Oral pharmacologic agents for treatment of type 2 diabetes mellitus
| Medication | Dosing | Renal dose adjustment | HbA1c reduction; monotherapy | HbA1c reduction; add-on | Hypoglycemia risk; monotherapy | Added benefits | Side effects/ disadvantages |
|---|---|---|---|---|---|---|---|
| SGLT-2 inhibitors | |||||||
| Canagliflozin | 100 mg once/day; can titrate to 300 mg/day | eGFR 45–60, ≤ 100 mg/day; eGFR < 45, avoid | 0.91%–116% | 0.37%–0.92% | Low | Weight loss, decreased blood pressure, works at all stages of type 2 diabetes mellitus | Genitourinary infections, mild increase LDL, volume depletion/ dizziness, transient increase in creatinine, less effective with decreased eGFR, euglycemic DKA |
| Dapagliflozin | 5 mg once/day; can titrate to 10 mg/day | eGFR < 60, avoid | 0.54%–0.66% | 0.4%–0.69% | Low | ||
| Empagliflozin | 10 mg once/day; can titrate to 25 mg/day | eGFR < 45, avoid | 0.74%–0.85% | 0.38%–0.64% | Low | ||
| Bile acid sequestrants | |||||||
| Colesevelam | 3.75 g once/day 1.875 g twice/day | No | 0%–0.5% | 0.3%–0.5% | Low | Decreased LDL, weight neutral | Increased triglycerides, constipation, decreased absorption of other medications |
| Dopamine-receptor agonists | |||||||
| Bromocriptine quick release | 0.8 mg once/day; titrate by 0.8 mg weekly until 1.6–4.8 mg/day achieved | No | 0.55% (single study) | 0.4%–0.7% | Low | Possible decreased CV events, weight neutral | Nausea, headache, diarrhea, fatigue |
CV = cardiovascular; DKA = diabetic ketoacidosis; eGFR = estimated glomerular filtration rate with units as mL/min/1.72m2; HbA1c = hemoglobin A1c; LDL = low-density lipoprotein; SGLT-2 = sodium-glucose cotransporter-2.
Based on information in Tran L, Zielinski A, Roach AH, et al. Pharmacologic treatment of type 2 diabetes: oral medications. Ann Pharmacother 2015; 49:540–556.