Oral Hypoglycemic Agents

1. Biguanides (Metformin) (Glibudon 500 mg) PC
2. Sulphonylurea (Glipizide(Glidiab), Glimepride(Amaryl), Gliclazide(Diamicron)) AC
3. TZD ( Rosiglitazone(Avandia) Qd->Bid, Pioglitazone(Actos) Qd) PO
4. α glucosidase inhibitor (Acarbose) WM
5. Rapid Acting Insulin Analog (Repaglinide(Novonorm), Nateglinide(Starlix))
6. DPPS (GLP 1 – Glucagon like peptide 1) inhibitor, Sitagliptin (Januvia) 1# Qd

1. Biguanides (Metformin) (Glibudon 500 mg) PC

Dosage: Can give 250 mg -> 850 mg Bid Tid (max dose=850 mg tid)
Mechanism: - decrease liver gluconeogenesis (main action)
-Increase insulin sensitivity
Side Effects: GI upset, Diarrhoea (most common)
Lactic acidosis in CRI patients,

2. Sulphonylurea (Glipizide(Glidiab), Glimepride(Amaryl), Gliclazide(Diamicron)) AC

AC: 30 min before meal
Mechanism: -Increase insulin secretion
Side Effects: hypoglycemia

3. TZD ( Rosiglitazone(Avandia) Qd->Bid, Pioglitazone(Actos) Qd) PO

Dosage: Avandia 4 mg -> 8 mg (max dose) daily
Actos 15 mg -> 45 mg (max dose) Qd.
Mechanism: -Increase insulin sensitivity
- Increase insulin uptake form muscle and adipose tissue.
Action: takes 2 weeks to 6 weeks. Act at nuclear receptor.
Side Effects: Fluid retension(5~10%). CI: CHF class 3 or 4
Elevated GOT and GPT. Check 3 monthly.
More severe anaemia.

4. α glucosidase inhibitor (Acarbose) WM

Dosage: 50~200 mg tid (max dose)
Mechanism: -Inhibit glucosidase degradation of polycyclic to monocyclic.
Side Effects: Abdominal pain, diarrhea, flatus passage.

5. Rapid Acting Insulin Analog (Repaglinide(Novonorm), Nateglinide(Starlix))

Dosage: Novonorm 1~4 mg tid (max dose), Starlix 120 mg tid (max dose)
Action: rapid action, short duration.( one meal one dose, no meal no dose)
Can use in CRI and easy to have hypoglycemic patients.
Mechanism: -Increase insulin release
Side Effects: Abdominal pain, diarrhea, flatus passage.


6. DPPS (GLP 1 – Glucagon like peptide 1) inhibitor
Sitagliptin (Januvia) 1# Qd

Mechanism: -Increase insulin release
(depend on serum glucose concentration)
-decrease gastric emptying time
Side Effects: GI upset.