologic: leucopenia, thrombocytopenia, aplastic anemia
 25% have 1° failure
o Poor sugar control: 6-12 weeks on medication/diet  50-75% have 2nd failure after 5 years
o Common 6-12 months, failure after initial control  Can close K channels in CV tissue

Question 5

Glyburide (Diabeta or Micronase)(sulf)

Answer 5

Hypoglycemia – used cautiously if:
o Renal/hepatic insufficiency
o Elderly
o Concurrent hypoglycemic drugs
o Malnourished – no sugars but extra insulin o Irregular dietary intake
o Alcoholics
 Weight gain
 GI upset
 Allergic skin reactions/photosensitivity – “sulfa”
 Hematologic: leucopenia, thrombocytopenia, aplastic anemia
 25% have 1° failure
o Poor sugar control: 6-12 weeks on medication/diet  50-75% have 2nd failure after 5 years
o Common 6-12 months, failure after initial control  Can close K channels in CV tissue

Question 6

Linagliptin (Tradjenta)(DPP4)

Answer 6

Nasopharyngitis
 Upper respiratory tract infections
 Headache
 Joint pain - ↑ incidence of severe/persistent pain
o Usually resolved after 1mo of D/C
o If pain still there probably not from DPP4  Acute pancreatitis – N/V, abdominal pain
o All diabetics at risk (unsure about exacerbation)
 N/V
 Constipation
 Skin reactions
 Expensive medication

Question 7

Liraglutide (Victoza)(GLP1)

Answer 7

Nausea/Vomiting – start low and don’t titrate until ready
 Hypoglycemia
 Pancreatitis – some fatalities
 Black box waring for Liraglutide and Bydureon
o Risk of Thyroid C-cell tumor
o Dose/duration dependent in rats
o CI: personal/family history of medullary thyroid
carcinoma MTC or multiple endocrine neoplasia
syndrome 2 (MEN2)
 Avoid if cancer in throat area – unless sure not thyroid

Question 8

Metformin (Glucophage or Glumetza)

Answer 8

May cause lactic acidosis
o Caution in renal dysfunction
 Males SCr >1.5mg/dL
 Female SCr >1.4mg/dL
 CrCl

Question 9

Pioglitazone (Actos)(TZD)

Answer 9

Hepatotoxicity
o N/V, abdominal pain, fatigue, anorexia, dark urine
Resumption of ovulation
Exacerbations of HF
o Caution in class III and IV
o ↑ edema
o >10lb weight gain in some patients (fluid)
Macular edema
↑ fracture risk – women high risk
o Wrist, forearms, ankles, feet
Maybe ↑ risk of CV death and MI-still unsure (if hx don’t use)
Pioglitazone (Actos) associated with ↑ risk bladder cancer

Question 10

Pramlintide (Symlin)

Answer 10

Risk of severe hypoglycemia with concomitant insulin
 N/V and anorexia
o ↓ over time
 Injectable medication – more injections on top of insulin
 Expensive
 Needs more frequent glucose monitoring

Question 11

Saxagliptin (Onglyza)(DPP4)

Answer 11

Nasopharyngitis
 Upper respiratory tract infections
 Headache
 Joint pain - ↑ incidence of severe/persistent pain
o Usually resolved after 1mo of D/C
o If pain still there probably not from DPP4  Acute pancreatitis – N/V, abdominal pain
o All diabetics at risk (unsure about exacerbation)
 N/V
 Constipation
 Skin reactions
 Expensive medication

Question 12

Sitagliptin (Januvia)(DPP4)

Answer 12

Nasopharyngitis
 Upper respiratory tract infections
 Headache
 Joint pain - ↑ incidence of severe/persistent pain
o Usually resolved after 1mo of D/C
o If pain still there probably not from DPP4  Acute pancreatitis – N/V, abdominal pain
o All diabetics at risk (unsure about exacerbation)
 N/V
 Constipation
 Skin reactions
 Expensive medication