Table 1.
Relationship among therapeutic class, medication dose and creatinine clearance.
| Class and Medication | Dose Adjustment Based on eGFR |
|---|---|
| Biguanide | |
| Metformin | USA prescribing information: contraindication for men with serum creatinine ≥1.5 mg/dL and women with serum creatinine ≥1.4 mg/dL UK guideline allows metformin in patients with eGFR >30 mL/min/1.73 m2 KDIGO recommends metformin in patients with eGFR >45 mL/min/1.73 m2 |
| Sulfonylureas | |
| Glipizide | No dose adjustment required |
| Glimepiride | Initiate conservatively at 1 mg daily Avoid use if eGFR <60 mL/min/1.73 m2 |
| Gliclazide | Reduce dose if eGFR <30 mL/min/1.73 m2. Not recommended if eGFR <15 mL/min/1.73 m2 |
| Glyburide or glibenclamide | Avoid use in patients with eGFR <60 mL/min/1.73 m2 |
| Meglitinides | |
| Repaglinide | Initial dose of 0.5 mg before meals when eGFR <30 mL/min/1.73 m2 |
| Nateglinide | Caution when used with eGFR <30 mL/min/1.73 m2. Initiate with 60 mg before meals |
| a-Glucosidase inhibitors | |
| Acarbose | Avoid if eGFR <30 mL/min/1.73 m2 |
| Miglitol | Avoid if eGFR <30 mL/min/1.73 m2 |
| TZDs | |
| Pioglitazone | No dose adjustment required. Use with caution in patients with CKD and hypervolemia |
| GLP-1 receptor agonists | |
| Exenatide | Avoid if eGFR <30 mL/min/1.73 m2. When eGFR between 30 and 50 mL/min/1.73 m2 dose should not exceed 5 mcg |
| Lixisenatide | Avoid if eGFR <50 mL/min/1.73 m2 |
| Liraglutide | Avoid if eGFR <60 mL/min/1.73 m2 |
| DPP-4 inhibitors | Sitagliptin and saxagliptin dose adjustment required based on eGFR |
| Sitagliptin | 100 mg daily if eGFR <50 mL/min/1.73 m2 |
| 50 mg daily if eGFR 30–50 mL/min/1.73 m2 | |
| 25 mg daily if eGFR <30 mL/min/1.73 m2 | |
| Saxagliptin | 5 mg daily if eGFR <50 mL/min/1.73 m2 |
| 2.5 mg daily if eGFR <50 mL/min/1.73 m2 | |
| Alogliptin | 1.25 mg per day when eGFR 30–60 mL/min/1.73 m2, and for those patients with eGFR <30 mL/min/1.73 m2 or hemodialysis, the dose should not exceed 6.25 mg/day |
| Linagliptin | No dose adjustment required |
| SGLT2 inhibitors | |
| Canagliflozin | No dose adjustment required if eGFR <60 mL/min/1.73 m2 |
| 100 mg daily if eGFR 45–59 mL/min/1.73 m2 | |
| Dapagliflozin | Avoid use if eGFR <60 mL/min/1.73 m2, and discontinue use if eGFR <45 mL/min/1.73 m2 |
Legend: USA: United State of America; UK: United Kingdom; KDIGO: Kidney Disease Improving Global Outcomes; eGFR: estimated glomerular filtration rate; TZDs: thiazolidinediones; GLP-1 receptor agonists: glucagon-like peptide-1 receptor agonists; DPP-4 inhibitors: dipeptidyl peptidase 4 (DPP-4) inhibitors; SGLT2 inhibitors: sodium- glucose cotransporter 2 (SGLT2) inhibitors.