Oral Antihyperglycemic Drugs
Oral antihyperglycemic agents lower glucose levels in the blood. They are commonly used in the treatment of diabetes mellitus. [1, 2]
Biguanides
-
Biguanides decrease hepatic glucose production, decrease gastrointestinal glucose absorption, and increase target cell insulin sensitivity
-
Contraindications: Metabolic acidosis with or without coma, abnormal creatinine clearance from any cause including diabetic ketoacidosis, shock, acute myocardial infarction, septicemia, renal disease (serum creatinine level ≥1.5 mg/dL in males or ≥1.4 mg/dL in females), lactation, radiologic contrast study within 48 hours
Sulfonylureas
-
Sulfonylureas increase beta-cell insulin secretion, decrease hepatic glucose output, and increase insulin receptor sensitivity at peripheral target tissues
-
Examples: Glyburide, glipizide, glimepiride, tolazamide, tolbutamide
-
Contraindications: Sulfa allergy, type 1 diabetes, diabetic ketoacidosis, concomitant use with bosentan
Thiazolidinediones
-
Thiazolidinediones increase insulin receptor sensitivity and influence the production of gene products involved in lipid and glucose metabolism; their mechanism of action depends on the presence of insulin for activity [5]
-
Examples: Pioglitazone, rosiglitazone
-
Contraindications: Hypersensitivity to product or components, established NYHA class III/IV heart failure
Alpha-glucosidase inhibitors
-
Inhibit the upper gastrointestinal enzymes that convert dietary starch and other complex carbohydrates into simple sugars, which can be absorbed
-
Examples: Acarbose (Precose) & Miglitol (Glycet)
-
Contraindications: Diabetic ketoacidosis; cirrhosis; inflammatory bowel disease, colonic ulceration, partial intestinal obstruction,