A list of oral diabetes medications with advantages, disadvantages, and side effects. Click on the name of a drug for more information.
Biguanides
Glucophage (generic name: metformin)
Glucophage XR (generic name: metformin hydrochloride) extended release
Fortamet (generic name: metformin hydrochloride) extended release
Glumetza (generic name: metformin hydrochloride) extended release
Riomet (generic name: metformin hydrochloride liquid)
What are Biguanides?
Metformin is the only member of the biguanides family in use today. Metformin (met-FOR-min) helps lower blood glucose by making sure your liver does not put extra glucose into the system when it is not needed. The ADA Standards of Medical Care in Diabetes recommend the inclusion of metformin (along with diet and exercise) in initial diabetes treatment. A good thing about metformin is that it does not cause blood glucose to get too low (hypoglycemia) when it is the only diabetes medicine you take.
Who can take this medicine?
Adults with type 2 diabetes can take metformin with their doctor’s approval and supervision. You should avoid metformin if you have liver or kidney problems, lung or heart disease, or conditions that cause low blood oxygen levels.
Who should not take this medicine?
People with certain types of heart problems, such as congestive heart failure, should use caution with this medicine. People with reduced kidney function or kidney disease should probably not take metformin. It should be used with caution if you regularly consume more than two to three drinks daily, so check with your doctor about that.
Advantages
Metformin, when used alone, is unlikely to cause low blood sugar. It is one of those medicines that always seems to help even after people have had diabetes for a while, and, for this reason, prescribers will often simply add another medicine to metformin rather than stopping it. Metformin usually does not cause weight gain, and some people will actually lose a small amount of weight while taking it.
Disadvantages
Metformin can cause annoying stomach problems when first starting it. For this reason, it is wise to start on a lower dose until your body gets used to it. If you are having surgery, tell your healthcare provider you take Metformin. You should be told to stop taking Metformin the day of the surgery, and also receive advice about when to start it back.
What dosage can I take, and how should I take it?
Depending upon the dosage form, whether regular tablet, long-acting tablet, or liquid, it is usually given from one to three times daily. The usual starting dose is 500mg, once a day. You can add another 500mg per day each week until you reach the final dose your prescriber wants you to take. Many people end up at around 2,000mg per day as the final dose. It is usually taken with a meal.
What are the common side effects?
- Once in a while, people on metformin can become weak, tired, or dizzy, and have trouble breathing. If you ever have these problems, call your doctor, or get medical help right away.
- You may have nausea, diarrhea, and/or other stomach symptoms when you first start taking metformin. These usually go away, especially if you start on a low dose and slowly increase to the proper amount.
- You may notice a metallic taste in your mouth.
Cycloset
(Generic name: Bromocriptine mesylate)
Bromocriptine is a first-of-its-kind drug that increases a natural substance called dopamine in the brain in order to improve blood sugar control in people with type 2 diabetes. It has a rather weak blood-sugar-lowering capability. Though the mechanism of action is not clear, it may centrally reverse many of the metabolic changes associated with insulin resistance and obesity.
Who can take Cycloset?
It may be used in selected patients with type 2 diabetes.
Who should not take Cycloset?
Cycloset tablets are not for everybody. Do not use them if you are allergic to bromocriptine or any other ingredient contained is this medicine, or if you are taking ergot medicines. Cycloset should not be used in type 1 diabetes, in people with diabetic ketoacidosis, or in certain types of migraine. If you’re breastfeeding, you should not use it, as it may interfere with breastmilk production.
Advantages
Cycloset might be helpful in certain patients who would benefit from its unique way of working.
Disadvantages
It has relatively weak blood-sugar-lowering ability, and has not been studied with many of the other diabetes medicines.
How is Cycloset taken?
Cycloset is taken once a day. The dose is started at .8mg daily, and increased each week up to 4.8mg daily, as tolerated. It is taken within two hours of waking up, and with food.
What are the most common side effects?
- Low blood pressure (hypotension)
- Fainting
- Gastrointestinal symptoms
- Headache, dizziness, and weakness
- May cause an increase in psychotic disorders, or reduce the effectiveness of drugs that treat psychosis
- These are not all of the side effects, so please consult with your healthcare provider before starting this medicine.
DPP-4 Inhibitors
Tradjenta (generic name: linagliptin)
Nesina (generic name: alogliptin)
Januvia (generic name: sitagliptin phosphate)
Onglyza (generic name: saxagliptin)
What are DPP-4 Inhibitors?
DPP-4 Inhibitors help support the incretin system of hormones in the gut. The DPP-4 enzyme quickly destroys natural incretin hormones, so if we inhibit the action of the DPP-4 enzyme, incretin hormones have more time to work. These incretin hormones go to work when you eat a meal and tell your pancreas to put out insulin to help control the rise in blood sugar. They also help slow down the release of sugar from the liver that seems to occur in people with type 2 diabetes after they eat. Together, these two actions are helpful in controlling blood sugar, particularly after-meal blood sugar spikes. DPP-4 inhibitors only work to help stimulate insulin release when the blood sugar is going up. When blood sugar starts to return to normal, the medicine stops stimulating insulin release. This glucose-dependent activity means that people who take a DPP-4 inhibitor alone will seldom have low blood sugar reactions. An additional benefit of DPP-4 inhibitors is that they are weight-neutral, meaning that they are unlikely to make you gain weight like some of the other diabetes medications.
Tradjenta
(Generic name: linagliptin)
What is Tradjenta?
Tradjenta is a member of the DPP-4 inhibitor family of medicines that we have nicknamed gliptins. Tradjenta works by enhancing the body’s natural ability to control high blood sugar. As your blood sugar begins to go up after a meal, Tradjenta goes to work by asking the pancreas to put out more insulin, and it also keeps the liver from putting out unneeded glucose. These two actions together tend to lower your blood sugar, particularly after meals. As blood sugar goes down to normal levels, the Tradjenta backs away. That is why it usually does not cause your blood sugar to drop too low.
Who can take Tradjenta?
Selected people with type 2 diabetes can use this prescription medication, alone or in combination with some of the other diabetes medicines.
Who should not take Tradjenta?
Tradjenta is not for people with type 1 diabetes, or for people with diabetic ketoacidosis (increased ketones in the blood or urine). It should be used with caution in people who are at high risk for pancreatitis. Do not take Tradjenta if you are allergic to linagliptin or any of the ingredients in Tradjenta. Symptoms of a serious allergic reaction to Tradjenta include rash; raised, red patches on the skin (hives); and swelling of the face, lips, and throat, which may cause difficulty breathing or swallowing. If you have any symptoms of a serious allergic reaction, stop taking Tradjenta and call your doctor right away.
What are the advantages?
Tradjenta, like the other DPP-4 inhibitors, is weight-neutral, meaning it does not cause weight gain. When used alone, it is unlikely to cause your blood sugar to be lowered to a dangerous level (hypoglycemia), because it does not cause insulin to be secreted when blood sugar is normal or low. It can be used alone or together with one of several common oral diabetes medicines, such as Metformin, a thiazolidinedione (TZD), or a sulfonylurea. It seems to work even better in combination that it does alone.
What dosage can I take, and how should I take it?
The initial dosage is 5mg taken once daily, with or without food.
What are the common side effects?
- stuffy or runny nose and sore throat
- cough
- diarrhea
- These are not all of the possible side effects, so tell your healthcare provider if you have side effects that are bothersome and do not go away.
What else should you know about Tradjenta before taking it?
There is more information about Tradjenta and pancreatitis. Please consult the accompanying FDA-approved medication guide for further information.
Nesina
(Generic name: alogliptin)
What is Nesina?
Nesina is another member of the DPP-4 inhibitor family of medicines that we call gliptins. It works by supporting the incretin system of hormones, thereby enhancing the body’s natural ability to control high blood sugar. As your blood sugar begins to go up after a meal, Nesina goes to work by asking the pancreas to put out more insulin, and it also keeps the liver from putting out unneeded glucose. These two actions together tend to lower your blood sugar—particularly after meals, but also during the rest of the day. Nesina works in a glucose-dependent way, meaning that as the blood sugar goes down to normal levels, Nesina backs away. For this reason, it usually does not cause the blood sugar to drop too low. It can be taken alone or in combination with some of the other commonly-prescribed medications for type 2 diabetes to produce a stronger effect.
Who can take Nesina?
Selected adults with type 2 diabetes can take Nesina.
Who should not take Nesina?
People with type 1 diabetes, those with ketoacidosis, or people who are allergic to any of its ingredients should not take Nesina. People with kidney or liver disease should use caution, and may need a dose adjustment to be able to take Nesina.
Advantages
Nesina is weight-neutral, meaning it does not cause weight gain like some of the other diabetes medicines. When used alone, it is unlikely to cause your blood sugar to be lowered to a dangerous level (hypoglycemia), because it does not cause insulin to be secreted when blood sugar is normal or low. It can be used alone or together with one of several common oral diabetes medicines, such as Metformin or thiazolidinedione (TZD). It seems to work even better in combination than it does alone.
What dosage can I take, and how should I take it?
The initial dosage is 25mg, taken orally, with or without food. If necessary, your doctor can decrease this to 12.5mg or 6.25mg. It is taken once daily.
What are the side effects?
The most common side effects of Nesina include:
- stuffy or runny nose and sore throat
- headache
- cold-like symptoms (upper respiratory tract infection)
What else should you know about Nesina before you start?
There are warnings about possible pancreatitis issues. Please consult the accompanying FDA-approved medication guide for further information.
Januvia
(Generic name: sitagliptin phosphate)
What is Januvia?
Januvia is an oral prescription medication used along with diet and exercise to control high blood sugar in adults with type 2 diabetes. It is a member of the DPP4 inhibitor family of medicines we have nicknamed gliptins. Januvia works by enhancing the body’s natural ability to control high blood sugar. As your blood sugar begins to go up after a meal, Januvia goes to work by asking the pancreas to put out more insulin, and it also keeps the liver from putting out unneeded glucose. These two actions together tend to lower your blood sugar, particularly after meals. As blood sugar goes down to normal levels, Januvia backs away. That is why it usually does not cause your blood sugar to drop too low.
Who can take Januvia?
Selected adults with type 2 diabetes can take Januvia, and it can be used in combination with some of the other diabetes medicines.
Who should not take Januvia?
It should not be used to treat people with type 1 diabetes or to treat diabetic ketoacidosis (dangerously high levels of certain acids, known as ketones, in the blood or urine). Talk to your healthcare provider if you are pregnant, plan to become pregnant, or are breastfeeding before starting Januvia. Januvia must be used with caution if you have a history of reduced kidney function or pancreatic disease.
Advantages
When used alone, Januvia is unlikely to cause your blood sugar to be lowered to a dangerous level (hypoglycemia), because it does not cause insulin to be secreted when blood sugar is normal or low. It can be used alone, or together with one of several common oral diabetes medicines such as Metformin, thiazolidinedione (TZD), or sulfonylurea. It seems to work even better in combination than it does alone.
What dosage can I take, and how should I take it?
Januvia is taken once per day, most often at the 100mg dose, and can be taken with or without food.
What are the common side effects?
- Upper respiratory infection
- Stuffy or runny nose and sore throat
- Headache
- Stomach discomfort and diarrhea
- These are not all of the possible side effects, so tell your healthcare provider if you have side effects that are bothersome and do not go away.
Onglyza
(Generic name: saxagliptin)
What is Onglyza?
Onglyza is an oral prescription medication used along with diet and exercise to control high blood sugar in adults with type 2 diabetes. It is a member of the DPP4 inhibitor family of medicines we have nicknamed gliptins. Onglyza works by enhancing the body’s natural ability to control high blood sugar. As your blood sugar begins to go up after a meal, Onglyza goes to work by asking the pancreas to put out more insulin, and it also keeps the liver from putting out unneeded glucose. These two actions together tend to lower your blood sugar, particularly after meals. As blood sugar goes down to normal levels, Onglyza backs away. That is why it usually does not cause your blood sugar to drop too low.
Who can take Onglyza?
Selected people with type 2 diabetes can take this medicine. It can be taken alone or in combination with some of the other diabetes medicines.
Who should not take Onglyza?
Onglyza should not be used to treat people with type 1 diabetes, or to treat diabetic ketoacidosis (dangerously high levels of certain acids, known as ketones, in the blood or urine). Talk to your healthcare provider if you are pregnant, plan to become pregnant, or are breastfeeding before starting Onglyza. It must be used with caution if you have reduced kidney function.
Advantages
When used alone, Onglyza is unlikely to cause your blood sugar to be lowered to a dangerous level (hypoglycemia), because it does not cause insulin to be secreted when blood sugar is normal or low. It can be used alone or together with one of several common oral diabetes medicines such as metformin, thiazolidinedione (TZD), or sulfonylurea. It seems to work even better in combination that it does alone.
What dosage can I take, and how should I take it?
Onglyza is usually taken one time each day, and it can be taken with or without food. Do not cut or crush the tablet before taking.
What are the common side effects?
Common side effects of Onglyza include:
- Upper respiratory tract infection
- Urinary tract infection
- Headache
- These are not all of the possible side effects, so tell your healthcare provider if you have any side effects that bother you, or that do not go away.
Thiazolidinediones (TZDs, or glitazones)
Actos (Generic name: pioglitazone)
Avandia (Generic name: rosiglitazone)
What are thiazolidinediones?
TZDs (some call them glitazones) are a family of medications that work by helping to treat one of the main problems in type 2 diabetes: insulin resistance. People with type 2 diabetes can be resistant to their own insulin, so that it cannot keep blood sugar within the normal range. This medicine makes the muscle and fat tissues of the body more sensitive to insulin, thereby lowering blood sugar. Both pioglitazone and rosiglitazone are very effective at reducing blood sugar. There are some concerns, however, about their association with heart problems. The Food and Drug Administration (FDA) restricted the use of rosiglitazone some time ago, but some of those restrictions have now been lifted. The use of Actos has been associated with bladder cancer, and both Actos and Avandia may increase fractures in women.
Who can take them?
Carefully selected adults with type 2 diabetes can take them, and they can be combined with some of the other diabetes medicines.
Who should not take them?
TZDs are not made to treat people with type 1, and should be avoided by those with diabetic ketoacidosis. Since they can cause congestive heart failure or make it worse, they should not be prescribed for anyone at risk for that condition and/or other serious heart conditions. People with liver problems may not be able to take them.
Please read the FDA-approved medication guides for pioglitazone and rosiglitazone for a complete list of precautions.
What dosage can I take, and how should I take it?
Dosage range is 15-45mg once daily for Actos, and 4mg to 8mg daily for Avandia. Both are taken by mouth.
What are the most common side effects of pioglitazone or rosiglitazone?
- Fluid retention and swelling
- Weight gain
- Shortness of breath
- Upper respiratory infections
- Headache
- Other potential side effects to these medicines are listed in the accompanying medication guide.
What else should you know before taking Actos (pioglitazone) or Avandia (rosiglitazone)?
Please read the information contained in the accompanying medication guide before taking one of these medicines.
SGLT-2 Inhibitors
Invokana (generic name: canagliflozin)
Farxiga (generic name: Dapagliflozin)
Jardiance (generic name: Empagliflozin)
What are SLGT-2 Inhibitors?
When glucose passes through the kidneys, some of it is reabsorbed and brought back into the bloodstream. This is normal, and does not cause any problems in people without diabetes. SGLT-2 inhibitors work by interfering with this process and allowing more glucose to be eliminated through the urine, thereby lowering blood sugar. SGLT-2 inhibitors not only lower blood sugar, but may also cause weight loss and lowering of blood pressure in some people.
Invokana
(Generic Name: canagliflozin)
What is Invokana?
Invokana was the first of its class to be approved by the Food and Drug Administration. It is a type of SGLT-2 inhibitor that slows the glucose recovery process by the kidneys, removing more glucose from the body in the urine. Increased excretion of glucose through urination leads to lower blood sugar levels.
This drug is for people with type 2 diabetes, and it is to be used along with diet and exercise.
Who can take Invokana?
Selected people over eighteen years of age with type 2 diabetes.
Who should not take Invokana?
People with type 1 diabetes or diabetic ketoacidosis, and people with severe kidney problems or who are on dialysis.
What dosage can I take, and how should I take it?
The initial dose is 100mg, taken once daily by mouth.
How often and when should I take Invokana?
Invokana should be taken once per day, as prescribed by a medical professional.
It is usually recommended that Invokana be taken before the first meal of the day. However, your doctor will tell you exactly how much to take, and when to take it.
What are THE possible side effects?
Possible side effects include dehydration, vaginal and penile yeast infections, urinary tract infections, changes in frequency of urination, hyperkalemia (too much potassium in the system), impairment of kidney function, low blood pressure, and increases in LDL cholesterol.
Increased loss of water and sodium from the medication can cause dehydration. If you feel dizzy, faint, lightheaded, or weak, see your medical professional. Risk of dehydration may be further increased if you have low blood pressure, take medicines to lower your blood pressure, are on a low-sodium diet, have kidney issues, or are sixty-five years of age or older.
There are risks involved with urination of increased levels of glucose. Urinary tract infections can result from urine with high sugar concentration. Women who take this drug may get vaginal yeast infections, and men may get a yeast infection of the skin around the penis. Talk to your doctor about what to do if you have symptoms of a yeast infection. Your doctor may suggest an over-the-counter antifungal medicine. Talk to your doctor right away if you use an over-the-counter antifungal medication and your symptoms do not go away.
Taking this drug with other diabetes medications can increase your risk of low blood sugar (hypoglycemia). If you experience symptoms including headache, drowsiness, weakness, dizziness, confusion, irritability, hunger, rapid heartbeat and/or sweating, you may be experiencing low blood sugar.
Are other diabetes medications used with it?
Invokana can be used in combination with other medicines. You are encouraged to consult with your doctor or pharmacist to learn about the interactions between Invokana and any medications you may be taking.
What should I tell my doctor before taking Invokana?
Tell your doctor about any other medications you are on, as well as general allergies and allergies you may have to the ingredients of Invokana. Also, tell your doctor if you have diabetic ketoacidosis.
Farxiga
(Generic name: dapagliflozin)
What is Farxiga?
Farxiga is the second drug in its class to be approved by the Food and Drug Administration. It is a type of SGLT-2 inhibitor that slows the glucose recovery process by the kidneys, thereby moving more glucose from the body into the urine. The extra glucose that passes into the urine is then eliminated from the body through urination, thereby lowering glucose levels. This drug is to be used along with diet and exercise to help lower blood sugar for people with type 2 diabetes.
Who can take Farxiga?
Selected people over eighteen years of age with type 2 diabetes.
Who should not take Farxiga?
People with type 1 diabetes or diabetic ketoacidosis, and people with severe kidney problems or who are on dialysis, should not take Farxiga. It should not be used if you have active bladder cancer. Your healthcare provider should do blood tests to check kidney function before and during treatment with Farxiga.
What dosage can I take, and how should I take it?
The initial dose is 5mg, taken once daily by mouth in the morning, with or without food. The dose may be increased to 10mg daily on the advice of your healthcare professional.
How often and when should I take Farxiga?
Farxiga should be taken once every day, as prescribed by a medical professional.
It can be taken with or without food.
What are the most common side effects?
- Vaginal yeast infections
- Nasopharyngitis (think cold and sore throat symptoms)
- Urinary tract infections
- Dehydration
- Penile yeast infections
- Hyperkalemia (too much potassium in the system)
- Low blood pressure
- Increases in LDL cholesterol
Are other diabetes medications used with it?
Farxiga can be used in combination with other medicines. You are encouraged to consult with your doctor or pharmacist to learn about the interactions between Farxiga and the medications you are taking.
What should I tell my doctor before taking Farxiga?
Tell your doctor about any other medications you are on, as well as general allergies and allergies you have to the ingredients in Farxiga. Also, tell your doctor if you have a history of bladder cancer.
What else should I know before taking Farxiga?
Please see the accompanying FDA approved medication guide for more information about warnings and side effects.
Jardiance
(Generic name: empagliflozin)
What is Jardiance?
Jardiance (empagliflozin) is an inhibitor of the sodium-glucose co-transporter 2 (SGLT2) used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. It works by allowing unneeded glucose to be eliminated by the urine, thereby lowering blood sugar.
Who can take Jardiance?
Jardiance is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Jardiance is not recommended for patients with type 1 diabetes, or for the treatment of diabetic ketoacidosis. It should not be given to people with severe kidney problems or patients on dialysis.
Advantages
In clinical trials, patients did not gain weight, and in fact, some lost weight when taking Jardiance. It also helped to slightly improve blood pressure. It can be used in combination with other medications such as Metformin, pioglitazone, sulfonylureas, or insulin for added benefit.
What dosage can I take, and how should I take it?
The recommended dose of Jardiance is 10mg once daily in the morning, taken with or without food. Jardiance may interact with diuretics, insulin, or insulin secretagogues. Tell your doctor about all of the medications and supplements you use.
What are the common side effects?
- Dehydration
- Dizziness
- Lightheadedness
- Weakness
- Yeast infection
- Low blood sugar
- Urinary tract infection
Sulfonylureas
Amaryl (generic name: glimepiride)
DiaBeta (generic name: glyburide)
Diabinese (generic name: chlorpropamide)
Glucotrol (generic name: glipizide)
Glucotrol XL (generic name: glipizide extended release)
Glynase PresTab (generic name: glyburide)
Orinase (generic name: tolbutamide)
Tolinase (generic name: tolazamide)
What are sulfonylureas?
Sulfonylureas are a family of diabetes medicines that have been around for over fifty years. They work by increasing insulin release from beta cells in the pancreas, which then lowers your blood sugar. For these pills to work, your pancreas has to be able to make some insulin, so if you have had diabetes for a long time, your pancreas might not have enough functioning beta cells for these medicines to work.
Who can take them?
Sulfonylureas are for selected adults with type 2 diabetes.
Who should not take a sulfonylurea?
They are not meant to treat type 1 diabetes or diabetic ketoacidosis, and are not for anyone who is pregnant or planning to become pregnant. They are possibly unsafe for anyone who is breastfeeding. If you have had a reaction to a sulfa drug, you should tell your healthcare provider. Elderly people who are at more of a risk for hypoglycemia should probably avoid sulfonylureas.
What dosage can I take, and how should I take it?
The members of this family of medicines all work the same way, but there are differences in how long they last and how often they are given. The dose you take will depend upon which particular sulfonylurea is prescribed for you.
Advantages
Sulfonylureas are all available generically, and are usually very inexpensive. They can also be combined with some of the other diabetes medicines, such as Metformin.
Disadvantages
These medicines are not very durable, meaning that their beneficial effect seems to go away over time. They can (and often do) cause low blood sugar, especially if you skip or delay a meal, or do some extra physical activity that you are not used to doing. They may also cause weight gain in some people.
What are the most common side effects of sulfonylureas?
- Hypoglycemia
- Upset stomach
- Skin rash or itching
- Weight gain
- Skin reactions to sun exposure (photosensitivity)
- These are not all of the side effects, so ask your healthcare provider for advice.
Glinides
Prandin (generic name: repaglinide)
Starlix (generic name: nateglinide)
What are Glinides?
Glinides are a class of medicines that help the pancreas to release insulin, resulting in a lowering of blood sugar. They work in a similar manner to the sulfonylureas, with the big difference being that they start to work faster and go away sooner. Because of the way they work, they can be taken just before a meal to help lower after-meal blood sugar rises, and since they stop working in about four hours, they are less likely to cause low blood sugar. These medicines may have an advantage in people with irregular eating schedules, because they are only taken if a meal is to be consumed. As type 2 diabetes progresses, the pancreas loses the ability to produce insulin, and glinides may no longer help.
Prandin
(Generic name: repaglinide)
What is repaglinide?
Repaglinide (brand name Prandin) is one of the members of the group of diabetes medicines that we have nicknamed glinides. Repaglinide was the first of the glinides to be marketed in the U.S. Glinides are taken just before meals, and cause the pancreas to release insulin. They primarily help to control after-meal blood sugar. This medicine only seems to work for about four to six hours after a dose, but that is an advantage, because it may cause fewer low blood sugar problems.
Who can take repaglinide?
Selected adults with type 2 diabetes can take repaglinide.
Who should not take it?
- Those with type 1 diabetes or diabetic ketoacidosis
- People with impaired kidney or liver function
- Women who are pregnant or breastfeeding
Advantages
Since glinides have a shorter duration of action, they seem to cause hypoglycemia less often than long-acting drugs that stimulate insulin output. For this reason, they are a better choice than long-acting sulfonylureas (SFUs), especially for people with erratic eating habits who often skip or delay meals. Repaglinide should not be taken if the meal is going to be skipped. It can also be given in combination with some other diabetes medications.
Disadvantages
Repaglinide must be timed correctly, and taken about fifteen to thirty minutes before each major meal, up to four times daily. Remember, the dose should not be taken if the meal is going to be skipped.
What dosage can I take, and how should I take it?
The initial dosage is .5mg, fifteen to thirty minutes before each meal, and it can be increased on a weekly basis up to 4mg before meals. It may be taken up to four times a day, if you eat four times in a day. The maximum total daily dose is 16mg in one twenty-four-hour period. If you skip a meal, you should not take the dose of repaglinide.
What are most common side effects?
- Low blood sugar, especially if you take the medicine and fail to eat afterward
- Upper respiratory symptoms or flu-like symptoms
- Back pain
- Diarrhea
- Dizziness
Starlix
(Generic name: nateglinide)
What is nateglinide?
Nateglinide (nah-TAG-lin-ide) is one of the members of a group of diabetes medicines called glinides. Nateglinide lowers blood glucose by stimulating the release of insulin from the pancreas. There are several families of medicines that stimulate the pancreas to produce insulin, but glinides have their own way of doing it that is a little different from some of the others. Glinides are taken just before meals, and cause insulin release that primarily helps to control after-meal blood sugar. They only seem to work for about four hours after a dose, but that is an advantage, because they seem to cause fewer low blood sugar problems.
Who can take nateglinide?
Selected adults with type 2 diabetes can take nateglinide.
Who should not take it?
- Those with type 1 diabetes or diabetic ketoacidosis
- People with impaired kidney or liver function
- Women who are pregnant or breastfeeding
Advantages
Since these medicines have a shorter duration of action, they seem to cause hypoglycemia less often than long-acting drugs that stimulate insulin output. For this reason, they are a better choice than long-acting sulfonylureas (SFUs), especially for people who have erratic eating habits and often skip or delay meals. They can also be given in combination with some other diabetes medications.
Disadvantages
They must be taken about thirty minutes before each major meal, up to three times daily. The dose should not be taken if the meal is skipped.
What dosage can I take, and how should I take it?
Nateglinide is taken at a dose of 60-120mg three times daily, up to thirty minutes before meals. It is not to be taken more than three times daily.
What are the most common side effects?
- Low blood sugar, especially if you take the medicine and fail to eat afterward
- Upper respiratory symptoms or flu-like symptoms
- Body aches and pains
- Dizziness
- Increased uric acid
Alpha-Glucosidase Inhibitors
Glyset (generic name: miglitol)
Precose (generic name: acarbose)
What are alpha-glucosidase inhibitors?
Alpha-glucosidase inhibitors are a class of oral medications that block the enzymes that digest starches. They help treat type 2 diabetes by causing a slower (and lower) rise of blood glucose throughout the day, mainly right after meals. There are now two alpha-glucosidase inhibitors: acarbose (AK-er-bose) and miglitol (MIG-leh-tall).
Who can take them? Who can’t?
Adults with type 2 diabetes can take alpha-glucosidase inhibitors with their doctor’s approval and supervision. You should avoid them if you have a history of gastrointestinal disease.
What dosage can I take, and how should I take it?
The initial dosage is 25mg, three times per day. This is adjusted at four- to eight-week intervals, and can increase to 50 or 100mg. It is taken orally, in tablet form.
How often should I take acarbose or miglitol?
Three times a day, at each meal. Your doctor might ask you to take the medicine less often, at first.
When should I take acarbose or miglitol?
With the first bite of a meal.
What are the possible side effects?
Taking this pill may cause stomach problems (gas, bloating, and diarrhea) that most often go away after you have taken the medicine for a while.
Are any other diabetes medications used with them?
Alpha-glucosidase inhibitors can be used in combination with other medicines. You are encouraged to consult with your doctor and pharmacist to learn about the interactions between alpha-glucosidase inhibitors and the medications you are taking.
What should I tell my doctor before taking alpha-glucosidase inhibitors?
Tell your doctor about any other medications you are on, as well as general allergies—and allergies you may have to the ingredients of acarbose or miglitol.
Welchol
(Generic Name: colesevelam HCl)
What is Welchol?
Welchol binds to the bile acids in the gut, resulting in a lowering of LDL cholesterol. Welchol has the unique ability to lower not only LDL, but also blood sugar levels. Welchol, along with diet and exercise, lowers blood sugar levels in patients with type 2 diabetes, and may be added to some other diabetes medications (Metformin, sulfonylureas, or insulin).
Who can take Welchol?
Selected adults can take Welchol to help treat type 2 diabetes, along with diet and exercise.
Who should not take Welchol?
- People with type 1 diabetes or diabetic ketoacidosis
- Those with a history of triglyceride-induced pancreatitis
- Those with triglyceride levels over 500mg/dL
- People with intestinal blockage, or who have trouble swallowing
- Those who take medicine for which absorption would be affected by Welchol
- People at risk for certain vitamin deficiencies
- Welchol can interfere with several important medicines. Check with your pharmacist or other healthcare provider before starting Welchol.
Advantages
It can help lower both blood sugar and bad cholesterol (LDL), and can be used in combination with some other diabetes medicines to produce a modest reduction in A1C levels (ninety-day average blood glucose levels). The dose may be taken either once or twice daily.
Disadvantages
The tablets are rather large, and the powder must be mixed before taking it. This medicine can reduce the effect of some other medicines if taken together, so it is important to speak with your pharmacist or healthcare provider about the best way to get the most out of all of your medicines.
What dosage should I take, and how should I take it?
The usual dose for diabetes is 3750mg daily. It can be taken in tablet or powder form. The tablets come in a 625mg size, so that means you would take a total of six tablets daily. The powder is available in both 1875 and 3750mg packets. The dose can be taken once a day, or divided into two doses taken with meals.
What are the most common side effects?
- Constipation
- Indigestion
- Nausea and vomiting
- Upper respiratory infections and flu-like symptoms
- Low blood sugar
- High triglycerides
- Body aches and pains
Reviewed by James A. Bennett, RPh, FACA, CDE, 10/16