Diabetes Drugs Flashcards
Metformin
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
Canagliflozin (Invokana)
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
Dapagliflozin (Farxiga)
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
Empagliflozin (Jardiance)
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
Ertugliflozin (Steglatro)
Initial: 5mg PO daily
Max: 15mg daily
Renal
- don’t use if eGFR is less than 30
- don’t use if ESRD on HD
Dulaglutide (Trulicity)
Initial: 0.75mg SQ weekly
Titrate up to 4.5 weekly prn
Caution in ESRD
Semaglutide (Ozempic)
Initial: 0.25mg SQ weekly (for 4 weeks)
Titrate from 0.5 -> 2mg
Liraglutide (Victoza)
Initial: 0.6mg SQ daily (for 7 days)
Titrate from 1.2 -> 1.8mg
Exenatide (Byetta)
Initial: 5mcg SQ BID (for 1 month)
Titrate to 10mcg BID
Don’t use if CrCL < 30
Exenatide (Bydureon BCise)
Initial: 2mg SQ weekly
Don’t use if CrCL < 30
Lixisenatide (Adylyxin)
Initial:10mcg SQ daily for 14 days
Titrate to 20mcg
Don’t use if eGFR is less than 15
Semaglutide (Rybelsus)
Initial: 3mg PO daily
Titrate from 7mg to 14mg prn
Tirzepatide (Mounjaro)
Initial: 2.5mg SQ weekly
Titrate by 2.5mg up to 15mg SQ weekly
Sitagliptin (Januvia)
100mg daily for CrCL > 50
50mg daily for CrCL 30-50
25mg daily for CrCL less than 30 or if on dialysis
Saxagliptin (Onglyza)
2.5-5mg once daily
2.5mg for CrCL < 50
Linagliptin (Tradjenta)
5mg daily
Alogliptin (Nesina)
25mg daily
12.5mg if CrCL 30-60
6.25 if CrCL < 30 or if on dialysis
Glimeperide (Amaryl)
Initial: 1-2mg daily
Max: 8mg
Glipizide (Glucotrol)
Initial: 2.5-5mg daily
Max: 40mg
Glipizide (Glucotrol XL)
Initial: 2.5-5mg daily
Max: 20mg
Glyburide (Micronase/Diabeta)
Initial: 1.25-5mg daily
Max: 20mg
Glyburide micronized (Glynase)
Initial: 1.5-3mg daily
Max: 12mg
Pioglitazone (Actos)
Initial: 15-30mg daily
Titrate dose every 12 weeks
Max: 30-45mg
Rosiglitazone (Avandia)
Initial: 4mg
Titrate dose every 12 weeks
Max: 8mg
Acarbose (Precose)
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)
Miglitol (Glyset)
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)
Pramlintide (Symlin)
For type 1:
Initial: 15mcg
Titrate by 15mcg up to 30-60mcg
For type 2:
Initial: 60mcg
Titrate up to 120mcg
Soliqua 100/33
Initial: 15u if less than 30u basal, 30u if more than 30u basal
Max: 60u
Xultophy 100/3.6
Initial: 16u
Max: 50u
Repaglinide (Prandin)
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
Nateglinide (Starlix)
Initial: 60mg (if A1c less than 8%), 120mg (if A1c is more than 8%)
Max: 360mg/day
