Prescribing Drug Information of NIDDM Patients

8/6/2019 Prescribing Drug Information of NIDDM Patients

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Asif Imran Ruben

ID- 2007-1-70-039

Mashiur Rahman

ID- 2006-2-70-044

MD. Ruhul Amin

ID- 2007-1-70-039

MD. Nazmul Haque

ID- 2007-


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Type 2 Diabetes risk factors includesType 2 Diabetes risk factors includes

Age of 45 years or older

Obesity

Family history of diabetes

Diabetes during pregnancy

Impaired Glucose Tolerance ( IGT )

Physical inactivity


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Symptoms of Type 2 DiabetesSymptoms of Type 2 Diabetes

The symptoms of type 2 Diabetes vary from person toperson but may include:

Increased thirst

Increased hunger (especially after eating)

Dry mouthNausea and occasionally vomiting

Frequent urination

Fatigue (weak, tired feeling)

Blurred visionNumbness or tingling of the hands or feet

Frequent infections of the skin, urinary tract or vagina


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Drugs used to treat NIDDM PatientsDrugs used to treat NIDDM Patients

Medications that increase the insulin output by the

pancreas

Sulfonylureas primarily lower blood glucose levels byincreasing the release of insulin from the pancreas.

Sulfonylureas


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1st Generation-

Carbutamide

Acetohexamide Chlorpropamide

Tolbutamide

Tolazamide

2nd Generation- Glipizide

Gliclazide

Glibenclamide

Gliquidone

Glyclopyramide

3rd Generation-

Glimepiride


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What Do They Do?What Do They Do?

When the body does not have enough insulin, or does

not use the insulin it has effectively, blood sugar levelsincrease. Sulfonylureas stimulate beta cells in the

pancreas to produce more insulin and also help the body

use insulin, lowering blood sugar levels by up to 20%.

Who Should Not UseWho Should Not Use SulfonylureasSulfonylureas??

Patients with type 1 diabetes or with allergies to

sulfonamides (sulfa drugs) should not use sulfonylureas.

In addition, sulfonylureas may have to be discontinued in

patients who are exposed to high levels of physical

stress (infection, injury or surgery, for example), and mayhave to be stopped temporarily for patients who are not

eating regularly. Glyburide should not be taken

simultaneously with Tracleer (bosentan), which is used

in the treatment of pulmonary artery hypertension.


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Side EffectsSide Effects

Hypoglycemia

Weight gain

Drug interaction (mainly 1st Generation)

Allergic reaction

-Pruritus

-Rash


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Brands in BangladeshBrands in Bangladesh

Brand Name Generic Name Dose Company Name

Comprid Tablet Gliclazide 80 mg & 30 mg Square

Secrin 1 Tablet Glimepiride 1 mg , 2 mg, 3 mg& 4 mg

Square

DIALON Glimepiride Eskayef

Consucon Gliclazide 80 mg Incepta

Losucon 1 & 2 Glimepiride 1 mg & 2 mg Incepta

Glims Glimepiride ! Mg & 2 mg Opsonin

Glizid Gliclazide 80 mg Opsonin


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Meglitinides also work on the pancreas to promote

insulin secretion. Unlike sulfonylureas that bind to

receptors on the insulin producing cells, meglitinides

work through a separate potassium based channel on

the cell surface. Unlike the sulfonylureas which last

longer in the body, repaglinide (Prandin) and nateglinide

(Starlix) are very short acting, with peak effects within

one hour. For this reason, they are given up to three

times a day just before meals. Since these drugs alsoincrease circulating insulin levels, they may cause

hypoglycemia, but the literature suggests this is less

frequent than the hypoglycemia seen with sulfonylureas.

Meglitinides


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How It Works?How It Works?

Meglitinides prevent a rise in blood sugar levels by

increasing the amount of insulin produced by thepancreas, similar to the way sulfonylurea medications

work.


Low blood sugar Upper respiratory infections, nasal and sinus

inflammation, and bronchitis

Joint pain

Nausea Weight gain

While repaglinide may cause low blood sugar and weight

gain, these side effects are milder than in those people

who take glyburide


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DrugDrug--Drug InteractionsDrug Interactions

Azole antifungals and erythromycin may interfere with the

metabolism of repaglinide, resulting in hypoglycemia. Rifampin

may decrease the effectiveness of repaglinide, resulting in

hyperglycemia. Calcium channel blockers, corticosteroids,

estrogens, isoniazid, nicotinic acid, oral contraceptives,

phenothiazines, phenytoin, sympathomimetics, thiazide diuretics,

and thyroid supplements may cause hyperglycemia in

combination with other antidiabetic agents, so blood glucoselevels should be closely monitored when one of these drugs is

added or discontinued. Monoamine oxidase inhibitors, non-

selective beta blockers, NSAID's, probenecid, salicylates, and

sulfonamides may cause hypoglycemia in combination with other

antidiabetic agents, so blood glucose levels should be closelymonitored when one of these drugs is added or discontinued.

DrugDrug--Food InteractionsFood Interactions

Should be taken 1-30 minutes prior to meals


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Brand Name GenericName Dose CompanyName

Repanid Repaglinide 0.5 mg, 1 mg

& 2 mg

Opsonin

NomopilR

epaglinide 0.5 mg, 1 mg& 2 mg Incepta


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Medications that decrease the amount of glucose

produced by the liver-

Biguanides are another type of diabetes medicine.Biguanides that helps lower blood glucose by making sure

your liver does not make too much glucose. Biguanides also

lowers the amount of insulin in the body.

Biguanides


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Metformin

Phenformin


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The most common side effects of metformin are-

Temporary nausea.

Loss of appetite. Diarrhea.

Increased abdominal gas.

A metallic taste


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Brand Name Generic Name Dose Company

Name

Comet XR 1 Gm

TabletMetformin HCl 1000 mg

Square

Comet 1 Gm Tablet Metformin HCl 1 gmSquare

Comet 500 Tablet Metformin HCl 500 mg

Square

Comet 750 Tablet Metformin HCl 750 mgSquare

Comet 850 Tablet Metformin HCl 850 mgSquare

Comet X

R500 Tablet Metformin

HCl 500 mg

Square

GLUNORMetformin

hydrochlorideEskayef

GLUNOR XRMetformin

hydrochlorideEskayef

Mefoglip 500 & 850Metformin

Hydrochloride

500 mg & 850 mg Incepta


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Medications that increase the sensitivity of cells to

insulin

Thiazolidinediones are oral medications that help lowerblood sugar in type 2 diabetes. In addition to a healthy diet

and exercise, they are another way to control blood sugar

levels.

Thiazolidinediones


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Rosiglitazone

Pioglitazone


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WhatWhat ThiazolidinedionesThiazolidinediones Do?Do?

Thiazolidinediones help to lower insulin resistance in cells,improving the way that the body responds to insulin.

Thiazolidinediones are typically taken by mouth once or

twice daily. They may be used alone, with other pills or with

insulin.

Who Should Not UseWho Should Not Use ThiazolidinedionesThiazolidinediones??

People with type 1 diabetes (requiring regular insulin

injections), heart failure or liver disease should not use

thiazolidinediones. Children and pregnant or nursing womenshould also avoid using these medications. People with eye

or bone problems should talk with their health care providers

before taking thiazolidinediones.


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Some reported side effects of thiazolidinediones include:

Upper respiratory infections and sinusitis

Headaches.

Mild anemia

Retention of fluid in the body. This may lead to heartfailure

Weight gain

Muscle pain

Women who take rosiglitazone (Avandia) or pioglitazone(Actos) may increase their risk for upper arm or foot

fractures, according to a warning from the U.S. Food and

Drug Administration


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Sensulin Rosiglitazone 2 mg & 4 mg

Square

Tos Pioglitazone 15 mg & 30 mg

Square

Piol Pioglitazone 15 mg & 30 mg Opsonin

Piodar 15 & 30 Pioglitazone 15 mg & 30 mg Incepta


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Medications that decrease the absorption of

carbohydrates from the intestine

A class of oral medications for type 2 diabetes that decrease

the absorption of carbohydrates from the intestine, resulting

in a slower and lower rise in blood glucose throughout the

day, especially right after meals.

Alpha glucosidase inhibitor


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How It Works?How It Works?

Acarbose and miglitol help keep blood sugar levels within a

safe range by slowing the rate at which the intestines absorb

sugar (glucose) from food. These medications do not cause

the pancreas to produce more insulin. They will not cause

low blood sugar (hypoglycemia) unless they are used in

combination with other oral medications for diabetes or with

insulin.

ContraindicationsContraindications

Diabetic Ketoacidosis (DKA)

Intestinal disorder Inflammatory Bowel Disease

Colonic Ulceration

Partial Intestinal Obstruction


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Poorly tolerated

Gastrointestinal side effects (unabsorbed carbohydrate)

Abdominal Pain

Diarrhea

Flatulence

Hypoglycemia

If used with other Oral Hypoglycemic agent or Insulin

Use oral glucose (not sucrose) to treat Hypoglycemia


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Dosages

Acarbose (Precose) Start dose: 25 mg PO tid at start of meal

Maintenance: 50-100 mg PO tid

Miglitol (Glyset)

Start dose: 25 mg PO tid at start of meal Maintenance: 50-100 mg PO tid


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New medications that affect glycemic control

Pramlintide (Symlin) is the first in a new class of injectable, anti-

hyperglycemic medications for use in patients with type 2 or type 1

diabetes treated with insulin. Pramlintide, the active ingredient in Symlin,

is a synthetic analog of human amylin, a naturally occurring

neuroendocrine hormone synthesized by pancreatic beta cells that helps

control glucose control after meals. Amylin, similar to insulin, is absent or

deficient in patients with diabetes.When used with insulin, this

compound can improve glycemic control and has additional benefits that

cannot be realized with insulin alone.

According to published data, Symlin reduces post meal blood sugar

peaks, reduces glucose fluctuations throughout the day, enhancessatiety (the sensation of fullness) leading to potential weight loss, and

lowers mealtime insulin requirements. Studies have shown it improves

A1C beyond the effect of insulin alone.

Symlin is taken just prior to meals, three times a day. It is given in

injection form and is used for:

Symlin (pramlintide)


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Type 2 diabetes, as an additional treatment in patients who

use mealtime insulin therapy and have failed to achieve

desired glucose control despite optimal insulin therapy, with

or without a concurrent sulfonylurea agent and/or metformin.

Type 1 diabetes, as an additional treatment in patients who

use mealtime insulin therapy and who have failed to achieve

desired glucose control despite optimal insulin therapy.

Symlin is considered a therapy option in patients withinsulin-using type 2 or type 1 diabetes, that are unable to

achieve adequate glycemic control despite individualized

insulin management. Insulin-using patients with type 2

diabetes may also be taking a concurrent sulfonylurea agent

and/or metformin.


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Exenatide (Byetta) is a medication on the market that has it's origins in

an interesting place--the Gila monster's saliva. Scientists studying thissmall lizard noted it could go a long time without eating. They found a

substance in it's saliva that slowed stomach emptying, thus making the

lizard feel fuller longer. This substance was similar in nature to a gut

hormone found in humans known as GLP-1. GLP-1 is broken down in

the body by an enzyme called DPP-IV. So, if you could make a

substance like GLP-1 that was not so easy to breakdown, this would

have potential benefit; thus, the studies began. Ultimately, after

modifying this hormone, exenatide (with the trade name Byetta) was

developed.

Byetta is the first in a class of drugs for the treatment of type 2 diabetes

called incretin mimetics. Byetta has been shown to have many of thesame effects on sugar regulation as GLP-1, so it mimics the body's

natural physiology for self-regulating blood sugar. Namely, it slows the

release of glucose from the liver, slows stomach emptying thereby

regulating delivery of nutrients to the intestine for absorption, and works

centrally in the brain to regulate hunger.

Byetta (exenatide)


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Byetta is indicated as additional therapy to improve controlof blood sugars in patients with type 2 diabetes who are

taking metformin, a sulfonylurea, or a combination of

metformin and a sulfonylurea but who have not achieved

adequate sugar control. It enhances the way the insulin

producing beta cells in the pancreas work. Insulin secretionincreases only when blood sugars are high and decreases

as blood sugars approach normal. In addition to enhancing

the normal physiology of the beta cell, Byetta suppresses

glucose release from the liver, slows stomach emptying and

the absorption of nutrients including carbohydrate, and

reduces intake of food.


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Victoza (lyraglutide) is an injectable prescription medicine

that improves blood sugar (glucose) in adults with type 2

diabetes when used with a diet and exercise program.

Victoza is not insulin. It is not known if Victoza is safe and

effective when used with insulin. Victoza is not for people

with type 1 diabetes or people with diabetic ketoacidosis.

Victoza is not recommended for use in children. Victoza, like

Byetta, belongs to a class of medicines known as glucagon-

like peptide-1 (GLP-1) receptor agonists, which help thepancreas make more insulin after eating a meal.

Victoza (lyraglutide)


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GLP-1 in the body is broken down by an enzyme called DPP

IV. Logically, you can either make a synthetic GLP-1 that is

not broken down by this enzyme (for example, Byetta) OR

you could try to stop the enzyme that breaks down the GLP-

1 your body already makes. Hence, the new class of drugscalled DPP IV inhibitors. They do just that, that is, they

inhibit this enzyme from breaking down GLP-1. This allows

GLP-1 already in the blood to circulate longer. There are a

number of companies working on this class of drug.

DPP-IV inhibitors


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Combination medications

Glyburide/metformin (Glucovance), rosiglitazone/metformin

(Avandamet), glipizide/metformin (Metaglip), andpioglitazone/metformin (Actoplus met), and metformin/sitagliptin

(Janumet) are are five relatively new combination pills that are on

the market to treat diabetes.


GlyrosGlimepiride +

Rosiglitazone1 mg + 4 mg

Square

RezulinPioglitazone +

Metformin HCl15mg+500mg

Square

SensimetRosiglitazone +

Metformin HCl4mg+1000mg

Square

TosirinPioglitazone +

Glimepiride30mg+2mg

Square


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Documents

Prescribing Drug Information of NIDDM Patients