Working Together to Manage Diabetes: Diabetes Medications Supplement 2007
This detailed reference booklet profiles medications to manage blood glucose (including insulin), blood pressure, and cholesterol.
Publication date: 05/01/2007
SECTION A Diabetes MedicationsTable 1. Oral Agents to Treat Type 2 Diabetes
| Agent |
Class |
Primary Action |
Typical Dosage |
Side Effects |
Precautions |
Critical Tests |
Comments |
Adapted from © 2006 The Diabetes Center, Old Saybrook, CT. Used with permission. A1C = glycated hemoglobin ALT = alanine aminotransferase CHF = congestive heart failure FPG = fasting plasma glucose GI = gastrointestinal XL = TZD= thiozolidinedione, CYP 450= cytochrome P 450
*Agents in a class of medicines share mechanisms of action, require similar precautions, and generally have similar side effects.
For proper usage, please read label. Agents should not be used in patients with type 1 diabetes. |
Tolbutamide (Ornase™)
Tolazamide (Tolinase™)
Chlorpropamide (Diabenese™) | Sulfonylureas
(1st generation) |
Increases insulin production in the pancreas. | Tolbutamide: 0.25-2.0 g/day in divided doses; maximum, 3 g/day
Tolazamide: 100-1,000 mg/day in divided doses; maximum, 1 g/day
Chlorpropamide: 100-500 mg/day twice a day; maximum, 750 mg/day | Hypoglycemia, weight gain, hyperinsulinemia
Disulfiram reaction with alcohol | Chlorpropamide remains active for up to 60 hours. Use extreme caution with elderly patients or patients with hepatic or renal dysfunction. | All are metabolized in liver. Periodic evaluation of liver function is suggested. | Use of these agents is not recommended unless the patient has a wellestablished history of taking them. Second-generation sulfonylureas provide more predictable results with fewer side effects and more convenient dosing. | Glyburide (Micronase™, Diabeta™,
Glynase™)
Glipizide (Glucotrol, Glucotrol XL™)
Glimepiride (Amaryl™) | Sulfonylureas
(2nd generation) | Increases insulin production in the pancreas. | Glyburide: 1.25-5 mg/once or twice a day; maximum, 20 mg/day
Glynase: 0.75-12.0 mg/day; maximum 12 mg/day
Glipizide: 2.5-20.0 mg/once or twice a day; maximum, 40 mg/day;
or XL* 2.5-10.0 mg/once or twice a day; maximum, 20 mg/day
Glimepiride: 1-8 mg/day; maximum, 8 mg/day | Hypoglycemia, weight gain, hyperinsulinemia | Clearance may be diminished in patients with hepatic or renal impairment. | | Glipizide is preferred with renal impairment.
Doses >15 mg should be divided.
Glimepiride indicated for use with insulin.
Shown to have some insulin-sensitizing effect. | | Repaglinide (Prandin™) | Meglitinide | Increases insulin release from pancreas. | New diagnosis or A1C <8%, 0.5 mg;
A1C >8%, 1-2 mg, 15-30 min before each meal;
increase weekly until results are obtained;
maximum, 16 mg/day | Hypoglycemia, weight gain, hyperinsulinemia | Use with caution on patient with hepatic or renal impairment. | | Patients should be instructed to take medication no more than 30 minutes prior to a meal. If meals are skipped or added, the medication should be skipped or added as well. Approved for use as monotherapy or in combinatin with TZD or metformin. | | Nateglinide (Starlix™) | Phenylalanine derivative | Increases insulin release from pancreas. | 60-120 mg before each meal | Minimal risk of hypoglycemia | Currently no contraindications available.
Use with caution with moderate to severe hepatic disease. | Periodic evaluation of liver function tests. | Approved as monotherapy or in combination with metformin or TZD. Has only a 2-hour duration of action. If meals are skipped or added, the medication should be skipped or added as well. | Metformin (Fortamet™,
Glumetza™, Glucophage™) | Biguanide | Primarily decreases hepatic glucose production.
Minor increase in muscle glucose uptake which may improve insulin resistance. | 500 mg/day twice a day with meals, increase by 500 mg every 1-3 wk,
twice or three times a day; usually most effective at 2,000 mg/day;
maximum, 2,550 mg/day Long acting form Glucophage XR™: 500mg once/day, max dose 2000mg once/day | Nausea, diarrhea, metallic taste, possible lactic acidosis | Due to increased risk of lactic acidosis, should not use if suspect frequent alcohol use, liver or kidney disease, or CHF. | Contraindicated if serum creatinine is:
>1.5 mg/dL in men or >1.4 mg/dL women.
Do not use if creatinine clearance is abnormal.
Monitor hematological and renal function annually. | Especially beneficial in obese patients due to potential for weight loss, improved lipid profile, and lack of potential for hypoglycemia requiring supplemental carbohydrate intake. Discontinue for 48 hr after contrast dye procedures. | | Rosiglitazone (Avandia™) | Thiazolidinedione | Decreases insulin resistance, increasing glucose uptake, fat redistribution; minor decrease in hepatic glucose output; preserves -cell function; decreases vascular inflammation. | Initially 4 mg/day in single or divided doses.
Increase to 8 mg/day in 12 wk, if needed;
maximum, 8 mg/day with or without food | Minor weight increase of 3-6 lbs., edema | Should not be used in patients with CHF or hepatic disease. Can cause mild-to-moderate edema. | Avoid initiation if ALT >2.5X upper limit of normal. Measure ALT periodically. Discontinue if ALT >3X upper limit of normal. | Approved for use as monotherapy and in combination with metformin, sulfonylureas, or insulin.
Less interactions associated with CYP-450. | | Pioglitazone (Actos™) | Thiazolidinedione | Decreases insulin resistance, increasing glucose uptake, fat redistribution; minor decrease in hepatic glucose output; preserves -cell function; decreases vascular inflammation. | Initially 15 or 30 mg/day;
maximum with or without food 45 mg for monotherapy,
30 mg for combination therapy | Minor weight increase of 3-6 lbs., edema | Should not be used in patients with CHF or hepatic disease. Can cause mild-to-moderate edema. | Avoid initiation if ALT >2.5X upper limit of normal. Measure ALT periodically. Discontinue if ALT >3X upper limit of normal. | Avoid initiation if ALT >2.5X upper limit of normal. Measure ALT periodically. Discontinue if ALT >3X upper limit of normal. | Acarbose (Precose™)
Miglitol (Glyset™) | Alpha-glucosidase inhibitor | Slows absorption of complex carbohydrate from GI tract. | 25 mg/day; increase by 25 mg/day every 4-6 wk;
maximum, split dose before meals (with first bite of food)
300 mg/day(150 mg/day for weight <60 kg) | Gas and bloating, sometimes diarrhea for both drugs | Should not be used if GI disorders are concurrent. | Avoid if serum creatinine is >2.0 mg/dL.
Monitor serum transaminase every 3 months for 1st year of therapy. | Approved for use as monotherapy and in combination with metformin, sulfonylureas, or insulin. If used with hypoglycemic agents, such as sulfonylureas or insulin, must treat hypoglycemia with glucose not sucrose. | |
Combinations |
|---|
Glucovance™
(Glyburide and Metformin) | Sulfonylureas and Biguanide | Decreases hepatic glucose production and increases insulin secretion. | Ratios of glyburide and metformin (in mg):1.25/250, 2.5/500, 5/500.
Initial: 1.25/250 once or twice a day, increased every 2 weeks.
2nd line: 2.5-5/500 twice a day, increased every1-2 weeks.
Average dose 7.5/1,500.
Maximum dose should not exceed 20 mg glyburide/2,000 mg metformin daily. | Hypoglycemia, weight gain, lactic acidosis | Should not be used if suspect frequent alcohol use, liver or kidney disease, or CHF. | Same caveats as individual components. | Patients may frequently use 2 different dose tablets to attain desired daily dosage and results. Discontinue for 48 hr after procedure using contrast dye. | Metaglip™
(Glipizide and Metformin) | Sulfonylureas and Biguanide | Decreases hepatic glucose production and increases insulin secretion. | Ratios of glipizide and metformin (in mg): 2.5/250, 2.5/500, 5/500.
Initial: 2.5/250 once or twice a day, increased every 2 weeks.
2nd line: 2.5-5/500 twice a day, increased every 1- 2 weeks.
Maximum doseshould not exceed 20 mg glipizide/2,000 mg metformin daily. | Hypoglycemia, weight gain, lactic acidosis | Should not be used if suspect frequent alcohol use, liver or kidney disease, or CHF. | Same caveats as individual components. | Patients may frequently use 2 different dose tablets to attain desired daily dosage and results. Discontinue for 48 hr after procedure using contrast dye. | Avandamet™
(Rosiglitazone and Metformin) | Thiazolidinedione and Biguanide | Decreases hepatic glucose production, increases glucose uptake, decreases insulin resistance, and preserves -cell function. | Ratios of rosiglitazone and metformin: 1 mg/500 mg, 2 mg/500 mg,
4 mg/500 mg, 2 mg/1,000 mg, 4 mg/1,000 mg twice a day;
dosage individualized based on current therapy.
Maximum, 8 mg/2,000 mg per day. | Edema, possible lactic acidosis | Should not be used if suspect frequent alcohol use, liver or kidney disease, or CHF. | Same caveats as individual components. | Less expensive than using agents separately. Reported decrease in GI upset associated with metformin and weight increase associated with rosiglitazone. Discontinue for 48 hr after procedure using contrast dye. | Actoplus Met™
(Pioglitazone and Metformin) | Thiazolidinedione and Biguanide | Decreases hepatic glucose production, increases glucose uptake, decreases insulin. | Ratios of pioglitazone and metformin: 15 mg/500 mg, 15 mg/850 mg | Same caveats as individual components. | Same caveats as individual components. | Same caveats as individual components. | Same caveats as individual components. | Avandaryl™
(Rosiglitazone and Glimepiride) | Thiazolidinedione and Sulfonylurea | Decreases insulin resistance and
increases insulin secretion. | Ratios of rosiglitazone and glimepiride: 4 mg/1 mg, 4 mg/1 mg | Same caveats as
individual components. | Same caveats as individual components. | Same caveats as individual components. | Same caveats as individual components. |
Table 2. Glucose-Lowering Activity-Oral Diabetes Agent
| Medication | Blood Glucose Most Affected | Greatest Risk for Hypoglycemia |
|---|
Adapted from © 2002, The Diabetes Center, Old Saybrook, CT, used by permission.
SMBG = self-monitoring of blood glucose |
| Sulfonylureas | Fasting and postprandial | Nocturnal, fasting, 4-6 hr after meals | | Meglitinide or phenylalanine derivative | Postprandial | 2-3 hr after meals | | Biguanide | Fasting and postprandial | After exercise if prolonged and strenuous | | Alpha-glucosidase inhibitor | Postprandial | None | | Thiazolidinedione | Fasting and postprandial | None | | Glucovance™ |
Fasting and postprandial | Nocturnal, fasting, 4-6 hr after meals | | Metaglip™ | Fasting | Nocturnal, fasting, 4-6 hr after meals | | Avandamet™ | Fasting and postprandial | After exercise if prolonged and strenuous | | Actoplus Met™ | Fasting and postprandial | After exercise if prolonged and strenuous | | Avandryl™ | Fasting and postprandial | Nocturnal, fasting, 4-6 hr after meals |
Table 3. Important Insulin Information*
| Insulin | Onset | Peak | Effective Duration | Maximal Duration | Comments |
|---|
Adapted from © 2006 The Diabetes Center, Old Saybrook, CT. Used with permission.
*Site rotation for injections is necessary for all types of insulin. |
| Human |
|---|
| Rapid Acting |
|---|
| Lispro (Humalog™) | < 15 min | 1-2 hr | 2-4 hr | 3-5 hr | Should be takenjust prior to or just after eating. | | Aspart (Novalog™) | < 15 min | 1-3 hr | 3-5 hr | 4-6 hr | Should be takenjust prior to or just after eating. | | Glulisine (Apidra™) | < 15 min | 0.5-1 hr | 3 hr | 3 hr | Should be takenjust prior to or just after eating. |
| Short Acting |
|---|
| Regular (Novolin R™, Humulin R™) | 0.5-1 hr | 2-4 hr | 3-5 hr | 8 hr | Best if taken 30 min before a meal. | tr>Intermediate Acting | | Lente (Novolin™, Humulin L™) | 3-4 hr | 4-12 hr | 12-18 hr | 16-20 hr | Limited supplies. | | NPH (Novolin N™, Humulin N™) | 2-4 hr | 4-10 hr | 10-16 hr | 14-18 hr | Bedtime dosing minimizes nocturnal hypoglycemia. | | Long Acting | Characterized by a “flat” or “peakless” concentration profile. |
|---|
Insulin glargine
(Lantus™) analog | 4-6 hr | None | 24 hr | 24 hr | cannot be mixed with any other insulin. Stress site rotation and not to use same syringe used with other insulins. Not recommended for pre-filling syringes. | | Detemir (Levemir™) | 3-4 hr | 50% in 3-4 hr,
lasting up to 14 hr | 5.7-23.2 hr | Dose dependent-
5.7-23.2 hr | cannot be mixed in same syringe with other insulins.
Duration of action is dose dependent: 6 hrs (0.1U/kg), 12hrs (0.2U/kg), 20 hrs (0.4U/kg), 23 hrs (0.8U/kg and 1.6U/kg). | | Ultralente | 6-10 hr | Minimal | 18-20 hr | 20-30 hr | Limited supplies. | | Pre-mixed Human |
|---|
Humalog™ 75/25
Novolog Mix™ 70/30 | <15 min | 1-2 hr | 10-16 hr | 14-18 hr | 75% NPL, 25% Lispro Should be taken just prior to or just after eating 70% NPH, 30% Aspart because of rapid onset. Caution because of name confusion with Humalog and Novolog. | Humulin™ 70/30
Novolin™ 70/30 | 0.5-1 hr | 2-10 hr | 10-16 hr | 14-18 hr | Humalin and Novolin are 70% NPH and 30% regular insulin. | | Animal Source |
|---|
| Regular | 0.5-2 hr | 3-4 hr | 4-6 hr | 6-8 hr | Conversion to human insulin recommended. Dose changes required (usually a 10% reduction in dose when switching to human). | | NPH | 4-6 hr | 8-14 hr | 16-20 hr | 20-24 hr | | Lente | 4-6 hr | 8-14 hr | 16-20 hr | 20-24 hr | | Inhaled Insulin |
|---|
| Exubera™ | 10-20 min | 30-90 min | 2-6 hr | 6 hr | Dosed in MG of powder, Available in 1 mg and 3 mg blisters.
1mg approx=3 IU insulin, 3mg approx=8 IU (Inhalation of 1 mg +1 mg +1 mg does not equal 3mg) |
Table 4. Recommended Insulin Storage
| Insulin Type | Refrigerated (36°F - 46°F) |
Room Temperature (59°F - 86°F) |
|---|
Adapted from © 2006 The Diabetes Center, Old Saybrook, CT. Used with permission.
*Suggested, not clinically established | | Vial | Opened | Unopened | Opened | Unopened | | Humalog™, Novolog™, Humulin™, Novolin™, Apidra™ | 28 days | until expiration date | 28 days | 28 days | | Lantus™ (10 mL) | 28 days | until expiration date | 28 days | 28 days | | Detemir (Levemir™) | 42 days | until expiration date | 42 days | 42 days | | Pens/Cartridges | Not in use | In use | | Humalog™ | Until expiration date | 28 days | | Humulin R™( available in cartridge only) | Until expiration date | 28 days | | Humulin N™ | Until expiration date | 14 days | | Humulin 70/30™ | Until expiration date | 10 days | | Humalog Mix 75/25™ | Until expiration date | 10 days | | Novolog™ | Until expiration date | 28 days | | Novolog Mix 70/30™ | Until expiration date | 14 days | | Novolin R™ (prefilled and 1.5-mL cartridge) | Until expiration date | 30 days | | Novolin R™ (3-mL cartridge) | Until expiration date | 28 days | | Novolin N™ (prefilled and 1.5-mL cartridge) | Until expiration date | 7 days | | Novolin N™ (3-mL cartridge) | Until expiration date | 14 days |
| Novolin 70/30™ (prefilled and 1.5-mL cartridge) | Until expiration date | 7 days | | Novolin 70/30™ (3-mL cartridge) | Until expiration date | 10 days | | Detemir (Levemir™) | Until expiration date | 42 days | | Apidra™ | Until expiration date | 28 days | | Lantus™ | Until expiration date | 28 days | | Self-filled syringes (Note: not recommended for glargine) | 14 days* | 7 days* | | Inhale Insulin | Not in use (unopened overwrap) | In use (unopened overwrap) | | Exubera™ (insulin blisters) | Room Temperature (59° F- 86° F) Until expiration date | Room Temperature (59° F- 86° F) 90days | | Release Unit | Do not refrigerate | Replace every 14 days | | Inhaler & Chamber | ReplaceYearly (Wash Weekly) |
Table 5. Incretins and Amylins
| Agent | Primary Action | How
Supplied/Storage | Typical Dosage | Duration
Action | Side Effects | Precautions | Comments |
|---|
| Adapted from © 2006 The Diabetes Center, Old Saybrook, CT. Used with permission. *DPP-4-dipeptidyl peptidase -4 GIP- glucose dependent insulinotropic polypeptide GLP-glucose like polypeptide ESRD-End Stage Renal Disease TZD-Thiazolidinedione | Exenatide
(Byetta™) | Decreases post-meal glucagon production Delays gastric emptying
Increases satiety, leading to decreased caloric intake.
Degree of response depends on plasma glucose levels | 250 mcg/ml:
- 5 mcg/dose prefilled pen
- 10 mcg/dose prefilled pen
If not in use: refrigerate until expiration date.
If in use: stable at room temperature
Discard after 30 days. | 5 mcg BID subcutaneous for first 1 month, then 10 mcg BID, injected within 60 minutes before morning and evening meal | Peak effects in approx 2 hours with maximal duration of 10 hours. | Nausea and hypoglycemia most common; occasional vomiting, diarrhea, jitters, dizziness, headache. | Not for use in patients with Type 1 diabetes, severe renal disease or ESRD*, or severe GI disease. | Consider lowering dose of sulfonylurea to avoid hypoglycemia when starting.
May reduce the rate of absorption of oral medication.
Medications requiring threshold concentrations should be taken 1 hour prior to injection.
Approved for use with sulfonylureas and/or metformin or in combination with a TZD* alone or with metformin. | Pramlintide
(Symlin™) | Decreases post-meal glucagon production Delays gastric emptying, Increases satiety, leading to decreased caloric intake.
Degree of response depends on plasma glucose levels | 5 ml vials containing 0.6 mg/ml. Requires U-100 insulin syringe for injection If not in use: refrigerate until expiration date.
If in use: room temperature Discard after 28 days. | Type 1 diabetes: 15-60 mcg starting with 15 mcg subcutaneously before meals of 30gm or more carbohydrate. Type 2 diabetes: 60-120 mcg starting with 60 mcg subcutaneous before meals. Titrate as directed by prescriber. | Maximum effect in 20 minutes with rapid elimination.
Maximum duration of 4 hours | Nausea and hypoglycemia most common. Doses are adjusted based on presentation of these side effects. Occasional vomiting, stomach pain, dizziness, indigestion. | Indicated for insulin treated type 2 diabetes or for type 1 diabetes.
Contraindicated in patients with hypoglycemia unawareness, gastroparesis. Or poor adherence Should never be mixed with insulin and should be injected separately. Reduce insulin dose by 50% when starting. | Requires patient testing of blood sugars before and after meals, frequent physician follow up, and thorough understanding of how to adjust doses of insulin and pramlintide.
May reduce the rate of absorption of orally administered medication. Medications requiring threshold concentrations should be taken 1 hour prior to injection. | Sitagliptin
(Januvia™) | DPP-4 inhibitor* Inhibits the DPP-4 enzyme that degrades GLP-1 and GIP resulting in 2-3 fold increased levels of these incretins. Increases insulin secretion in presence of elevated plasma glucose. Reduces postmeal glucagon secretion . | 25mg, 50mg, 100mg tablets | 100 mg po qD
Moderate renal insufficiency
(CrCl>30 to <50mL/min): 50mg/day
Severe renal insufficiency
(CrCl <30mL/min): 25mg/day | Approximately
24 hours | Low incidence of side effects including hypoglycemia or gastrointestinal symptoms Headache, upper respiratory tract infection, nasopharyngitis | Not for use in type 1 diabetes Assessment of renal function is recommended prior to initiation and periodically thereafter. | May be used as monotherapy or in combination with metformin or TZDs.
Not associated with weight loss |
Table 6. Hypoglycemia Treatment
| Agent | Primary
Action | How Supplied/Storage | Typical
Dosage | Duration
Action | Side
Effects | Precautions | Comments |
|---|
| Adapted from © 2006 The Diabetes Center, Old Saybrook, CT. Used with permission. | | Glucagon | Converts liver glycogen to glucose | 1 mg vial with diluent; emergency kit, 1 mg vial with prefilled syringe of diluent. Before reconstitution, room temperature until expiration date. After reconstitution, may be stored for up to 48 hours under refrigeration. | 0.5-2 mg subcutaneous | 15 min, should be followed by carbohydrate snack. | Occasional nausea and vomiting | Must be reconstituted prior to injection. Should be followed by carbohydrate snack and blood glucose testing every 15 minutes until glucose level returns to acceptable levels. | Patient should be instructed to teach colleagues, family, etc. how to give injection. Only use if patient isunconscious or unable to eat or drink. All people taking insulin should receive a prescription for glucagon kit for emergency use. |
Table 7. Recommended Control Measures
| Biochemical Index | Preprandial | Peak postprandial | A1C (ADA)* | Blood pressure | LDL | TG | HDL |
|---|
| Adapted from © 2006 The Diabetes Center, Old Saybrook, CT. Used with permission. LDL=low density lipoprotein TG=triclycerides HDL=high density lipoprotein *ADA-American Diabetes Association |
| Goal | 90-130 mg/dL | <180 mg/dL | <7% | <130/80 | <100 | <150 | >40 |
SECTION B Medications to Lower High Blood Pressure
| Category | Generic Name | Brand NameTM | Minimum Daily Dose | Maximum Daily Dose | Special Considerations for class of drugs |
|---|
* Agents in a class of medicines share mechanisms of action, require similar precautions and generally have similar side effects.
CC= extended release XL=extended release SR=sustained release CR=controlled release CD=extended release XR=extended release PM=extended release, controlled onset LA = long acting HS=extended release, controlled onset Dosages based on JNC7 usual dose range.
Note: There are many combination medications for the control of blood pressure. The indications and caveats are the same for each individual component. |
Angiotensin converting
enzyme (ACE) inhibitors | benazepril | Lotensin™ | 10 mg QD | 40 mg QD or divided | May cause cough. May increase potassium concentrations. Do not use potassium or salt substitutes without consulting physician. Do not use if pregnant or if trying to conceive. Caution if creatinine >1.5. |
|---|
| captopril | Capoten™ | 25 mg divided dose | 100 mg divided dose | | enalapril | Vasotec™ | 5 mg QD | 40 mg QD or divided | | fosinopril | Monopril™ | 10 mg QD | 40 mg QD or divided | | lisinopril | Prinivil, Zestril™ | 10 mg QD | 40 mg QD | | moexipril | Univasc™ | 7.5 mg QD | 30 mg QD or divided | | perindopril | Aceon™ | 4 mg QD | 8 mg QD | | quinapril | Accupril™ | 10 mg QD | 80 mg QD or divided | | ramipril | Altace™ | 2.5 mg QD | 20 mg QD or divided | Angiotensin II
receptor blockers | trandolapril | Mavik™ | 1 mg QD | 4 mg QD | May cause dizziness and upset stomach. Do not use potassium or salt substitutes without consulting physician. Do not use if pregnant or if trying to conceive. Caution if creatinine >1.5. |
|---|
| candesartan | Atacand™ | 8 mg QD | 32 mg QD or divided | | eprosartan | Teveten™ | 400 mg QD | 800 mg QD or divided | | irbesartan | Avapro™ | 150 mg QD | 300 mg QD | | losartan | Cozaar™ | 25 mg QD | 100 mg QD or divided | | olmesartan | Benicar™ | 20 mg QD | 40 mg QD | | telmisartan | Micardis™ | 20 mg QD | 80 mg QD | | valsartan | Diovan™ | 80 mg QD | 320 mg QD | | Calcium channel blockers | amlodipine | Norvasc™ | 2.5 mg QD | 10 mg QD | May cause constipation, dizziness, upset stomach, and flushing. Call physician for shortness of breath, unusual heartbeat, or swelling of feet or hands. |
|---|
| diltiazem | Cardizem LA™ | 120 mg QD | 540 mg QD | | diltiazem | Cardizem CD™ | 180 mg QD | 420 mg QD | | diltiazem | Dilacor XR™* | 180 mg QD | 420 mg QD | | diltiazem | Tiazac™ | 180 mg QD | 420 mg QD | | felodipine | Plendil™* | 2.5 mg QD | 20 mg QD | | isradipine | DynaCircCR™* | 2.5 mg QD | 10 mg QD | | nicardipine | Cardene SR™* | 60mg in divided dose | 120 mg divided dose | | nifedipine | Adalat CC™* | 30 mg QD | 60 mg QD | | nifedipine | Procardia XL™* | 30 mg QD | 60 mg QD | | nisoldipine | Sular™* | 10 mg QD | 40 mg QD | | verapamil | Calan™ | 80 mg QD in divided dose | 320 mg divided dose | | verapamil | Calan SR ™ | 120 mg QD | 480 mg divided dose | | verapamil | Covera HS™* | 120 mg QD | 360 mg QD | | verapamil | Isoptin™ | 80 mg QD in divided dose | 320 mg divided dose | | verapamil | Isoptin SR™* | 120 mg QD | 480 mg QD or divided | | verapamil | Verelan™ | 80 mg QD in divided dose | 320 mg divided dose | | verapamil | Verelan PM™ | 120 mg QD | 360 mg QD | | Thiazides and related diuretics | bedroflumethiazide | Naturetin™ | 2.5 mg QD | 20 mg QD | May increase blood glucose concentrations. Take in morning to minimize diuretic effect at night. May cause low potassium, need to monitor level. |
|---|
| chlorothiazide | Diuril™ | 125 mg QD | 500 mg QD or divided | | chlorthalidone | Hygroton™ | 12.5 mg QD | 25 mg QD | | hydrochlorothiazide | HydroDIURIL™ | 12.5 mg QD | 50 mg QD or divided | | hydrochlorothiazide | Microzide™ | 12.5 mg QD | 50 mg QD or divided |
| indapamide | Lozol™ | 1.25 mg QD | 2.5 mg QD | | methyclothiazide | Enduron™ | 2.5 mg QD | 5 mg QD | | metolazone | Mykrox™ | 0.5 mg QD | 1.0 mg QD | | metolazone | Zaroxolyn™ | 2.5 mg QD | 5 mg QD | | Loop diuretics | bumetanide | Bumex™ | 0.5 mg QD | 2 mg QD or divided | May cause low potassium. Need blood test to monitor level. (Parenteral drug available) May cause photosensitivity:sunscreen recommended. |
|---|
| ethacrynic acid | Edecrin™ | 25 mg QD | 200 mg divided dose | | furosemide | Lasix™ | 20 mg QD | 80 mg QD or divided | | torsemide | Demadex™ | 2.5 mg QD | 10 mg QD | Potassium-sparing
diuretics | amiloride | Midamor™ | 5 mg QD | 10 mg QD | Do not use potassium or salt substitutes without consulting physician. Need to monitor potassium level. |
|---|
| triamterene | Dyrenium™ | 50 mg QD or divided | 100 mg divided dose | Aldosterone receptor
blockers | eplerenone | Inspra™ | 50 mg QD | 100 mg divided dose |
|---|
| spironolactone | Aldactone™ | 25 mg QD | 50 mg divided dose | | ß-blockers | acebutolol | Sectral™ | 200 mg QD | 800 mg divided dose | Intrinsic sympathomimetic activity. May alter blood glucose, may mask signs of low blood. Call physician for slow heart rate (<60), confusion, or swelling of feet or legs. Can cause claudication. Do not discontinue abruptly. |
|---|
| atenolol | Tenormin™ | 25 mg QD | 100 mg QD | | betaxolol | Kerlone™ | 5 mg QD | 20 mg QD | | bisoprolol | Zebeta™ | 2.5 mg QD | 10 mg QD | | carteolol | Cartol™ | 2.5 mg QD | 10 mg QD | | metoprolol | Lopressor™ | 50 mg QD | 100 mg QD or divided | | metoprolol | Toprol XL™* | 50 mg QD | 100 mg QD | | nadolol | Corgard™ | 40 mg QD | 120 mg QD | | penbutolol | Levatol™ | 10 mg QD | 40 mg QD | | pindolol | Visken™ | 10 mg in divided dose | 40 mg divided dose | | propranolol | Inderal™ | 40 mg divided dose | 160 mg divided dose | | propranolol | Inderal LA™* | 60 mg QD | 180 mg QD | | timolol | Blocadren™ | 20 mg divided dose | 40 mg divided dose | | α-blockers | doxazosin | Cardura™ | 1 mg QD | 16 mg QD | To prevent dizziness, avoid standing up suddenly, especially with the first few doses. |
|---|
| prazosin | Minipress™ | 2 mg in divided dose | 20 mg divided dose | | terazosin | Hytrin™ | 1 mg QD | 20 mg QD | | Combined α-and ß-blockers | carvedilol | Coreg™ | 12.5 mg divided dose | 50 mg divided dose | May mask signs of low blood glucose levels. Take with food to avoid stomach upset. |
|---|
| labetalol | Normodyne™ | 200 mg divided dose | 800 mg divided dose | | labetalol | Trandate™ | 200 mg divided dose | 800 mg divided dose | | Direct vasodilators | hydralazine | Apresoline™ | 25 mg QD | 100 mg divided dose | May cause headaches, fluid retention, or fast heart rate. |
|---|
| midoxidil | Loniten™ | 2.5 mg QD | 80 mg divided dose | | Central α-agonists | clonidine | Catapres™ | 0.1 mg QD | 0.8 mg divided dose | Do not discontinue drug suddenly without consulting physician. |
|---|
| clonidine | Catapres TTS™* (patch) | 0.1 mg Q week | 0.3 mg Q week | | methyldopa | Aldomet™ | 250 mg divided dose | 1,000 mg divided dose | | guanfacine | Tenex™ | 0.5 mg QD | 2 mg QD | | Peripheral Anti-adrenergics | guanadrel | Hylorel™ | 10 mg in divided dose | 75 mg divided dose | May cause dizziness, nasal congestion, and depression. |
|---|
| guanethidine | Ismelin™ | 10 mg QD | 50 mg QD | | resperine | | 0.1 mg divided dose | 0.25 mg divided dose |
For all anti-hypertensives: - Ask pharmacist before using OTC products.
- Monitor blood pressure regularly.
- To prevent dizziness, advise patient to stand up slowly. If dizziness persists, refer to health care provider.
Information about high blood pressure can be found at the following Web sites:
Health care professionals: www.nhlbi.nih.gov/health/prof/heart/index.htm
Information for people with diabetes: www.nhlbi.nih.gov/hbp
Drugs used to treat high blood pressure: www.nhlbi.nih.gov/guidelines/hypertension/express.pdf
SECTION C Medications for the Treatment of Dyslipidemia
| Category | Generic Name | Brand Name | Minimum Daily Dose | Maximum Daily Dose | Special Considerations for class of drugs |
|---|
| HMG-Coa = 3-hydroxy-3-methylglutaryl coenzyme A LDL = low-density lipoprotein HDL = high-density lipoprotein TC = total cholesterol TG = plasma triglycerides generic = generic drug manufacturers |
| HMG-CoA reductase inhibitors (statins) | atorvastatin | Lipitor™ | 10 mg QD | 80 mg in divided doses | Main action: Lowers LDL (“bad”) cholesterol.
Also lowers TG and modestly raises HDL. Have blood tests for liver enzyme concentrations. Notify physician if muscle aches or weakness develops. Use caution if combined with fibric acid derivatives due to the increased risk of rhabdomyolysis. |
|---|
| fluvastatin | Lescol™ | 20 mg QD | 80 mg in divided doses | | fluvastatin | Lescol XL™ | 80 mg QD | 80 mg in divided doses | | lovastatin | Mevacor™ | 10 mg QD | 80 mg in divided doses | | lovastatin (extended-release) | Altocor™ | 20 mg QD | 60 mg QD | | pravastatin | Pravachol™ | 10 mg QD | 80 mg QD | | rosuvastatin | Crestor™ | 5 mg QD | 40 mg QD | | simvastatin | Zocor™ | 5 mg QD | 80 mg in divided doses | | Cholesterol absorption inhibitors | ezetimibe | Zetia™ | 10 mg QD | 10 mg QD | Main action: Lowers LDL cholesterol; inhibits absorption of cholesterol. If used with a statin, take together. If used with bile acid sequestrant, ezetimibe should be taken 2 hr before or 4 hr after bile acid sequestrant. |
|---|
| Nicotinic acid (niacin) | nicotinic acid (extended release) | Niaspan™ | 50-100 mg QD | 2,000 mg QD | Main action: Lowers LDL cholesterol increases HDL (“good”) cholesterol, lowers triglycerides. Take with food. May cause flushing. May increase blood glucose levels. Have blood tests for liver enzyme concentrations. Long-acting forms may be more likely to cause liver malfunction. |
|---|
| nicotinic acid | | 250 mg/day QD | Titrated up to 1500mg therapeutic dose in 3 divided doses. Maximum dose= 3000mg | | Lipid combinations | lovastatin-niacin | Advicor™ | 20 mg/500 mg QD | 40 mg/2,000 mg QD | Main action: Reduces LDL, TC , and TG and increases HDL due to the individual actions of niacin and lovastatin. |
|---|
| simvastatin-ezetimibe | Vytorin™ | 10 mg/10 mg QD | 80 mg/10 mg QD | Main action: Reduces LDL cholesterol. | | Amlodipine+atorvastatin | Caduet™ | 2.5mg/10mg QD | 10 mg/80 mg QD | Blood Pressure medication (Calcium channel blocker) (see Blood pressure med chart)+lipid (statin) medication. Same comments as individual | | Fibric acid derivatives | fenofibrate | Tricor™ | 48 mg QD | 145 mg QD | Main action: Lowers triglycerides, increases HDL cholesterol. Perform blood tests for liver enzyme concentrations. Adjust dose based on age and renal impairment. Notify physician if muscle aches or weakness develops. |
|---|
| fenofibrate | Lofibra™ | 67 mg QD | 200 mg QD | | fenofibrate | Triglide™ | 50 mg QD | 160 mg QD | | fenofibrate | Antara™ | 43 mg QD | 130 mg QD | | gemfibrozil | Lopid™ | 1,200 mg BID | 1,200 mg BID | | Bile acid sequestrants | cholestyramine | LoCHOLEST™ | 4 g QD | 24 g in divided doses | Main action: Lowers LDL cholesterol. May cause constipation and stomach upset. May need to be taken at a different time than other medications to avoid drug interactions. May increase triglycerides blood concentrations. Can be combined with other agents such as statins. |
|---|
| cholestyramine light | LoCHOLEST light™ | 4 g QD | 24 g in divided doses | | cholestyramine | Questran™ | 4 g QD | 24 g in divided doses | | cholestyramine light | Questran light™ | 4 g QD | 24 g in divided doses | | cholestyramine | Prevalite™ | 4 g QD | 24 g in divided doses | | cholestipol | Colestid™ | 2g QD or BID | 6g QD or BID | | colesevelam | Welchol™ | 1,875 mg (3 tablets) QD | 4,375 mg (7 tabs) QD or BID |
Revised
March 2007
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