Oral Diabetes Prescription Medications

Insulinis a hormone produced by cells in the pancreas called beta cells. Insulin helps the body useblood glucose(a type of sugar) for energy. People withtype 2 diabetesdo not make enough insulin and/or their bodies do not respond well to it, leading to elevated blood sugar levels. Oral (non-insulin) diabetes medications bring blood sugar levels into thenormal rangein a variety of ways.

• Oral diabetes medications are only used to treat type 2 ornon-insulin-dependent diabetes.
• Patients with type 1 diabetes are dependent on insulin for their treatment.

Here are the types of the oral (non-insulin) medications and applications

Medications that increase insulin production

• The earliest oral diabetes drugs were the sulfonylureas. These work by stimulating the pancreas to produce more insulin.
• The oldest of these drugs still on the market is chlorpropamide (Diabinese), which has been used for more than 50 years.
• The second-generation sulfonylureas are taken once or twice a day. They includeglipizide(Glucotrol,Glucotrol XL),glyburide(Micronase,DiaBeta, Glynase), andglimepiride(Amaryl).
• Meglitinidesalso stimulate the release of more insulin from beta cells.
• Repaglinide(Prandin) andnateglinide(Starlix) are taken before every three meals.

Medications that decrease glucose production and increase insulin sensitivity

• One drug makes up the class of oral diabetes medications known as thebiguanides, and that ismetformin(Glucophage). It works by decreasing the production of glucose by the liver and by making the muscle more sensitive to insulin.
• Thethiazolidinediones,rosiglitazone(Avandia) andpioglitazone(Actos), work in a similar way.

Medications that slow the breakdown of carbohydrates

• Alpha-glucosidase inhibitorsapproach the blood glucose issue in a different way. By inhibiting the breakdown of starches in the intestine, these medications slow the rise in blood sugar normally seen after a meal. Examples includeacarbose(Precose) and miglitol (Glyset).

Medications that increase insulin production and decrease glucose production

• The last category of oral diabetes medications is the DPP-4 inhibitorsitagliptin(Januvia). This drug works by inhibiting the action of an enzyme in the body that leads to increase in insulin release. It also decreases the production of glucose by the liver.

During digestion, pancreatic beta cells release not only insulin but in a much smaller amount, the hormone amylin, which helps mediate sharp rises in blood glucose levels following meals.

• Pramlintide(Symlin) is a new, synthetic form of amylin that may help improve blood glucose control for some type 1 and type 2 diabetic people who use insulin.
  • Pramlintide has few side effects (nausea is the main one) but it adds another set of injections to a diabetic person's daily pharmaceutical routine, as it cannot be mixed in the same syringe with insulin.
• Another non-insulin injection for people with diabetes is exenatide (Byetta). This medication, originally derived from a compound found in thesalivaof the Gila monster, triggers insulin release from the pancreas when blood glucose levels rise. Exenatide is meant to be used along with oral diabetes drugs. It is dosed twice daily and should be injected within an hour of the morning and evening meals. Recently, the FDA warned that exenatide may increase the risk of severe even fatalpancreatitis(inflammation of the pancreas) and that the drug should be discontinued and not restarted if signs and symptoms of pancreatitis develop (severe abdominal pain, for example). It is not for use in people with type 1 diabetes.

Many people with type 2 diabetes will take a combination of medications to help control their diabetes. With combination therapy, there is an increased risk of low blood sugar.

• The sulfonylureasmay causehypoglycemia(low blood sugar), skin rash or itching, sensitivity to sunlight, upset stomach, and weight gain.
• The meglitinides可能会导致低血糖和体重增加。
• People takingbiguanidesmay developlactic acidosis, a rare but severe side effect. Excessive alcohol intake while on metformin can contribute to the development of lacticacidosis. Other side effects include a metallic taste in the mouth and diarrhea.
• Thiazolidinedionescan increase the risk of heart failure and should not be used in patients with symptoms of heart failure. Liver enzymes should be checked regularly with use. Other side effects include weight gain, fatigue, swelling of the legs or ankles, and increased risk for fractures in female patients. Avandia may have potential increased risk for heart attack.
• Alpha-glucosidase inhibitorsmay causegastrointestinalproblems (nausea, gas, bloating), although they are usually fleeting.
• The DPP-4 inhibitorsitagliptin (Januvia) may cause serious allergic reactions, sore throat, upper respiratory infection, and headache.
• Pramlintide (with insulin)may cause gastrointestinal problems (nausea, vomiting, abdominal pain,anorexia), slight weight loss, headache, fatigue, dizziness, coughing,sorethroat, and skin reactions at the injection site.
• Side effects ofexenatidemay include slight weight loss, nausea, vomiting, and diarrhea.

Many drugs can affect your blood sugar levels, affecting in turn how well your diabetes medication works. Make sure your doctor is aware of all other medications and supplements you are taking to ensure the proper dosing of your diabetes medicine.

There is much overlap of medications that may interact with oral diabetes drugs. These include but are not limited to some:

• Heart medications
• Decongestants
• Antibiotics
• Thiazides
• Steroids
• Thyroiddrugs
• 雌激素
• Oral contraceptives
• Seizure medications
• Psychiatric medications
• Cholesterolmedications

Digestive enzyme medications (such asamylase, and pancreatin) may reduce the effectiveness of alpha-glucosidase inhibitors and should not be taken at the same time.

These drugs can cause potentially severe hypoglycemia when used with insulin and can delay the absorption of some oral drugs given at the same time. They should not be used with other drugs affecting gastrointestinal motility or agents that work by affecting gut absorption of nutrients (such as alpha-glucosidase inhibitors).

Because Byetta may affect the absorption of some drugs given orally, including antibiotics, those drugs should not be used within an hour of a Byetta injection. The drug may also interact with warfarin.

Diabetes medications can have interactions with other medications or supplements being used. The use of more than one diabetes medication can increase the risk for hypoglycemia. Beta-blocker medications can mask the symptoms of hypoglycemia.

磺酰脲类药物可能increase the risk of death fromcardiovascular disease. Prolonged exercise and alcohol intake increases the risk for hypoglycemia. Patients undergoing surgery or who have had recenttrauma, stress, or infection may need to switch fromsulfonylureato insulin to manage blood sugar levels. People with kidney or liver disease need to take precautions.

Becausemeglitinidesmay cause hypoglycemia, they should be taken right before meals to minimize the possibility of hypoglycemia. If a meal is to be skipped, the dose of the medication should also be skipped.

Thiazolidinedionesmay cause or exacerbate heart failure. Trouble breathing, rapid weight gain, and fluid retention may indicate the onset of heart failure.

Avandia may potentially increase the risk of a heart attack.

Alpha-glucosidase inhibitorsshould not be used in people with intestinal diseases such as inflammatory bowel disease orintestinal obstruction. People with kidney dysfunction may not be able to these medications.

Alpha-glucosidase inhibitors should be taken with the first bite of each meal.

Patients with kidney disease may require dosage adjustment if they are using aDPP-4 inhibitor.

People with a history of liver disease, heavy drinking, or kidney disease may not be able to take biguanides. Inform medical personnel of biguanide use prior to any radiological tests which require an injection of dye.

Severe hypersensitivity reactions have occurred during the use of sitagliptin.

Pramlintide is only appropriate for certain people with diabetes who use insulin and are having problems maintaining their blood sugar levels. Because of the potential for severe hypoglycemia with the use of pramlintide is with insulin, adjustments to insulin dosage and more frequent glucose monitoring may be necessary. Insulin and pramlintide should not be mixed in the same syringe.

Exenatidemay increase the risk of severe even fatal pancreatitis. Byetta should not be used in people with type 1 diabetes or to treat diabetic ketoacidosis.

Patients with severe kidney disease or gastrointestinal disease should not use exenatide.

Hypersensitivity reactions may occur following treatment with exenatide due to formation of antibodies.

• 氯磺丙脲(氯磺丙脲)
• Glyburide (Micronase, Diabeta,Glynase PresTab)
• 格列吡嗪(Glucotrol Glucotrol XL)
• Glimepiride (Amaryl)
• Tolbutamide
• Acetohexamide
• Tolazamide (Tolinase)

• Nateglinide (Starlix)
• Repaglinide (Prandin)

• Rosiglitazone (Avandia)
• Pioglitazone (Actos)

• Metformin (Glucophage, Glucophage XR,Riomet,Fortamet,Glumetza)

• Acarbose (Precose)
• Meglitol (Glyset)

• Sitagliptin (Januvia)

Oral diabetes medications may also come in combination tablets such asMetaglip(glipizide/metformin),Prandimet(repaglinide/metformin),Glucovance(glyburide/metformin),Janumet(sitagliptin/metformin),Avandamet(rosiglitazone/metformin),Avandaryl(rosiglitazone/ glimepiride),Duetact(pioglitazone/glimepiride),Actoplus Met(pioglitazone/metformin).

SOURCES:
American Diabetes Associationwww.diabetes.org
Food and Drug Administration www.fda.gov
Wikipedia www.wikipedia.org
WebMD www.webmd.com
www.diabetes.niddk.nih.gov
National Institute of Diabetes, Digestive and Kidney Diseases
FDA Drug Database www.accessdata.fda.gov
Daily Med www.dailymed.nlm.nih