Antidiabetic Oral Medications

Oral Hypoglycemic Agents

Group

 Action Adverse Effects Remarks
Sulfonylureas

1st Generation:

Chlorpropamide (Diabinese)

2n Generation:

Glyburide (DiaBeta)

Glipizide (Glucotrol)
  • Stimulates release of insulin.
  • Increases insulin receptor sensitivity.
  • Hypoglycemia
  • Wt gain
  • GI distress
  • Hepatotoxicity
  • Possible disulfirim reaction if taken concurrently with alcohol.
 The sulfonamide component in the typical sulfa antibiotics is of a slightly different molecular structure than that in sulfonylureas. Although cross-reactivity is technically possible, current literature does not consider this likely, and sulfonylureas are typically well tolerated in patients with a sulfa allergy.
Meglitinides

nateglinide (Starlix)

repaglinide (Prandin)

 Stimulate insulin release.
  • Hypoglycemia
  • Upper resp infections
  • Flulike symptoms
  • Back pain
 Short duration
Biguanides

Metformin – generic name – only drug in this class

Immediate release brand names:

Glucophage, Riomet

Extended release brand names:

Fortamet, Glucophage XR, and Glumetza
  • Delays gi uptake of glucose
  • Decreases gluconeogenesis
  • Decreases glycogenolysis
  • Decreases insulin resistance
  • Mostly GI: A/N/V/D
  • Metallic taste
  • Lactic acidosis – treat with hemodialysis

Does not cause wt gain and rarely causes hypoglycemia.

 Should not be given to patients with impaired renal function, due to possibility of lactic acidosis.
Contraindications:
Heart failure, liver failure, hx of lactic acidosis, or concurrent serious infections.
Two days before or after IV contrast.
Garlic and ginseng may increase hypoglycemia.
Alpha-Glucosidase Inhibitors

Acarbose (Precose)

 Block enzyme action in small intestine inhibiting breakdown of complex CHO into mondosaccharides. CHO must be in monosaccharide form for absorption.
  • Mostly GI: flatulence, diarrhea, abdominal distention
  • Hypoglycemia
 Hypoglycemia must be treated with glucose and not sucrose (table sugar).
Garlic and ginsing may increase hypoglycemia.
Thiazolidinediones (or glitazones)

Pioglitazone (Actos)

Rosiglitazone (Avandia)
  • Decreases insulin resistance.
  • Inhibits hepatic gluconeogenesis.
  • Fluid retention
  • Headache
  • Wt gain
  • Hepatotoxicity
  • Hypoglycemia rare
 Monitor liver function
Contraindications:
Heart failure


Source: Adams, M.P., & Holland, L.N. (2011). Pharmacology for nurses: A pathophysiologic approach. Pearson; Boston, Mass.
Pharm Oral Hypoglycemic Agents