MedicationAverage A1C reductionPotential adverse effectsPrecautions/contraindications

  • Alpha-glucosidase inhibitors

  • Acarbose (Precose)

  • Miglitol (Glyset)

  • 0.5% to 0.8%

  • Flatulence, diarrhea, abdominal bloating

  • Avoid when creatinine clearance < 25 mL per minute per 1.73 m2 (0.42 mL per second per m2)

  • Most effective when given with a starchy, high-fiber diet

  • Reverse hypoglycemia with glucose, not sucrose

  • Biguanides

  • Metformin

  • 1.0% to 1.3%

  • Nausea, diarrhea, abdominal bloating

  • Extended-release preparations have fewer gastrointestinal adverse effects

  • Estimated GFR 30 to 44 mL per minute per 1.73 m2: review use of metformin

  • Estimated GFR < 30 mL per minute per 1.73 m2: discontinue use

  • Discontinue during acute illness or procedure that could predispose patient to lactic acidosis

  • Dipeptidyl-peptidase-4 inhibitors

  • Alogliptin (Nesina)*

  • Linagliptin (Tradjenta)*

  • Saxagliptin (Onglyza)*

  • Sitagliptin (Januvia)*

  • 0.5% to 0.9%

  • Headache, pancreatitis (rare)

  • Linagliptin does not require dosage adjustment in renal insufficiency

  • Saxagliptin dosage adjustment required when administered with concomitant CYP3A4 inhibitors

  • Glucagon-like peptide-1 receptor agonists

  • Albiglutide (Tanzeum)*

  • Dulaglutide (Trulicity)*

  • Exenatide (Byetta, Bydureon)*

  • Liraglutide (Victoza)*

  • 0.8% to 2.0%

  • Nausea, vomiting, sense of fullness

  • Weight loss of 1 to 4 kg (2.2 to 8.8 lb) is likely

  • Pancreatitis (rare)

  • Exenatide is not recommended if creatinine clearance < 30 mL per minute per 1.73 m2 (0.50 mL per second per m2)

  • Boxed warning for personal or family history of medullary thyroid carcinoma; patients with multiple endocrine neoplasia type 2

  • Meglitinides

  • Nateglinide (Starlix)*

  • Repaglinide (Prandin)

  • 0.5% to 1.0%

  • Hypoglycemia

  • Metabolized primarily by the liver (CYP3A4 and CYP2C9)

  • Sodium-glucose cotransporter 2 inhibitors

  • Canagliflozin (Invokana)*

  • Dapagliflozin (Farxiga)*

  • Empagliflozin (Jardiance)*

  • 0.5% to 0.9%

  • Increased urinary tract and genital infections, increased low-density lipoprotein cholesterol level

  • Weight loss of 0.7 to 3.5 kg (1.5 to 7.7 lb) is typical

  • Dosage adjustment required in renal insufficiency

  • Sulfonylureas

  • Glimepiride (Amaryl)

  • Glipizide (Glucotrol)

  • Glyburide

  • 0.4% to 1.2%

  • Hypoglycemia, weight gain

  • Dosage adjustment required in renal insufficiency

  • Administer with meals

  • Thiazolidinediones

  • Pioglitazone (Actos)

  • Rosiglitazone (Avandia)

  • 0.5% to 1.4%

  • Weight gain, edema

  • Contraindicated in patients with New York Heart Association class III or IV congestive heart failure

  • Decrease concomitant insulin dose at initiation