Diabetic Drugs
Protocols
Metformin Hydrochloride:
Brand name: Comet(square),Formet(biopharma)
Preparation:500mg,850mg,1gm,
Oral
Type 2 diabetes mellitus
Adult: Conventional preparation: Initially, 500 mg
Type 2 diabetes mellitus
Adult: Conventional preparation: Initially, 500 mg
bid or tid, or 850 mg 1-2 times daily, may increase
gradually to 2000 mg daily at intervals of at least 1 wk.
Maximum daily dose of 2550 mg per day.
Modified-release preparation: Initially, 500 mg once daily,
Maximum daily dose of 2550 mg per day.
Modified-release preparation: Initially, 500 mg once daily,
may increase in increments of 500 mg at intervals of at least 1 wk
to max 2000 mg once daily at night. If glycaemic control is not
sufficient, dose may be divided to give 1000 mg bid.
Not to exceed 2000 mg/day
Polycystic ovary syndrome
Initial: 500 mg/day in the morning for 1 wk, then 500 mg
Not to exceed 2000 mg/day
Polycystic ovary syndrome
Initial: 500 mg/day in the morning for 1 wk, then 500 mg
twice daily for 1 wk, then 1.5-1.7 g/day in 2-3 divided doses.
Elderly: Initial and maintenance dosing should be conservative.
Hepatic impairment: Avoid use; risk of lactic acidosis
Elderly: Initial and maintenance dosing should be conservative.
Hepatic impairment: Avoid use; risk of lactic acidosis
Oral
Type 2 diabetes mellitus
Child: >10 yr Initially, 500 mg 1-2 times daily or 850 mg once daily,
Type 2 diabetes mellitus
Child: >10 yr Initially, 500 mg 1-2 times daily or 850 mg once daily,
may increase gradually to max 2000 mg daily in 2 or 3 divided doses
at intervals of at least 1 wk.
Renal impairment
Obtain eGFR before starting metformin
eGFR <30 mL/min/1.73 m²: Contraindicated
eGFR 30-45 mL/min/1.73 m²: Not recommended to
Obtain eGFR before starting metformin
eGFR <30 mL/min/1.73 m²: Contraindicated
eGFR 30-45 mL/min/1.73 m²: Not recommended to
initiate treatment
Monitor eGFR at least annually or more often for
Monitor eGFR at least annually or more often for
those at risk for renal impairment (eg, elderly)
If eGFR falls below 45mL/min/1.73 m² while taking
If eGFR falls below 45mL/min/1.73 m² while taking
metformin, risks and benefits of continuing therapy
should be evaluated
If eGFR falls below 30 mL/min/1.73 m²: while taking
If eGFR falls below 30 mL/min/1.73 m²: while taking
metformin, discontinue the drug
Should be taken with food.
Type 2 DM, Polycystic ovarian syndrome,
Acute or chronic metabolic acidosis with or without
coma (including diabetic ketoacidosis). Renal failure,
severe renal or hepatic impairment, acute conditions
which may affect renal function e.g. dehydration,
severe infection or shock. Cardiac failure, CHF,
IDDM, severe impairment of thyroid function; acute
or chronic alcoholism. Acute or chronic diseases which
may cause tissue hypoxia e.g. cardiac or respiratory
failure, recent MI or shock. Pregnancy, lactation.
Anorexia, nausea, vomiting, diarrhoea, wt loss, flatulence,
occasional metallic taste; weakness; hypoglycaemia; rash,
malabsorption of vit B12. Chest discomfort, flushing, palpitation,
chills, headache, lightheadedness, indigestion, abdominal
discomfort.
Potentially Fatal: Lactic acidosis in presence of renal failure
Potentially Fatal: Lactic acidosis in presence of renal failure
and alcoholism. Patients may experience a metallic taste and
there may be weight loss, which in some diabetics
could be an advantage.
Biguanides
Category: Not Classified
pregnancy_description
pregnancy_description
Metformin is a biguanide w/ antihyperglycaemic effects,
lowering both basal and postprandial plasma glucose.
It decreases hepatic glucose production by inhibiting
gluconeogenesis and glycogenolysis; delays intestinal
absorption of glucose; and enhances insulin sensitivity by
increasing peripheral glucose uptake and utilisation.
Additive effect w/ sulfonylureas. Thiazide diuretics, corticosteroids,
phenothiazines, OC, sympathomimetics, niacin, Ca channel blockers
and isoniazid may exacerbate loss of glycaemic control. ACE inhibitors
may reduce fasting blood glucose concentrations. May increase
serum level w/ cimetidine. Potentially Fatal: Concurrent use w/
iodinated contrast agents may increase the risk of
metformin-induced lactic acidosis.
Per Unit Price: Tk. 4.02
Package: 100's pack
Package: 100's pack
Linagliptin:
Brand name: Linatab(incepta)
Linita(square),Lijenta(nippro)
Preparation: 5 mg tablet
Oral
Type 2 diabetes mellitus
Adult: 5 mg once daily.
Indicated for adults with diabetes mellitus
Type 2 diabetes mellitus
Adult: 5 mg once daily.
Indicated for adults with diabetes mellitus
type II along with diet and exercise to lower
blood sugar; may be used as monotherapy or
in combination with other common antidiabetic
medications including metformin, sulfonylurea,
pioglitazone, or insulin.
Elderly: No dose adjustment is necessary based on age.
Hepatic or renal impairment: No dosage adjustment required.
Elderly: No dose adjustment is necessary based on age.
Hepatic or renal impairment: No dosage adjustment required.
Safety and efficacy not established
Renal Impairment: No dose adjustment.
May administer with or without food
Type 2 Diabetes Mellitus
Patients with a history of a hypersensitivity reaction to
linagliptin, such as urticaria, angioedema, or bronchial
hyperreactivity. Type 1 DM. Treatment of diabetic ketoacidosis.
1-10%
Nasopharyngitis (4.3%),Hyperlipidemia (2.8%; with pioglitazone),
Nasopharyngitis (4.3%),Hyperlipidemia (2.8%; with pioglitazone),
Cough (2.4%; with metformin and sulfonylurea),Hypertriglyceridemia
(2.4%; with sulfonylurea),Weight gain (2.3%; with pioglitazone),
Hypoglycemia 7.6% overall incidence, 22.9% incidence compared
Hypoglycemia 7.6% overall incidence, 22.9% incidence compared
with placebo plus metformin and a sulfonylurea
Incidence similar to placebo with monotherapy or combined with
Incidence similar to placebo with monotherapy or combined with
metformin or pioglitazone
Dipeptidyl Peptidase-4 (DPP-4) inhibitor
Category: Not Classified
pregnancy_description
pregnancy_description
Dipeptidyl peptidase 4 (DPP-4) inhibitor; increases and prolongs
incretin hormone activity which is inactivated by DPP-4 enzyme.
Incretins regulate glucose homeostasis by increasing insulin
synthesis and release from pancreatic beta cells and reducing
glucagon secretion from pancreatic alpha cells .
Increased risk of hypoglycaemia when used w/ an insulin
secretagogue (e.g. sulfonylurea) or insulin. Plasma concentration
of linagliptin may be decreased by strong inducers of P-glycoprotein
(e.g. rifampicin) and may be increased by strong P-glycoprotein
inhibitors (e.g. ritonavir).
Per Unit Price: Tk. 15
Package: 20's pack
Package: 20's pack
Gliclazide:
Preparation: Comprid(square),consucon(incepta)
Dimerol(drug int)
Preparation: 60 & 80 mg
Oral
Type 2 diabetes mellitus
Adult: Initially, 40-80 mg daily gradually increased to
Type 2 diabetes mellitus
Adult: Initially, 40-80 mg daily gradually increased to
320 mg daily if necessary. Doses >160 mg daily are
given in 2 divided doses.
Modified-release tab: Initially, 30 mg once daily, may
Modified-release tab: Initially, 30 mg once daily, may
increase in increments of 30 mg up to max 120 mg daily.
Interval between doses should be at least 1 mth.
For non-respondent patients, dose may be increased after 2 wk.
For non-respondent patients, dose may be increased after 2 wk.
Should be taken 30 mintues before meal or with meal.
Type 2 DM
Type 1 DM, diabetes complicated with ketoacidosis; hypersensitivity;
severe renal and hepatic impairment. Pregnancy and lactation.
GI disturbances, skin reaction, leucopenia, thrombocytopenia,
agranulocytosis, haemolytic anaemia, cholestatic jaundice,
vomiting, diarrhoea, gastritis, increased transaminases.
Sulfonylureas
Category: Not Classified
pregnancy_description
pregnancy_description
Gliclazide stimulates insulin secretion from pancreatic beta-cells,
reduces insulin uptake and glucose output by the liver, and
increases insulin sensitivity at peripheral target sites. It
decreases microthrombosis by partial inhibition of platelet
aggregation and adhesion, and by restoring fibrinolysis w/ an
increase in tissue plasminogen activator (t-PA) activity.
May increase hypoglycaemic effect w/ phenylbutazone. Potentiation
of blood glucose lowering effect w/ other antidiabetics (e.g. acarbose,
insulins, metformin), beta-blockers, ACE inhibitors, H2-receptor
antagonists, MAOIs, sulfonamides, clarithromycin and NSAIDs.
Chlorpromazine, glucocorticoids, ritodrine, salbutamol and terbutaline
may cause increases in blood glucose levels. May diminish hypoglycaemic
effect w/ danazol. May increase anticoagulant effect of warfarin. Potentially
Fatal: Increased hypoglycaemic effect w/ miconazole
Per Unit Price: Tk. 7.02
Package: 60's pack
Package: 60's pack
Glimepiride:
Brand name: Amaryl(synovia),Dialon(SKF)
preparation: 1,2,3 mg
Oral
Type 2 diabetes mellitus
Adult: Initially, 1-2 mg daily. May be increased in
Type 2 diabetes mellitus
Adult: Initially, 1-2 mg daily. May be increased in
increments of 1-2 mg at intervals of 1-2 wk.
Maintenance: 4 mg daily. Max: 6 mg daily.
Elderly: Initially, 1 mg once daily.
Hepatic impairment: Severe: Contraindicated.
Elderly: Initially, 1 mg once daily.
Hepatic impairment: Severe: Contraindicated.
Safety and efficacy not established
Renal impairment: 1 mg PO qDay; titrate dose
based on fasting blood glucose levels
Severe: Contraindicated.
Severe: Contraindicated.
Should be taken with food. Take immediately before o
during breakfast, or the 1st main meal of the day.
Do not skip meals.
Type 2 DM
Diabetic ketoacidosis with or without coma.
>10%
Hypoglycemia (4-20%)
1-10%
Dizziness (1.7%),Asthenia (1.6%),Headache (1.5%),
Hypoglycemia (4-20%)
1-10%
Dizziness (1.7%),Asthenia (1.6%),Headache (1.5%),
Nausea (1.1%)
<1%
Allergic skin reactions,Erythema,Morbilliform or maculopapular
<1%
Allergic skin reactions,Erythema,Morbilliform or maculopapular
eruptions,Pruritus,Urticaria,Diarrhea,Gastrointestinal pain,Vomiting,
Agranulocytosis,Anemia,Aplastic anemia,Leukopenia, Pancytopenia
,Thrombocytopenia, hemolytic,Cholestasis,Elevation of liver enzyme
levels,Hepatic porphyria reactions,Jaundice (rare),Disulfiram-like
reactions,Hyponatremia
Sulfonylureas
Category: C
pregnancy_description
pregnancy_description
Glimepiride stimulates the insulin release from pancreatic
beta-cells and reduces glucose output from the liver. It also
increases insulin sensitivity at peripheral target sites.
Salicylates, sulfonamides, chloramphenicol, clarithromycin,
coumarin anticoagulants, probenecid, CYP2C9 inhibitors, fibric
acid derivatives, disopyramide, fluoxetine, quinolones, ACE
inhibitors, MAOIs and ?-blockers may potentiate the hypoglycaemic
action of glimepiride. Thiazides and other diuretics, corticosteroids,
phenothiazines, thyroid products, oestrogens, phenytoin,
nicotinic acid, sympathomimetics and CYP2C9 inducers may
reduce hypoglycaemic effect of glimepiride. Reduced plasma
concentration w/ colesevelam.
Per Unit Price: Tk. 6.9
Package: 30's Pack
Package: 30's Pack