Sitagliptin (100mg a day) DPP-4 inhibitor – inhibits DPP-4 enzyme resulting in increased availability of incretin hormones which stimulate insulin secretion Renal function: Reduce dose to 50mg od if eGFR 30-50 ml/min/1.73m² Reduce dose to 25mg od if eGFR < 30 ml/min/1.73m² GI problems Nasopharyngitis Pancreatitis Rash Take with or without food Hypo unlikely if used on its own Pancreatitis symptoms include persistent, severe abdominal pain Weight neutral Linagliptin (5mg a day) Same as sitagliptin No dose adjustment needed in renal and hepatic impairment Cough Nasopharyngitis Pancreatitis Same as sitagliptin Same as sitagliptin Alogliptin (25mg a day) Same as sitagliptin Renal function: Reduce dose to 12.5mg od if eGFR Reduce dose to 6.25mg if eGFR < 30 ml/min/1.73m² Avoid in severe hepatic impairment GI problems Nasopharyngitis Pancreatitis Rash Same as sitagliptin Same as sitagliptin Not licensed for monotherapy Dapagliflozin (10mg a day; initiation not recommended in ≥ SGLT-2 inhibitor – reversibly inhibits SGLT-2 in proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion Renal function: Avoid if eGFR <60ml/min/1.73m² Hepatic function: Initial dose 5mg a day in severe impairment, increase according to response GI problems Thirst Polyuria Increased risk of genital infections UTI Low BP Volume depletion Risk of DKA Take with or without food Hypo unlikely if used on its own MHRA advice on risk of DKA DKA symptoms: N&V, abdominal pain, sleepiness, a sweet smell to the breath Possible wt loss
Insulin regimens for T2DM Treatment option should reflect Lifestyle, general well being, ability to self-test BGs Presence of obesity Choice of device NICE recommend Continue to offer metformin if no contraindications or intolerance Review the continued need for other hypoglycaemic drugs Regimens A single daily (usually bedtime) dose of basal insulin or BD (before breakfast and evening meal) pre-mixed combinations or Basal bolus – basal insulin + short or rapid acting insulin for meal times Human NPH insulin – preferred basal insulin as per NICE
Drug Renal and hepatic function Side effects Advice for patients Other info Atorvastatin (10mg to 80mg a day) Renal function: Initially 20mg a day in CKD, increased if necessary (on specialist advice if eGFR < 30ml/min/1.73m²); max 80mg a day Hepatic function: Caution in pts with history of liver disease Avoid in active liver disease, discontinue if transaminases of more than 3x upper limit Myalgia Sleep disturbance Hyperglycaemia Hepatitis GI problems Can be taken any time of the day If taking at night and problem with sleep, change to morning Report unexplained muscle pain, tenderness or weakness to GPs Not more than one or two small glasses of grapefruit juice a day Choice of statin as per NICE guidance Beware of drug interaction such as antibiotics, antifungals, etc Simvastatin (10mg to 80mg at night) Renal function: Doses >10mg a day should be used with caution if eGFR < 30ml/min/1.73m² Hepatic function: Same as atorvastatin Same as atorvastatin Take at night Report unexplained muscle pain, tenderness or weakness to GPs Avoid grapefruit juice Beware of drug interaction such as antibiotics, antifungals, calcium channel blockers, etc