Table 2.
Dosing recommendations for noninsulin antihyperglycemic agents currently available in the United States in the setting of CKD19,37,38
| Medication | Recommended Dosing with Impaired GFR, ml/min per 1.73 m2 |
|---|---|
| Biguanides | |
| Metformin | No dose adjustment if eGFR>45 |
| Do not initiate or assess risk/benefit if currently on metformin if eGFR=30–45 | |
| Discontinue if eGFR<30 | |
| Second generation sulfonylureas | |
| Glipizide | No dose adjustment required |
| Glimepiride | Initiate conservatively at 1 mg daily |
| Glyburide | Avoid use |
| Meglitinides | |
| Repaglinide | Initiate conservatively at 0.5 mg with meals if eGFR<30 |
| Nateglinide | Initiate conservatively at 60 mg with meals if eGFR<30 |
| Thiazolidinediones | |
| Pioglitazone | No dose adjustment required |
| Rosiglitazone | No dose adjustment required |
| α-Glucosidase inhibitors | |
| Acarbose | Avoid if eGFR<30 |
| Miglitol | Avoid if eGFR<25 |
| GLP-1 RAs | |
| Exenatide | Not recommended with eGFR<30 |
| Liraglutide | No dose adjustment recommended by manufacturer |
| Lixisenatide | No dose adjustment required for eGFR=60–89 |
| No dose adjustment required for eGFR=30–59, but patients should be monitored for AEs and changes in kidney function | |
| Clinical experience is limited with eGFR=15–29; patients should be monitored for AEs and changes in kidney function | |
| Avoid if eGFR<15 | |
| Albiglutide | No dose adjustment required for eGFR=15–89 per manufacturer |
| Dulaglutide | No dose adjustment recommended by manufacturer |
| DPP-4 inhibitors | |
| Sitagliptin | 100 mg daily if eGFR>50 |
| 50 mg daily if eGFR=30–50 | |
| 25 mg daily if eGFR<30 | |
| Saxagliptin | 5 mg daily if eGFR>50 |
| 2.5 mg daily if eGFR≤50 | |
| Linagliptin | No dose adjustment required |
| Alogliptin | 25 mg daily if eGFR>60 |
| 12.5 mg daily if eGFR=30–60 | |
| 6.25 mg daily if eGFR<30 | |
| Amylinomimetic | |
| Pramlintide | Specific guidelines for dosage adjustment in CKD are not available |
| SGLT-2 inhibitors | |
| Canagliflozin | No dose adjustment required if eGFR≥60 |
| 100 mg daily if eGFR=45–59 | |
| Avoid use and discontinue in patients with eGFR persistently <45 | |
| Dapagliflozin | Avoid initiating if eGFR<60 |
| Not recommended with eGFR=30–60 | |
| Contraindicated with eGFR<30 | |
| Empagliflozin | No dose adjustment required if eGFR≥45 |
| Avoid use and discontinue in patients with eGFR persistently <45 |
AE, adverse event.