Diabetes Drugs

Question 1

Metformin

Answer 1

Initial: 500mg PO BID or 850mg PO daily

Max: 1000mg PO BID

Renal:
- if eGFR is between 30-45, reduce metformin dose by 50%
- if eGFR is less than 30, stop metformin/don’t start

Question 2

Canagliflozin (Invokana)

Answer 2

Initial: 100mg PO daily

Max: 300mg PO daily

Renal
- if eGFR is less than 30, don’t start
- don’t use if ESRD on HD

Question 3

Dapagliflozin (Farxiga)

Answer 3

Initial: 5mg PO daily

Max: 10mg PO daily

Renal
- if eGFR is less than 25, don’t start
- don’t use if ESRD on HD

Question 4

Empagliflozin (Jardiance)

Answer 4

Initial: 10mg PO daily

Max: 25mg PO daily

Renal
- don’t use if eGFR is less than 30
- don’t use if ESRD on HD

Question 5

Ertugliflozin (Steglatro)

Answer 5

Initial: 5mg PO daily

Max: 15mg daily

Renal
- don’t use if eGFR is less than 30
- don’t use if ESRD on HD

Question 6

Dulaglutide (Trulicity)

Answer 6

Initial: 0.75mg SQ weekly
Titrate up to 4.5 weekly prn

Caution in ESRD

Question 7

Semaglutide (Ozempic)

Answer 7

Initial: 0.25mg SQ weekly (for 4 weeks)
Titrate from 0.5 -> 2mg

Question 8

Liraglutide (Victoza)

Answer 8

Initial: 0.6mg SQ daily (for 7 days)
Titrate from 1.2 -> 1.8mg

Question 9

Exenatide (Byetta)

Answer 9

Initial: 5mcg SQ BID (for 1 month)
Titrate to 10mcg BID

Don’t use if CrCL < 30

Question 10

Exenatide (Bydureon BCise)

Answer 10

Initial: 2mg SQ weekly

Don’t use if CrCL < 30

Question 11

Lixisenatide (Adylyxin)

Answer 11

Initial:10mcg SQ daily for 14 days
Titrate to 20mcg

Don’t use if eGFR is less than 15

Question 12

Semaglutide (Rybelsus)

Answer 12

Initial: 3mg PO daily
Titrate from 7mg to 14mg prn

Question 13

Tirzepatide (Mounjaro)

Answer 13

Initial: 2.5mg SQ weekly
Titrate by 2.5mg up to 15mg SQ weekly

Question 14

Sitagliptin (Januvia)

Answer 14

100mg daily for CrCL > 50
50mg daily for CrCL 30-50
25mg daily for CrCL less than 30 or if on dialysis

Question 15

Saxagliptin (Onglyza)

Answer 15

2.5-5mg once daily
2.5mg for CrCL < 50

Question 16

Linagliptin (Tradjenta)

Answer 16

5mg daily

Question 17

Alogliptin (Nesina)

Answer 17

25mg daily
12.5mg if CrCL 30-60
6.25 if CrCL < 30 or if on dialysis

Question 18

Glimeperide (Amaryl)

Answer 18

Initial: 1-2mg daily

Max: 8mg

Question 19

Glipizide (Glucotrol)

Answer 19

Initial: 2.5-5mg daily

Max: 40mg

Question 20

Glipizide (Glucotrol XL)

Answer 20

Initial: 2.5-5mg daily

Max: 20mg

Question 21

Glyburide (Micronase/Diabeta)

Answer 21

Initial: 1.25-5mg daily

Max: 20mg

Question 22

Glyburide micronized (Glynase)

Answer 22

Initial: 1.5-3mg daily

Max: 12mg

Question 23

Pioglitazone (Actos)

Answer 23

Initial: 15-30mg daily
Titrate dose every 12 weeks

Max: 30-45mg

Question 24

Rosiglitazone (Avandia)

Answer 24

Initial: 4mg
Titrate dose every 12 weeks

Max: 8mg

Question 25

Acarbose (Precose)

Answer 25

25mg QD for 7-14 days
25mg BID week 3-4
25mg TID week 5-12
50mg TID (max if < 50kg)
100mg TID (max if > 50kg)

Question 26

Miglitol (Glyset)

Answer 26

25mg QD for 7-14 days
25mg BID week 3-4
25mg TID week 5-12
50mg TID (max if < 50kg)
100mg TID (max if > 50kg)

Question 27

Pramlintide (Symlin)

Answer 27

For type 1:
Initial: 15mcg
Titrate by 15mcg up to 30-60mcg

For type 2:
Initial: 60mcg
Titrate up to 120mcg

Question 28

Soliqua 100/33

Answer 28

Initial: 15u if less than 30u basal, 30u if more than 30u basal

Max: 60u

Question 29

Xultophy 100/3.6

Answer 29

Initial: 16u

Max: 50u

Question 30

Repaglinide (Prandin)

Answer 30

Initial: 0.5mg (if A1c less than 8%), 1-2mg (if A1c is more than 8%)

Max: 16mg/day, max clinical dose maybe only 6mg/day

Question 31

Nateglinide (Starlix)

Answer 31

Initial: 60mg (if A1c less than 8%), 120mg (if A1c is more than 8%)

Max: 360mg/day