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. 2020 Jan 27;9:212607. doi: 10.7573/dic.212607

Table 6.

Overview of precautions and contraindications for oral antidiabetic medications.10,14,15

Biguanide: metformin
Diarrhea and abdominal discomfort
B-12 deficiency
History of DKA, lactic acidosis, metabolic acidosis (contraindication)
Renal Adjustment (eGFR <30 contraindicated)
Sulfonylureas: glyburide, glipizide, glimepiride, glibenclamide, gliclazide
Hypoglycemia
Weight gain
Diarrhea, nausea
Caution renal insufficiency
Uncertain cardiovascular safety
Meglitinides: repaglinide, nateglinide
Hypoglycemia
Weight gain
Uncertain cardiovascular safety
Must be taken with meals
Thiazolidinediones: pioglitazone, rosiglitazone
Weight gain
Macular edema
Edema/increased risk of CHF (avoid NYHA class III/IV CHF)
Rosiglitazone increases LDL
Fracture risk
Avoid in increased liver function tests
SGLT-2 inhibitors: canagliflozin, dapagliflozin, empagliflozin, ertugliflozin
Urinary tract infections
Genital fungal infections
Necrotizing fasciitis (Fournier’s Gangrene)
Hypotension
Dehydration
Fracture risk (canagliflozin)
Amputation risk (canagliflozin)
Euglycemia ketoacidosis
Increase in LDL
Increase serum creatinine (acute kidney injury)
Bladder cancer risk (dapagliflozin)
Dipeptidyl peptidase-4 inhibitors: sitagliptin, saxagliptin, alogliptin, linagliptin, vildagliptin
Joint pain
Pancreatitis (rare)
Hypersensitivity reactions
Heart failure risk (saxagliptin, alogliptin)
α-Glucosidase inhibitors: acarbose, miglitol
Diarrhea, flatulence, abdominal pain
Avoid in severe renal or hepatic disease
Hypoglycemia must be treated with glucose, not sucrose or complex carbohydrates
Must take with food
Bile acid sequestrant: colesevelam
Constipation, nausea, bloating
Increased triglycerides
Space doses with other medications
Dopamine receptor agonist: bromocriptine
Orthostatic hypotension
Dizziness, headache, somnolence
Nausea, vomiting, diarrhea
Worsen psychiatric disorders
Injectable antidiabetic medications
Glucagon-like peptide-1 (GLP-1) agonists: exenatide, lixisenatide, dulaglutide, liraglutide, semaglutide (available orally and injectable)
Black box warning: medullary thyroid carcinoma and multiple endocrine neoplasia syndrome type 2
Nausea, vomiting, diarrhea
Jittery feeling, headache, dizziness
Hypoglycemia risk with sulfonylureas and insulin
Risk of acute pancreatitis
Risk of cholelithiasis
Caution gastroparesis
Avoid all GLP-1 agonists in severe renal impairment
Caution retinopathy and semaglutide titrate slowly
Amylin analog: pramlintide acetate
Hypoglycemia
Nausea, vomiting, anorexia
Caution with gastroparesis
Insulin:
Hypoglycemia
Weight gain
Possible injection site reactions or erratic absorption from not rotating sites
Incorrect use of pen or technique of injecting insulin can affect blood sugar
Not storing insulin correctly and using expired insulin can affect blood sugar
Multiple injections may be required with different insulin
Frequent dose adjustments
Misidentification, inaccurate dosing, incorrect timing
Inhaled insulin requires lung function monitoring; cannot be used if you have asthma, COPD, smoker, lung cancer, dexterity problems, children