44


Chapter 2


Box 2.15 (cont.) Glucose-Lowering Medications for Type 2 Diabetes4,14


• Usual dosage information ○ Januvia: 100 mg once daily with or without food ○ Onglyza: 2.5–5 mg once daily ○ Tradjenta: 5 mg once daily ○ Nesina: 25 mg once daily


Bile acid sequestrants


• Example: Colesevelam (Welchol) • Principal action: Binds bile acids in intestinal tract, increasing hepatic bile acid production


• Advantages: No hypoglycemia; lowers LDL-C


• Disadvantages: Generally modest HbA1c efficacy; constipa- tion, increased TG levels; may interfere with absorption of other medications; high cost


Dopamine-2 agonists


• Example: Bromocriptine (Cycloset) • Principal action: Activates dopaminergic receptors; increases insulin sensitivity


• Advantages: No hypoglycemia; decrease weight; decrease blood pressure


• Disadvantages: Generally modest HbA1c efficacy; dizziness/ syncope, nausea, fatigue, rhinitis; high cost


Sodium-glucose cotransporter 2 (SGLT2) inhibitors


• Examples: ○ Canagliflozin (Invokana) ○ Dapagliflozin (Farxiga) ○ Empagliflozin (Jardiance)


• Expected decrease in HbA1c: 0.5%–1.0%


• Principal action: Inhibits SGLT2 in the proximal nephron, which blocks glucose reabsorption by the kidney, increasing glucosuria


• Advantages: No hypoglycemia; decrease weight; decrease blood pressure; effective at all states of type 2 diabetes (T2D)


Continued on next page.


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