Diabetes Treatments

DIABETES TREATMENTS
Generic	Brand	Strength	Form	Dose
ALPHA-GLUCOSIDASE INHIBITOR
acarbose	—	25mg, 50mg, 100mg	tabs	Adults: Initially 25mg 3 times daily (once daily to minimize GI effects and increase gradually); increase at 4–8wk intervals if needed. Range: 50–100mg 3 times daily. ≤60kg: max 50mg 3 times daily; >60kg: max 100mg 3 times daily. Children: Not established.
miglitol	Glyset	25mg, 50mg, 100mg	tabs	Adults: Initially 25mg 3 times daily with meals (once daily to minimize GI effects and increase gradually). Increase to 50mg three times daily after 4–8wks; usual max 100mg 3 times daily. Children: Not established.
AMYLIN ANALOGUE/AMYLINOMIMETIC
pramlintide	Symlin	1000mcg/mL	SC inj	Adults: Type 1: initially 15mcg; titrate in 15mcg increments (max 60mcg) if no significant nausea occurs for ≥3 days. If nausea occurs at 45 or 60mcg dose, reduce to 30mcg; if not tolerated, consider discontinuing therapy. Type 2: initially 60mcg; may increase to 120mcg if no significant nausea occurs for ≥3 days; if nausea occurs at 120mcg reduce to 60mcg. Children: Not established.
BIGUANIDE
metformin	—	500mg, 850mg, 1000mg	tabs	Adults: ≥17yrs: Monotherapy: initially 500mg twice daily or 850mg once daily; may increase by increments of 500mg at 1wk intervals or 850mg in divided doses at 2wk intervals. Or, may increase from 500mg twice daily to 850mg twice daily after 2wks. Max 2.55g/day in 2–3 divided doses. Children: <10yrs: not established. ≥10yrs: Monotherapy only: initially 500mg twice daily; may increase by 500mg increments at 1wk intervals. Max 2g/day in 2 divided doses.
		500mg, 750mg, 1000mg	ext-rel tabs	Adults: ≥17yrs: initially 500mg once daily with PM meal; may increase by 500mg increments at 1wk intervals; max 2g/day in 1–2 divided doses. If higher doses needed, switch to IR form at max 2.55g/day in divided doses. Children: <17yrs: Not established.
		500mg/5mL	oral soln	Adults: ≥17yrs: initially 500mg (5mL) twice daily or 850mg (8.5mL) once daily; may increase in increments of 500mg at 1wk intervals or 850mg at 2wk intervals; max 2.55g/day (25.5mL) in 2–3 divided doses. Children: <10yrs: not established. ≥10yrs: initially 500mg (5mL) twice daily; may increase in increments of 500mg at 1wk intervals; max 2g/day (20mL) in divided doses twice daily.
	Glumetza	500mg, 1000mg	ext‑rel tabs	Adults: Initially 500mg once daily with PM meal; may increase by 500mg increments at 1-2wk intervals; max 2g once daily. Children: Not established.
BILE ACID SEQUESTRANT
colesevelam	Welchol	625mg	tabs	Adults: 3 tabs twice daily or 6 tabs once daily. Suspension: one 3.75g pkt once daily in 8oz of water, fruit juice, or diet soft drinks. Children: Not established.
colesevelam	Welchol for Oral Suspension	3.75g	pwd pkts
DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITOR
alogliptin	Nesina	6.25mg, 12.5mg, 25mg	tabs	Adults: 25mg once daily. Renal impairment: moderate (CrCl ≥30–<60mL/min): 12.5mg once daily; severe (CrCl ≥15–<30mL/min) or ESRD: 6.25mg once daily. Children: Not established.
linagliptin	Tradjenta	5mg	tabs	Adults: 5mg once daily. Children: Not established.
sitagliptin	Januvia	25mg, 50mg, 100mg	tabs	Adults: 100mg once daily. Renal impairment: eGFR ≥30–<45mL/min/1.73m²: 50mg once daily; eGFR <30mL/min/1.73m² or ESRD on dialysis: 25mg once daily. Children: Not established.
DPP-4 INHIBITOR + BIGUANIDE
alogliptin/ metformin	Kazano¹	12.5mg/500mg, 12.5mg/1000mg	tabs	Adults: Take twice daily with food; increase dose gradually to reduce GI effects. Max 25mg alogliptin/2000mg metformin per day. Children: Not established.
linagliptin/ metformin	Jentadueto²	2.5mg/500mg, 2.5mg/850mg, 2.5mg/1000mg	tabs	Adults: Previously not on metformin: initially 2.5mg/500mg twice daily. Previously on metformin: start with 2.5mg linagliptin and current metformin dose twice daily. Previously on linagliptin and metformin: switch on mg/mg basis. Max 2.5mg/1000mg twice daily. Children: Not established.
linagliptin/ metformin	Jentadueto XR²	2.5mg/1000mg, 5mg/1000mg	ext-rel tabs	Adults: Currently not treated with metformin: initially 5mg/1000mg once daily. Already treated with metformin: start with 5mg linagliptin and current metformin dose once daily. Already treated with linagliptin and metformin or Jentadueto: switch to XR tabs containing 5mg linagliptin and current metformin dose once daily. Max 5mg/2000mg daily. Children: Not established.
sitagliptin/ metformin	Janumet²	50mg/500mg, 50mg/1000mg	tabs	Adults: Not currently treated with metformin: initially 50mg/500mg twice daily; titrate gradually. Previously on metformin alone: initially 50mg twice daily of sitagliptin plus metformin dose. Previously on metformin 850mg twice daily: start with 50mg/1000mg twice daily. All: max 100mg sitagliptin/2000mg metformin per day. Children: Not established.
sitagliptin/ metformin	Janumet XR²	50mg/500mg, 50mg/1000mg, 100mg/1000mg	ext‑rel tabs	Adults: Not currently treated with metformin: initially 100mg/1000mg once daily; titrate gradually. Previously on metformin alone: initially 100mg daily of sitagliptin plus metformin dose. Previously on metformin 850mg twice daily or 1000mg twice daily: start with two 50mg/1000mg tablets (taken together) once daily. Previously on Janumet: maintain same total daily dose of each component. All: max 100mg sitagliptin/2000mg metformin per day. Renal impairment (if eGFR later falls <45mL/min/1.73m²): max 50mg/day of sitagliptin. Children: Not established.
DPP-4 INHIBITOR + THIAZOLIDINEDIONE
alogliptin/ pioglitazone	Oseni	12.5mg/30mg, 25mg/15mg, 25mg/30mg, 25mg/45mg	tabs	Adults: Inadequately controlled on diet/exercise, or on metformin or alogliptin monotherapy: initially 25mg/15mg or 25mg/30mg daily. Previously on pioglitazone alone: initially 25mg/15mg, 25mg/30mg, or 25mg/45mg daily. Previously on alogliptin and pioglitazone: switch on a mg/mg basis. NYHA Class I or II HF: initially 25mg/15mg. All: max 25mg/45mg daily. Renal impairment: moderate (CrCl ≥30–<60mL/min): 12.5mg/15mg, 12.5mg/30mg, or 12.5mg/45mg daily; severe or ESRD: not recommended. Children: Not recommended.
DOPAMINE RECEPTOR AGONIST
bromocriptine	Cycloset	0.8mg	tabs	Adults: Initially 0.8mg once daily with food in the AM; may increase by 0.8mg per week as tolerated until max 4.8mg/day. Usual range: 1.6–4.8mg/day. Children: Not established.

Generic	Brand	Strength	Form	Dose
GLINIDE
nateglinide	—	60mg, 120mg	tabs	Adults: 120mg 3 times daily, 1–30mins before meals. If near glycemic goal, initially 60mg 3 times daily. Children: Not established.
repaglinide	—	0.5mg, 1mg, 2mg	tabs	Adults: Treatment-naive, or HbA1c <8%, or CrCl 20–40mL/min: initially 0.5mg with 2–4 meals daily. Previously treated with antidiabetic agents and HbA1c ≥8%: initially 1–2mg with 2–4 meals daily. Both: titrate by doubling dose at intervals of ≥1wk; range 0.5–4mg with 2–4 meals daily; max 16mg/day. Children: Not established.
GLUCAGON-LIKE PEPTIDE-1 (GLP-1) RECEPTOR AGONIST
dulaglutide	Trulicity	0.75mg/0.5mL, 1.5mg/0.5mL, 3mg/0.5mL, 4.5mg/0.5mL	SC inj	Adults: Initially 0.75mg once weekly; increase to 1.5mg once weekly if inadequate response. If additional glycemic control is needed, increase in 1.5mg increments after ≥4wks on the current dose; max 4.5mg once weekly. Children: <10yrs: not established. ≥10yrs: Initially 0.75mg once weekly. If additional glycemic control is needed, may increase to max 1.5mg once weekly after ≥4wks on the 0.75mg dose.
exenatide	Byetta	250mcg/mL	SC inj	Adults: Initially 5mcg twice daily, within 60mins before AM and PM meals; may increase to 10mcg twice daily after 1 month. Children: Not established.
exenatide ext‑rel	Bydureon BCise	2mg	SC inj	Adults and Children: <10yrs: not established. ≥10yrs: 2mg once weekly.
liraglutide	Victoza	6mg/mL	SC inj	Adults: Initially 0.6mg/day for 1wk, then increase to 1.2mg/day; may increase to 1.8mg/day after ≥1wk if additional control is required. If >3 days elapsed since last dose, reinitiate at 0.6mg/day, then titrate. Children: <10yrs: not established. ≥10yrs: initially 0.6mg/day; after ≥1wk, may increase to 1.2mg/day if additional control is required; may further increase to 1.8mg/day after ≥1wk if needed. If >3 days elapsed since last dose, reinitiate at 0.6mg/day, then titrate.
semaglutide	Ozempic	2mg/3mL, 4mg/3mL, 8mg/3mL	SC inj	Adults: Initially 0.25mg once weekly for 4wks, then 0.5mg once weekly for ≥4wks; if additional control needed, may increase to 1mg once weekly. If additional control needed after ≥4wks on 1mg, may increase to max 2mg once weekly. Children: Not established.
semaglutide	Rybelsus	3mg, 7mg, 14mg	tabs	Adults: Take ≥30mins before AM meal. Initially 3mg once daily for 30 days, then increase to 7mg once daily; may increase to 14mg once daily if additional glycemic control needed after ≥30 days on 7mg dose. Taking two 7mg tabs to achieve a 14mg dose: not recommended. Children: Not established.
GLUCOSE-DEPENDENT INSULINOTROPIC POLYPEPTIDE RECEPTOR + GLP-1 RECEPTOR AGONIST
tirzepatide	Mounjaro	2.5mg/0.5mL, 5mg/0.5mL, 7.5mg/0.5mL, 10mg/0.5mL, 12.5mg/0.5mL, 15mg/0.5mL	SC inj	Adults: Initially 2.5mg once weekly for 4wks, then increase to 5mg once weekly. If additional control is needed, increase in 2.5mg increments after ≥4wks on the current dose; max 15mg once weekly. Children: Not established.
SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITOR
bexagliflozin	Brenzavvy⁴	20mg	tabs	Adults: eGFR ≥30mL/min/1.73m²: 20mg once daily in the AM. Children: Not established.
canagliflozin	Invokana⁴	100mg, 300mg	tabs	Adults: eGFR ≥60mL/min/1.73m²: initially 100mg once daily; may increase to max 300mg once daily for additional glycemic control. eGFR 30–<60mL/min/1.73m²: max 100mg once daily. eGFR <30mL/min/1.73m²: do not initiate, however with albuminuria >300mg/day: may be continued at 100mg once daily. Children: Not established.
dapagliflozin	Farxiga	5mg, 10mg	tabs	Adults: eGFR ≥45mL/min/1.73m²: initially 5mg once daily in the AM; may increase to 10mg once daily. Children: Not established.
empagliflozin	Jardiance⁴	10mg, 25mg	tabs	Adults and Children: <10yrs: not established. ≥10yrs: Initially 10mg once daily in the AM; may increase to 25mg, if tolerated.
ertugliflozin	Steglatro	5mg, 15mg	tabs	Adults: eGFR ≥45mL/min/1.73m²: initially 5mg once daily; may increase to max 15mg once daily. Children: Not established.
SGLT2 INHIBITOR + BIGUANIDE
canagliflozin/ metformin HCl	Invokamet³	50mg/500mg, 50mg/1000mg, 150mg/500mg, 150mg/1000mg	tabs	Adults: Currently not treated with canagliflozin or metformin: initially 50mg/500mg twice daily. eGFR ≥60mL/min/1.73m² and require additional glycemic control: if tolerating canagliflozin 50mg twice daily, may increase to max 150mg twice daily and may increase metformin to max 1000mg twice daily, with gradual metformin dose escalation to reduce GI adverse reactions.Renal impairment (eGFR 45–<60mL/min/1.73m²): max canagliflozin 100mg/day; (eGFR 30–<45mL/min/1.73m²): assess the benefit/risk of continuing therapy; max canagliflozin 100mg/day. Children: Not established.
canagliflozin/ metformin HCl	Invokamet XR³	50mg/500mg, 50mg/1000mg, 150mg/500mg, 150mg/1000mg	ext-rel tabs	Adults: Currently not treated with canagliflozin or metformin: initially two XR (50mg/500mg) tabs once daily. eGFR ≥60mL/min/1.73m² and require additional glycemic control: if tolerating canagliflozin 100mg daily, may increase to max 300mg once daily and may increase metformin to max 2000mg once daily, with gradual metformin dose escalation to reduce GI adverse reactions. Renal impairment (eGFR 45–<60mL/min/1.73m²): max canagliflozin 100mg/day; (eGFR 30–<45mL/min/1.73m²): assess the benefit/risk of continuing therapy; max canagliflozin 100mg/day. Children: Not established.
dapagliflozin/ metformin HCl ext‑rel	Xigduo XR²	2.5mg/1000mg, 5mg/500mg, 5mg/1000mg, 10mg/500mg, 10mg/1000mg	ext-rel tabs	Adults: Take in the AM with food. Glycemic control (not already on dapagliflozin): initiate with dapagliflozin 5mg once daily. May adjust dose as tolerated; max 10mg/2000mg daily. Children: Not established.
empagliflozin/ metformin HCl	Synjardy³	5mg/500mg, 12.5mg/500mg, 5mg/1000mg, 12.5mg/1000mg	tabs	Adults and Children: <10yrs: not established. ≥10yrs: Take twice daily with meals; increase dose gradually. Max 25mg/2000mg daily.
	Synjardy XR³	5mg/1000mg, 10mg/1000mg, 12.5mg/1000mg, 25mg/1000mg	ext‑rel tabs	Adults: Take once daily with AM meal; increase dose gradually. Max 25mg/2000mg daily. Children: Not established.
ertugliflozin/ metformin HCl	Segluromet³	2.5mg/500mg, 2.5mg/1000mg, 7.5mg/500mg, 7.5mg/1000mg	tabs	Adults: Take twice daily with meals. Base dose on patient’s current regimen; increase gradually as tolerated. Max 15mg/2000mg daily. Children: Not established.
SGLT2 INHIBITOR + DPP-4 INHIBITOR
dapagliflozin/ saxagliptin	Qtern⁵	5mg/5mg, 10mg/5mg	tabs	Adults: Not currently treated with dapagliflozin: initially 5mg/5mg once daily in the AM; may increase to 10mg/5mg once daily. Children: Not established.
empagliflozin/ linagliptin	Glyxambi⁴	10mg/5mg, 25mg/5mg	tabs	Adults: Initially 10mg/5mg once daily in the AM; may increase to 25mg/5mg once daily. Children: Not established.
ertugliflozin/ sitagliptin	Steglujan³	5mg/100mg, 15mg/100mg	tabs	Adults: eGFR ≥45mL/min/1.73m²: Initially 5mg/100mg once daily in the AM; may increase to max 15mg/100mg once daily. Children: Not established.
SGLT2 INHIBITOR + DPP-4 INHIBITOR + BIGUANIDE
empagliflozin/ linagliptin/ metformin HCl ext-rel	Trijardy XR³	5mg/2.5mg/1000mg, 10mg/5mg/1000mg, 12.5mg/2.5mg/1000mg, 25mg/5mg/1000mg	tabs	Adults: Currently on metformin (± linagliptin): switch to similar total daily dose plus empagliflozin 10mg and linagliptin 5mg. Currently on metformin and empagliflozin (± linagliptin): switch to similar total daily dose plus linagliptin 5mg. Max: 25mg/5mg/2000mg per day. Children: Not established.
SULFONYLUREA
glimepiride	Amaryl	1mg, 2mg, 4mg	scored tabs	Adults: Initially 1–2mg once daily with first AM meal; after reaching a dose of 2mg, may further increase by 1–2mg at 1–2wk intervals if needed; max 8mg/day. Children: Not recommended.
glipizide 2nd generation	—	5mg, 10mg	scored tabs	Adults: Initially 5mg daily, 30mins before a meal. Elderly or hepatic disease: initially 2.5mg daily. Increase by 2.5–5mg every few days based on blood glucose response. Max once daily dose: 15mg. Max total daily dose: 40mg. Give in divided doses if >15mg. Children: Not established.
glipizide 2nd generation	Glucotrol XL	2.5mg, 5mg, 10mg	ext‑rel tabs	Adults: Initially 5mg daily with breakfast. Usual range: 5–10mg once daily; max 20mg daily. Elderly, renal or hepatic impairment: initially 2.5mg. Children: Not established.
glyburide 2nd generation	—	1.25mg, 2.5mg, 5mg	scored tabs	Adults: Initially 2.5–5mg daily with first AM meal. Elderly or debilitated: initially 1.25mg daily. Increase by 2.5mg at weekly intervals if needed per blood glucose. Maintenance: 1.25–20mg daily in single or divided doses (consider divided doses above 10mg daily); max 20mg daily. Children: Not established.
glyburide, micronized 2nd generation	Glynase PresTab	1.5mg, 3mg, 6mg	scored tabs	Adults: Initially 1.5–3mg daily with breakfast. Debilitated: initially 0.75mg daily. Increase by 1.5mg at weekly intervals if needed. Maintenance: 0.75–12mg daily in single or divided doses (consider divided doses above 6mg daily); max 12mg daily. Children: Not established.
SULFONYLUREA + BIGUANIDE
glipizide/ metformin	—	2.5mg/250mg, 2.5mg/500mg, 5mg/500mg	tabs	Adults: First-line: initially 2.5mg/250mg once daily; or, if FPG is 280–320mg/dL, may start at 2.5mg/500mg twice daily. May increase by 1 tab/day every 2wks; max 10mg/1000mg or 10mg/2000mg per day in divided doses. Second-line: (previously treated with sulfonylurea or metformin only): 2.5mg/500mg or 5mg/500mg twice daily⁶; may increase by increments of ≤5mg/500mg up to minimum effective dose or max 20mg/2000mg/day. Previously treated with sulfonylurea plus metformin): may be switched to 2.5mg/500mg or 5mg/500mg⁶. Children: Not established.
glyburide/ metformin	—	2.5mg/500mg, 5mg/500mg	tabs	Adults: Not controlled on diet/exercise (use individual components): initially glyburide 1.25mg and metformin 250mg once daily (twice daily if baseline HbA1c >9% or FPG >200mg/dL). May increase by increments of 1.25mg glyburide and 250mg metformin per day every 2wks. Not controlled on sulfonylurea and/or metformin: initially 2.5mg/500mg or 5mg/500mg twice daily⁶. May increase by increments of up to 5mg/500mg. Both: max 20mg/2000mg/day. Children: Not recommended.
THIAZOLIDINEDIONE
pioglitazone	Actos	15mg, 30mg, 45mg	tabs	Adults: Without CHF: initially 15mg or 30mg once daily; max 45mg once daily. With CHF (NYHA Class I or II): initially 15mg once daily. Children: Not recommended.
THIAZOLIDINEDIONE + BIGUANIDE
pioglitazone/ metformin	ACTOplus met²	15mg/500mg, 15mg/850mg	tabs	Adults: Previously on pioglitazone and/or metformin: switch on a mg/mg basis. Initially 15mg/500mg twice daily or 15mg/850mg once daily; may titrate gradually as needed; max 45mg pioglitazone/2550mg metformin per day. With CHF (NYHA Class I or II): initially 15mg/500mg or 15mg/850mg once daily. Children: Not recommended.
THIAZOLIDINEDIONE + SULFONYLUREA
pioglitazone/ glimepiride	Duetact	30mg/2mg, 30mg/4mg	tabs	Adults: Previously on glimepiride, or glimepiride + pioglitazone: Initially one 30mg/2mg or one 30mg/4mg tab once daily. Previously on pioglitazone, or pioglitazone + other sulfonylurea: initially one 30mg/2mg tab once daily. Children: Not recommended.
NOTES
KEY: DPP-4 = dipeptidyl peptidase-4; ER = extended-release; ESRD = end stage renal disease; FPG = fasting plasma glucose; GLP-1 = glucagon-like peptide-1; IR = immediate-release; SGLT2 = sodium-glucose co-transporter 2 ¹ Renal impairment (eGFR 30–60mL/min/1.73m²): not recommended; (eGFR <30mL/min/1.73m²): contraindicated. ² Renal impairment (eGFR 30–45mL/min/1.73m²): initiation not recommended. If eGFR falls <45mL/min/1.73m², assess risk/benefit; discontinue if eGFR falls <30mL/min/1.73m² (contraindicated). ³ Renal impairment (eGFR <45mL/min/1.73m²): initiation not recommended; (eGFR <30mL/min/1.73m²): contraindicated. ⁴ Renal impairment (eGFR <30mL/min/1.73m²): not recommended. ⁵ Moderate to severe renal impairment (eGFR <45mL/min/1.73m²), ESRD, or on dialysis: contraindicated. ⁶ Initial dose should not exceed previous daily doses of individual components Not an inclusive list of medications and/or official indications. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling. (Rev. 1/2024)

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