The Medicine of Diabetes Therapy

Pharmacotherapy of Diabetes (Lantana Pharmacy in Camarillo: Jae K Shin R.Ph 323- 810- 3360)

1. Biguanides

• Metformin (Glucophage, Glucophage XR®)
• Primarily decreases hepatic glucose production and also increases peripheral insulin sensitivity. (Opens the door of cells so glucose can be utilize better)
• 1st line agent in most patients
• No hypoglycemia risk
• Monitor diarrhea and abdominal cramping. (It can be reduced by taking with food)

2. 2nd Generation Sulfonylureas

• Glimepiride(Amaryl®)
• Glipizide (Glucotrol®, Glucotrol XL®)
• Glyburide (Diabeta®, Micronase®)
• Micronized glyburide (Glynase®)
• Stimulates insulin secretion from the pancreas
• 2nd line agent
• Risk of Hypoglycemia is very common
• Any agent should be taken before meals

3. Combination of Biaguanides and 2nd generation Sulfonylureas

• Glipizide/Metformin (Metaglip®)
• Glyburide/Metformin Glucovanc®)

4. a-glucosidase inhibitors

• Acarbose (Precose®)
• Miglitol (Glyset®)
• Prevent digestion of Carbohydrates

5. Thiazolidinediones

• Pioglitazone (Actos®)
• Pioglitazone/Metformin (ActosPlusMet®)
• Primarily increase insulin sensitivity. Also decreases hepatic glucose output

6. Meglitinide

• Repaglinide (Prandin®)
• Nateglinde (Starlix®)
• Increase insulin secretion from pancreas

7. Amylin Mimetics(Injection)

• Pramlintide (Symlin®)
• Slows down the movement of food through the intestine. This slows down the absorption of glucose from the intestine, which reduces sudden
• increases in blood glucose.

8. Insulin Delivertives(Injection)

• 1. Regular(humulin, novolin)
• 2. NPH
• 3. 70/30(N+R)
• 4. 50+50(N+R)
• 5. Lispro (Humalog); 100units/ml 10ml bottle, Kwikpen 3ml X 5
• 6. Lispro(Hmalog 200); 200units/ml Kwikpen 3ml X 5
• 7. 75/25(lispro protamin +Humalog)
• 8. 50+50(lisipro protamin +Humalog)
• 9. Aspart(Novolog)
• 10. 70/30(Aspart protamine+Novolog)
• 11. Glulisine(Apidra)
• 12. Glargine(Lantus): 100units/ml, 10ml bottle, Lantus Solostar 3ml X 5
• 13. Glargine(Toujeo): 300units/ml Toujeo Solostar 1.5ml X 5
• 14. Detemir(Levemir)

9. GLP-1 AG(incretin Mimetic)(Injection, but Not Insulin)

• Exenatide (Byetta®)
• Exenatide ER (Byduron®)
• Liraglutide (Victoza®)
• Dulaglutide(Trulicity*)
• Albiglutide(Tanzeum*)
• (Liraglutide(Saxenda*)—only approved Obesity control
• Increases insulin and decrease glucagon when glucose levels are elevated, increases satiety

10. DPP-IV Inhibitors

• Sitaglipitin (Januvia®)
• Sitagliptin/Metformin (Janumet®)
• Saxgliptin(Trajenta*)
• Saxgliptin/Metformin(Jentadueto*)
• linagliptin (Onglyza®)
• alogliptin (Nesina®)
• alogliptin/metformin(Kazano*)
• slogliptin/pioglitazon(Oseni*)
• Prevents incretin breakdown

11. SLGT-2

• Canagliflozin (Invokana®)
• Canagliflozin/Metformin(Invokamet)
• Dapagliflozin(Farxiga*), Dapagliflozin/Metformin(Xigduo XR)
• Empagliflozin(Jandiance*), Empagliflozin/Metformin(Synjardy)
• Empagliflozin/linagliptin(Glyzambi*)
• Reduces renal glucose reabsorption and increasing urinary excretion of glucose

12. Inhailed Insulin

• Afrezza(human insulin powder); single use 4 units, 8 units, 12 units/each short acting