WORKING
TOGETHER
TO MANAGE
DIABETES
MEDICATIONS SUPPLEMENT
SECTION A
T AB L E 1 . O R AL AG E N T S T O T R E AT T Y P E 2 D I AB E T E S *
DIABETES MEDICATIONS
Agent
Class
Primary Action
Typical Dosage
Side Effects
Precautions
Critical Tests
Comments
Tolbutamide (Ornase TM )
Tolazamide (Tolinase TM )
Chlorpropamide (Diabenese TM )
Sulfonylureas
(1st generation)
Increases insulin production
in the pancreas.
Tolbutamide: 0.25–2.0 g/day in
divided doses; maximum, 3 g/day
Tolazamide: 100–1,000 mg/day in
divided doses; maximum, 1 g/day
Chlorpropamide: 100–500 mg/day
twice a day; maximum, 750 mg/day
Hypoglycemia, weight
gain, hyperinsulinemia
Disulfiram reaction with
alcohol
Chlorpropamide remains active for up to
60 hours. Use extreme caution with elderly
patients or patients with hepatic dysfunction.
All are metabolized in liver.
Periodic evaluation of liver function is
suggested.
Use of these agents is not recommended
unless the patient has a well-established history
of taking them. Second-generation sulfonylureas
provide more predictable results with fewer
side effects and more convenient dosing.
Glyburide (Micronase TM , Diabeta TM ,
Glynase TM )
Glipizide (Glucotrol, Glucotrol XL TM )
Glimepiride (Amaryl TM )
Sulfonylureas
(2nd generation)
Increases insulin production
in the pancreas.
Clearance may be diminished in patients
with hepatic or renal impairment.
Ineffective if c-peptide test is negative. (type
1 diabetes)
Glipizide is preferred with renal impairment.
Doses >15 mg should be divided.
Glimepiride indicated for use with insulin.
Shown to have some insulin-sensitizing effect.
Repaglinide (Prandin TM )
Meglitinide
Increases insulin release
from pancreas.
Glyburide: 1.25–5 mg/once or twice a day; Hypoglycemia, weight
maximum, 20 mg/day
gain, hyperinsulinemia
Glynase: 0.75–12.0 mg/day; maximum 12
mg/day
Glipizide: 2.5–20.0 mg/once or twice a day;
maximum, 40 mg/day; or XL* 2.5–10.0
mg/once
or twice a day; maximum, 20 mg/day
Glimepiride:
1–8or
mg/day;
maximum,
8 mg/day Hypoglycemia, weight
New diagnosis
A1c <8%,
0.5 mg;
A1c >8%, 1–2 mg, 15–30 min before
gain, hyperinsulinemia
each meal; increase weekly until results
are obtained; maximum, 16 mg/day
Use with caution on patient with hepatic or
renal impairment.
Ineffective if c-peptide test is negative. (type
1 diabetes)
Patients should be instructed to take medication
no more than 30 minutes prior to a meal. If
meals are skipped or added, the medication
should be skipped or added as well.
Nateglinide (Starlix TM )
Phenylalanine derivative
Increases insulin release
from pancreas.
60–120 mg before each meal
Minimal risk of hypoglycemia
Currently no contraindications available.
Use with caution with moderate to severe
hepatic disease.
Periodic evaluation of liver function tests.
Approved as monotherapy or in combination
with metformin or TZD. Has only a 2-hour
duration of action.
Metformin (Glucophage TM )
Biguanide
Decreases insulin resistance,
primarily decreasing hepatic glucose
output; minor increase in muscle
glucose uptake.
500 mg/day twice a day with meals,
increase by 500 mg every 1–3 wk,
twice or three times a day; usually
most effective at 2,000 mg/day;
maximum, 2,550 mg/day
Nausea, diarrhea,
metallic taste, possible
lactic acidosis
Due to increased risk of lactic acidosis,
should not use if suspect frequent alcohol
use, liver or kidney disease, or CHF.
Contraindicated if serum creatinine is:
>1.5 mg/dL in men or >1.4 mg/dL women.
Do not use if creatinine clearance is abnormal.
Monitor hematological and renal function
annually.
Especially beneficial in obese patients due to
potential for weight loss, improved lipid profile,
and lack of potential for hypoglycemia requiring
supplemental carbohydrate intake. Discontinue for
48 hr after contrast dye procedures.
Rosiglitazone (Avandia TM )
Thiazolidinedione
Decreases insulin resistance, increasing glucose uptake, fat redistribution;
minor decrease in hepatic glucose
output; preserves ß-cell function;
decreases vascular inflammation.
Initially 4 mg/day in single or divided
doses. Increase to 8 mg/day in 12 wk,
if needed; maximum, 8 mg/day with
or without food
Minor weight increase of
3–6 lbs., edema
Should not be used in patients with
CHF or hepatic disease. Can cause mild-tomoderate edema.
Avoid initiation if ALT >2.5X upper limit of
normal. Measure ALT periodically. Discontinue if
ALT >3X upper limit of normal.
Approved for use as monotherapy and in combination with metformin, sulfonylureas, or insulin.
Less interactions associated with CYP-450
Pioglitazone (Actos TM )
Thiazolidinedione
Decreases insulin resistance,
increasing glucose uptake, fat redistribution; minor decrease in hepatic
glucose output; preserves ß-cell function; decreases vascular inflammation.
Initially 15 or 30 mg/day;
maximum with or without food
45 mg for monotherapy,
30 mg for combination therapy
Minor weight increase of
3–6 lbs., edema
Should not be used in patients with
CHF or hepatic disease. Can cause mild-tomoderate edema.
Avoid initiation if ALT >2.5X upper limit of
normal. Measure ALT periodically. Discontinue if
ALT >3X upper limit of normal.
Approved as monotherapy or for use with metformin, sulfonylureas, or insulin. Metabolized via
CYP-450. Patients taking other agents also using
CYP-450 pathway should be evaluated for drug
interactions and monitored more frequently for
glycemic control.
Acarbose (Precose TM )
Miglitol (Glyset TM )
Alpha-glucosidase
inhibitor
Slows absorption of complex carbohydrate from GI tract.
25 mg/day; increase by 25 mg/day
every 4–6 wk; maximum, split dose
before meals (with first bite of food)
300 mg/day (150 mg/day for weight
<60 kg)
Gas and bloating,
sometimes diarrhea
for both drugs
Should not be used if GI disorders
are concurrent.
Avoid if serum creatinine is >2.0 mg/dL.
Monitor serum transaminase every 3 months
for 1st year of therapy.
Approved for use as monotherapy and in combination with metformin, sulfonylureas, or
insulin. If used with hypoglycemic agents, such
as sulfonylureas or insulin, must treat hypoglycemia with glucose.
Glucovance TM
(Glyburide and Metformin)
Sulfonylureas and
Biguanide
Decreases hepatic glucose
production and increases insulin
secretion.
Hypoglycemia, weight
gain, lactic acidosis
Should not be used if suspect frequent
alcohol use, liver or kidney disease, or CHF.
Contraindicated if serum creatinine is
>1.5 mg/dL in men, or 1.4 mg/dL in
women, or if creatinine clearance is
abnormal.
Monitor hematologic and renal function
annually.
Patients may frequently use 2 different dose
tablets to attain desired daily dosage and
results. Discontinue for 48 hr after procedure
using contrast dye.
Metaglip TM
(Glipizide and Metformin)
Sulfonylureas and
Biguanide
Decreases hepatic glucose
production and increases insulin
secretion.
Ratios of glyburide and metformin (in mg):
1.25/250, 2.5/500, 5/500. Initial: 1.25/250
once or twice a day, increased every
2 weeks. 2nd line: 2.5–5/500 twice a day,
increased every 1–2 weeks. Average dose
7.5/1,500. Maximum dose should not
exceed
20 mg glyburide/2,000 mg metformin daily.
Ratios of glipizide and metformin (in mg):
2.5/250, 2.5/500, 5/500. Initial: 2.5/
250 once or twice a day, increased every
2 weeks. 2nd line: 2.5–5/500 twice a day,
increased every 1–2 weeks. Maximum dose
should not exceed 20 mg glipizide/
2,000 mg metformin daily.
Hypoglycemia, weight
gain, lactic acidosis
Should not be used if suspect frequent
alcohol use, liver or kidney disease, or CHF.
Contraindicated if serum creatinine is
>1.5 mg/dL in men, or >1.4 mg/dL in
women, or if creatinine clearance is
abnormal.
Monitor hematologic and renal function
annually.
Patients may frequently use 2 different dose
tablets to attain desired daily dosage and
results. Discontinue for 48 hr after procedure
using contrast dye.
Avandamet TM
(Rosiglitazone and
Metformin)
Thiazolidinedione and
Biguanide
Decreases hepatic glucose
production, increases glucose
uptake, decreases insulin
resistance, and preserves ß-cell
function.
Ratios of rosiglitazone and
metformin: 1 mg/500 mg, 2 mg/
500 mg, 4 mg/500 mg, 2 mg/
1,000 mg, 4 mg/1,000 mg twice a day;
dosage individualized based on current
therapy. Maximum, 8 mg/2,000 mg
per day
Edema, possible lactic
acidosis
Should not be used if suspect frequent
alcohol use, liver or kidney disease, or CHF.
Contraindicated if serum creatinine is
>1.5 mg/dL in men, or >1.4 mg/dL in
women, or if creatinine clearance is
abnormal.
Monitor hematologic and renal function
annually.
Less expensive than using agents separately.
Reported decrease in GI upset associated with
metformin and weight increase associated with
rosiglitazone. Discontinue for 48 hr after
procedure using contrast dye.
Combinations
Adapted from © 2005 The Diabetes Center, Old Saybrook, CT. Used by permission.
A1c = glycated hemoglobin ALT = alanine aminotransferase CHF = congestive heart failure FPG =
fasting plasma glucose GI = gastrointestinal XL = extended release
1
WORKING TOGETHER TO MANAGE DIABETES
*Agents in a class of medicines share mechanisms of action, require similar precautions, and generaly have similar side effects.
For proper usage, please read label. Agents should not be used in patients with type 1 diabetes.
DIABETES MEDICATIONS SUPPLEMENT
2
TABLE 2. IMPORTANT INSULIN INFORMATION*
Insulin
Onset
Peak
Effective
Duration
Maximal
Duration
TABLE 4. RECOMMENDED INSULIN STORAGE
Comments
Insulin Type
Human
Lispro (HumalogTM)
Aspart (NovalogTM)
Glulisine (ApidraTM)
Regular
NPH
Lente
Ultralente
Novolin 70/30
Humulin 70/30
Humalog 75/25TM
Novolog 70/30TM
<15 min
<15 min
<15 min
0.5–1 hr
2–4 hr
3–4 hr
6–10 hr
0.5–1 hr
1–2 hr
1–3 hr
0.5–1 hr
2–4 hr
4–10 hr
4–12 hr
Minimal
2–10 hr
2–4 hr
3–5 hr
3 hr
3–5 hr
10–16 hr
12–18 hr
18–20 hr
10–16 hr
3–5 hr
4–6 hr
3 hr
4–8 hr
14–18 hr
16–20 hr
20–30 hr
14–18 hr
<15 min
1–2 hr
10–16 hr
14–18 hr
Should be taken just prior to or just after eating.
Insulin glargine
(LantusTM)
4–6 hr
None
24 hr
24 hr
Cannot be mixed with any other insulin. Stress site
rotation and not to use same syringe used with
other insulins. Not recommended for pre-filling
syringes.
0.5–2 hr
3–4 hr
4–6 hr
6–8 hr
4–6 hr
4–6 hr
8–14 hr
8–14 hr
16–20 hr
16–20 hr
20–24 hr
20–24 hr
Conversion to human insulin recommended. Dose
changes required (usually a 10% reduction in dose
when switching to human).
Animal Source
Regular
NPH
Lente
Should be taken just prior to or just after eating.
Best if taken 30 min before a meal.
Bedtime dosing minimizes nocturnal
hypoglycemia.
Frequently
used in pediatric patients over NPH.
Can convert to Humalog 75/25TM or
Novolog 70/30TM dose per dose.
Adapted from © 2005, The Diabetes Center, Old Saybrook, CT. Used by permission.
*Site rotation for injections is necessary for a l types of insulin.
Glucagon
Exenatide
(ByettaTM)
Pramlintide
(SymlinTM)
Primary
Action
Converts liver
glycogen to
glucose
Modulates
gastric
emptying,
glucagon
production.
Increases
satiety, leading
to decreased
caloric intake.
For type 2 diaModulates
betes
gastric
emptying,
glucagon
production.
Increases
satiety, leading
to decreased
caloric intake.
How
Supplied/Storage
1 mg vial with diluent;
emergency kit, 1 mg vial
with prefilled syringe of
diluent. Before reconstitution, room temperature
until expiration date. After
reconstitution, may be
stored for up to 48 hours
under
refrigeration.
5 mcg/ml
prefilled pen
10 mcg/ml prefilled pen
Typical
Dosage
0.5–2 mg
subcutaneous
Duration
Action
15 min, should
be followed by
carbohydrate
snack.
5 mcg BID
Approximately
subcutaneous for 10 hours
1 month, then
Not in use: refrigerate until 10 mcg BID,
expiration date. In use:
injected within
room temperature, discard 60 minutes before
after 30 days.
morning and
evening meal.
5 ml vials containing
Type 1:
Elimination t
0.6 mg/ml. Requires U-100 15–60 mcg
of 48 minutes
insulin syringe for injection starting; 15 mcg
subcutaneous
Not in use: refrigerate until before meals of
expiration date. In use:
30 gm or more
room temperature, discard carbohydrate.
after 28 days.
Type 2:
60–120 mcg starting; 60 mcg subcutaneous. Titrate
as directed by
prescriber.
Adapted from © 2005, The Diabetes Center, Old Saybrook, CT.
2
1/2
Side Effects Precautions
Comments
Occasional
nausea and
vomiting
Patient should be instructed to teach colleagues,
family, etc. how to give
injection. Only use if
patient is unconscious or
unable to eat or drink.
Nausea and
hypoglycemia
most common;
occasional
vomiting,
diarrhea, jitters,
dizziness,
headache.
Must be reconstituted prior
to injection. Should be
followed by carbohydrate
snack and blood glucose
testing every 15 minutes
until glucose level returns
to acceptable levels.
Consider lowering dose of
sulfonylurea to avoid
hypoglycemia when starting. May reduce the rate of
absorption of oral
medication.
Medications requiring
threshold concentrations
should be taken 1 hour
prior to injection.
Nausea and
Contraindicated with:
Requires patient testing of
hypoglycemia hypoglycemic unawareblood sugars before and
most common. ness, gastroparesis.
after meals, frequent
Doses are
Patient non-adherence.
physician followup, and
adjusted based
thorough understanding of
on presentation Should never be mixed
how to adjust doses of
with
insulin.
Insulin
dose
of these side
insulin and Symlin.
should be reduced by 50% May reduce the rate of
effects.
when starting.
Occasional
absorption of orally adminvomiting,
istered medication.
stomach pain,
Medications requiring
dizziness,
threshold concentrations
indigestion.
should be taken 1 hour
prior to injection.
WORKING TOGETHER TO MANAGE DIABETES
VIAL
Opened
HumalogTM, NovologTM, HumulinTM, NovolinTM, ApidraTM
LantusTM (10 mL)
Detemir (LevemirTM) release pending
28 days
28 days
Unopened
Until expiration date
Until expiration date
PENS/CARTRIDGES
Room Temperature (59°F–86°F)
Opened
Unopened
28 days
28 days
28 days
28 days
Not in use
HumalogTM
In use
Humulin N
Humulin 70/30TM
Humalog Mix 75/25TM
Until expiration date
Until expiration date
Until expiration date
Until expiration date
Until expiration date
28 days
28 days
14 days
10 days
10 days
NovologTM
Novolog Mix 70/30TM
Novolin RTM (prefilled and 1.5-mL cartridge)
Novolin RTM (3-mL cartridge)
Novolin NTM (prefilled and 1.5-mL cartridge)
Novolin NTM (3-mL cartridge)
Novolin 70/30TM (prefilled and 1.5-mL cartridge)
Novolin 70/30TM (3-mL cartridge)
Detemir (LevemirTM) release pending
ApidraTM
LantusTM
Self-filled syringes
Until expiration date
Until expiration date
Until expiration date
Until expiration date
Until expiration date
Until expiration date
Until expiration date
Until expiration date
Until expiration date
Until expiration date
Until expiration date
14 days*
28 days
14 days
30 days
28 days
7 days
14 days
7 days
10 days
Humulin RTM ( available in cartridge only)
TM
28 days
28 days
7 days*
Adapted from © 2005, The Diabetes Center, Old Saybrook, CT. Used with permission.
*Suggested, not clinicaly established
TABLE 5. GLUCOSE-LOWERING ACTIVITY—ORAL DIABETES AGENT
“NEW TABLE 3.” GLUCAGON AND GLUCAGON-LIKE PEPTIDES (GLP-1 )
Agent
Refrigerated (36°F–46°F)
Not for use with type 1
diabetes, patients with
severe renal disease or
ESRD, or severe GI disease
Medication
Blood Glucose Most Affected SMBG* Testing to Recommend Greatest Risk for Hypoglycemia
Sulfonylureas
Fasting and postprandial
Meglitinide phenylalanine derivative
Biguanide
Postprandial
Fasting
Alpha-glucosidase inhibitor
Thiazolidinedione
Postprandial
Fasting and postprandial
GlucovanceTM
Fasting and postprandial
MetaglipTM
Fasting
AvandametTM
Fasting and postprandial
2–3 times per day,
especially fasting
2 hr after meal
Fasting
2 hr after meal
2–3 times per day,
especially fasting
2–3 times per day,
especially fasting
2–3 times per day
especially fasting
2–3 times per day
especially fasting
Nocturnal, fasting, 4–6 hr after
meals
2–3 hr after meals
After exercise if prolonged
and strenuous
None
None
Nocturnal, fasting, 4–6 hr after
meals
Nocturnal, fasting 4–6 hr after
meals
None
Adapted from © 2005, The Diabetes Center, Old Saybrook, CT. Used with permission.
SMBG = self-monitoring of blood glucose
“NEW TABLE 6.” RECOMMENDED CONTROL MEASURES
Biochemical Index
Goal
Preprandial
Peak postprandial
ADA Alc
AACE Alc
Blood pressure
LDL
TG
HDL
90–130 mg/dL
<180 mg/dL
<7%
<6.5%
<130/80
<100
<150
>40
Adapted from © 2005, The Diabetes Center, Old Saybrook, CT. Used with permission.
LDL = low density lipoprotein TG = triclycerides HDL = high density lipoprotein
DIABETES MEDICATIONS SUPPLEMENT
4
SECTION B
M E D I C AT I O N S T O T R E AT
HIGH BLOOD
CHOLESTEROL
Category
Brand Name
Generic Name
Manufacturer
Minimum Daily Maximum Daily Special Considerations*
Dose
Dose
HMG-CoA
reductase
inhibitors
(statins)
Lipitor
Lescol
Lescol XL
Mevacor
Pfizer
Novartis
Novartis
Merck
generic†
Aura Labs
10 mg
20 mg
80 mg
10 mg
10 mg
20 mg
80 mg
80 mg
80 mg
80 mg
80 mg
60 mg
Pravachol
atorvastatin
fluvastatin
fluvastatin
lovastatin
lovastatin
lovastatin
(extended-release)
pravastatin
10 mg
80 mg
Crestor
Zocor
Zetia
rosuvastatin
simvastatin
ezetimibe
Bristol-Myers
Squibb
Astra Zeneca
Merck
Merck
Schering-Plough
5 mg
5 mg
10 mg
40 mg
80 mg
10 mg
Niaspan
nicotinic acid
Kos
(extended release)
300 mg
2,000 mg
(starting dose)
nicotinic acid
generic†
300 mg
Advicor
lovastatinniacin
Kos
20 mg/500 mg 40 mg/2,000
mg
Vytorin
Merck Schering
Plough
Pfizer
generic†
Abbott
10 mg/10 mg
40 mg/10 mg
Tricor
simvastatinezetimibe
gemfibrozil
gemfibrozil
fenofibrate
1,200 mg
1,200 mg
54 mg
1,200 mg
1,200 mg
160 mg
LoCHOLEST
LoCHOLEST
light
Questran
cholestyramine
cholestyramine
light
cholestyramine
Warner Chilcott
Warner Chilcott
4g
4g
24 g
24 g
Par
Pharmaceuticals
Par
Pharmaceuticals
Upsher Smith
generic†
generic†
4g
24 g
4g
24 g
4g
4g
4g
24 g
24 g
24 g
Altocor
Cholesterol
absorption
inhibitors
Nicotinic acid
(niacin)
Lipid
combinations
Fibric acid
derivatives
Bile acid
sequestrants
Lopid
Questran light cholestyramine
light
Prevalite
cholestyramine
cholestyramine
cholestyramine
light
Welchol
colesevelam
5
Sankyo
2,000 mg
Main action: Lowers LDL (“bad”)
cholesterol.
Have blood tests for liver enzyme
concentrations.
Notify physician if severe muscle
aches or pain develops.
Use caution if combined with
fibric acid derivatives due to the
increased risk of rhabdomyolysis.
Main action: Lowers LDL cholesterol;
inhibits absorption of cholesterol.
If used with a statin, take together.
If used with bile acid sequestrant,
ezetimibe should be taken 2 hr before
or 4 hr after bile acid sequestrant.
Main action: Lowers LDL cholesterol
increases HDL (“good”) cholesterol,
lowers triglycerides.
Take with food.
May cause flushing.
May increase blood glucose levels.
Have blood tests for liver enzyme
concentrations.
Long-acting forms may be more
likely to cause liver malfunction.
Main Action: Reduces LDL, TC, and
TG increases HDLdue to the
and
individual
Main
Action:
Reduces
LDL
actions
of niacin
and lovastatin.
cholesterol.
Main action: Lowers triglycerides,
increases HDL cholesterol.
Perform blood tests for liver enzyme
concentrations.
Notify physician of muscle pain
immediately.
Main action: Lowers LDL cholesterol.
May cause constipation and
stomach upset.
May need to be taken at a different
time than other medications to avoid
drug interactions.
May increase triglycerides blood
concentrations.
Welchol unit for dose?
1,875 (3
4,375 (7
tablets)
tablets)
HMG-Coa = LDL = low-density lipoprotein HDL = high-density lipoprotein TC = total cholesterol TG = plasma triglycerides
†generic = generic drug manufacturers
SECTION
Category
Brand Name
Generic Name
Manufacturer
Angiotensinconverting
Accupril
Aceon
quinapril
perindopril
Pfizer
Solvay
Altace
enzyme (ACE) Capoten
inhibitors
Lotensin
Mavik
Monopril
ramipril
captopril
captopril
benazepril
trandolapril
fosinopril
Monarch
Apothecon
generic†
Novartis
Abbot
Bristol-Myers
Squibb
generic†
Merck
generic†
Schwarz
Merck
generic†
AstraZeneca
AstraZeneca
Bristol-Myers
Squibb
Sankyo
Merck
Novartis
BoehringerIngelheim
Biovail
Bayer
Searle
Searle
generic†
Roche
Roche
Biovail
Biovail
generic†
Searle
Watson
Reliant
Reliant
Abbott
Abbott
Pfizer
AstraZeneca
Pfizer
Pfizer
generic†
AstraZeneca
Andrx Pharm
Forest
Schwarz
Schwarz
Prinivil
Univasc
Vasotec
Zestril
Angiotensin II Atacand
receptor
Avapro
blockers
Benicar
Cozaar
Diovan
Micardis
Calcium
channel
blockers
Teveten
Adalat CC*
Calan
Calan SR
Cardene*
Cardene SR*
Cardizem
Cardizem CD
Covera HS*
Dilacor XR*
DynaCirc*
DynaCirc CR*
Isoptin
Isoptin SR*
Norvasc
Plendil*
Procardia*
Procardia XL*
Sular*
Taztia XT
Tiazac
Verelan
Verelan PM
fosinopril
lisinopril
lisinopril
moexipril
enalapril
enalapril
lisinopril
candesartan
irbesartan
olmesartan
losartan
valsartan
telmisartan
eprosartan
nifedipine
verapamil
verapamil
verapamil
nicardipine
nicardipine
diltiazem
diltiazem
diltiazem
verapamil
diltiazem
isradipine
isradipine
verapamil
verapamil
amlodipine
felodipine
nifedipine
nifedipine
nifedipine
nisoldipine
dilaizem
diltiazem
verapamil
verapamil
Minimum Daily Maximum Daily Special Considerations
Dose
Dose
5 mg
4 mg
80 mg
16 mg
1.25 mg
25 mg
25 mg
5 mg
1 mg
10 mg
20 mg
450 mg
450 mg
20 mg
8 mg
80 mg
10 mg
2.5 mg
2.5 mg
7.5 mg
2.5 mg
1 mg
2.5 mg
15 mg
150 mg
80 mg
80 mg
80 mg
60 mg
40 mg
8 mg
80 mg
32 mg
300 mg
20 mg
25 mg
80 mg
20 mg
40 mg
100 mg
320 mg
80 mg
400 mg
30 mg
120 mg
120 mg
120 mg
60 mg
60 mg
120 mg
120 mg
120 mg
180 mg
180 mg
2.5 mg
2.5 mg
120 mg
120 mg
2.5 mg
2.5 mg
30 mg
30 mg
30 mg
20 mg
120 mg
120 mg
120 mg
100 mg
800 mg
120 mg
480 mg
480 mg
480 mg
120 mg
120 mg
360 mg
360 mg
360 mg
480 mg
540 mg
20 mg
20 mg
480 mg
480 mg
10 mg
20 mg
120 mg
120 mg
120 mg
60 mg
480 mg
540 mg
480 mg
400 mg
May cause cough.
May increase potassium concentrations.
Do not use potassium or salt substitutes without consulting physician.
WORKING TOGETHER TO MANAGE DIABETES
Brand Name
Thiazides
and related
diuretics
Diuril
Minimum Daily Maximum Daily Special Considerations
Dose
Dose
2,000 mg
2,000 mg
10 mg
100 mg
100 mg
100 mg
100 mg
5 mg
5 mg
100 mg
1.0 mg
10 mg
20 mg
10 mg
10 mg
10 mg
20 mg
20 mg
200 mg
80 mg
80 mg
May increase blood glucose
concentrations.
Take in morning to minimize
diuretic effect at night.
May cause low potassium.
Potassiumsparing
diuretics
Aldactone
Diamox
400 mg
400 mg
300 mg
20 mg
20 mg
1,000 mg
1,000 mg
Do not use potassium or salt
Carbonic
anhydrase
inhibitors
50 mg
50 mg
50 mg
5 mg
5 mg
250 mg
250 mg
â-blockers
Blocadren
May cause dizziness and upset
stomach.
Do not use potassium or salt substitutes without consulting physician.
May cause constipation, dizziness,
upset stomach, and flushing.
Call physician for shortness of breath,
unusual heartbeat, or swelling of feet
or hands.
Manufacturer
500 mg
500 mg
2.5 mg
12.5 mg
12.5 mg
12.5 mg
12.5 mg
1.25 mg
1.25 mg
12.5 mg
0.25 mg
2.5 mg
2.5 mg
2.5 mg
0.5 mg
0.5 mg
5 mg
5 mg
25 mg
80 mg
80 mg
Loop diuretics
Do not use if pregnant or if trying to
conceive.
Caution if creatinine >1.5.
Generic Name
chlorothiazide
Merck
chlorothiazide
generic†
Enduron
methyclothiazide Abbott
HydroDIURIL hydrochlorothiazid Merck
ehydrochlorothiazid generic†
e
Hygroton
chlorthalidone
Norvartis
chlorthalidone
generic†
Lozol
indapamide
Aventis
indapamide
generic†
Microzide
hydrochlorothiazid Watson
e
Mykrox
metolazone
Celltech
metolazone
generic†
Naturetin
bedroflumethia Princeton
zide
Zaroxolyn
metolazone
Celltech
Bumex
bumetanide
Roche
bumetanide
generic†
Demadex
torsemide
Roche
torsemide
generic†
Edecrin
ethacrynic acid
Merck
Lasix
furosemide
Aventis
furosemide
generic†
Do not use if pregnant or if trying to
conceive.
Caution if creatinine >1.5.
*Agents in a class of medicines share mechanisms of action, require similar precautions and generaly have similar side effects.
CC = extended release XL = extended release SR = sustained release CR = controled release CD = extended release XR = extended release
PM = extended release, controled onset HS = extended release, controled onset †generic = generic drug manufacturers
7
Category
Dyrenium
Midamor
spironolactone
spironolactone
triamterene
amiloride
amiloride
acetazolamide
acetazolamide
Searle
generic†
GlaxoSmithKline
Merck
generic†
Wyeth-Ayerst
generic†
Need blood test to monitor level.
May cause low potassium.
Need blood test to monitor level.
May cause photosensitivity:
sunscreen recommended.
substitutes without consulting
physician.
May take with food if medicine
upsets stomach.
May cause hand/foot tingling that
can be confused with neuropathy.
Cartol
Corgard
Inderal
Inderal LA*
Kerlone
Levatol
Lopressor
Tenormin
Toprol XL*
Visken
Zebeta
timolol
Merck
2.5 mg
10 mg
timolol
carteolol
nadolol
generic†
2.5 mg
2.5 mg
40 mg
10 mg
10 mg
320 mg
40 mg
40 mg
40 mg
40 mg
5 mg
5 mg
10 mg
25 mg
25 mg
25 mg
25 mg
50 mg
2.5 mg
2.5 mg
2.5 mg
2.5 mg
320 mg
640 mg
640 mg
640 mg
40 mg
40 mg
40 mg
450 mg
450 mg
100 mg
100 mg
400 mg
10 mg
10 mg
20 mg
20 mg
nadolol
propranolol
propranolol
propranolol
betaxolol
betaxolol
penbutolol
metoprolol
metoprolol
atenolol
atenolol
metoprolol
pindolol
pindolol
bisoprolol
bisoprolol
Abbott
Bristol-Myers
Squibb
generic†
Wyeth-Ayerst
Wyeth-Ayerst
generic†
Searle
generic†
Schwarz
Novartis
generic†
AstraZeneca
generic†
AstraZeneca
Novartis
generic†
Lederle
generic†
May mask signs of low blood
glucose levels.
May alter blood glucose.
Call physician for slow heart rate
(<60),
confusion,
or swelling of feet or legs.
Can cause claudication.
XL = extended release LA = long acting †generic = generic drug manufacturers
DIABETES MEDICATIONS SUPPLEMENT
8
C
BLO O D PRES SURE *
M ED I C AT I O N S T O L O W E R H I G H BL O O D P R E S S U R E ( c o n t i n u e d )
M EDIC AT IO NS T O LOW ER HIG H
MEDICATIONS TO LOWER HIGH BLOOD PRESSURE ( c o n t i n u e d )
Category
Brand Name
Generic Name
á-blockers
Cardura
doxazosin
doxazosin
terazosin
terazosin
prazosin
prazosin
carvedilol
labetalol
labetalol
labetalol
hydralazine
hydralazine
midoxidil
methyldopa
methyldopa
clonidine
Manufacturer
Minimum Daily Maximum Daily Special Considerations
Dose
Dose
Pfizer
1 mg
16 mg
To prevent dizziness, avoid standing
generic†
1 mg
16 mg
up suddenly, especially with the first
Hytrin
Abbott
1 mg
40 mg
few doses.
generic†
1 mg
40 mg
Minipress
Pfizer
1 mg
20 mg
generic†
2 mg
40 mg
Combined áCoreg
GlaxoSmithKline 6.25 mg
50 mg
May mask signs of low blood glucose
and â-blockers Normodyne
Key
100 mg
2,400 mg
levels.
Trandate
Faro
100 mg
2,400 mg
Take with food to avoid stomach
upset.
generic†
100 mg
2,400 mg
Direct
Apresoline
Novartis
40 mg
300 mg
May cause headaches, fluid retention,
vasodilators
generic†
40 mg
300 mg
or fast heart rate.
generic†
2.5 mg
100 mg
Central
Aldomet
Merck
250 mg
3,000 mg
Do not discontinue drug suddenly
†
á-agonists
generic
250 mg
3,000 mg
without consulting physician.
Catapres
Boehringer0.1 mg
2.4 mg
Ingelheim
Catapres TTS* clonidine
Boehringer0.1 mg
0.6 mg
(patch)
Ingelheim
clonidine
generic†
0.1 mg
2.4 mg
Peripheral
Hylorel
guanadrel
Fisons
10 mg
75 mg
May cause dizziness, nasal
AntiIsmelin
guanethidine
Novartis
10 mg
50 mg
congestion, and depression.
adrenergics
resperine
generic†
0.1 mg
1.0 mg
*Agents in a class of medicines share mechanisms of action, require similar precautions, and generaly have similar side effects.
TTS = transdermal therapeutic system †generic = generic drug manufacturers
For all anti-hypertensives:


Ask pharmacist before using OTC products.
Monitor blood pressure regularly.

To prevent dizziness, advise patient to stand up slowly. If dizziness persists, refer to health care provider.
Information about high blood pressure can be found at the following Web sites:
Health care professionals: http://www.nhlbi.nih.gov/health/prof/heart/index.htm
Information for people with diabetes: http://www.nhlbi.nih.gov/hbp
Drugs used to treat high blood pressure: http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf
Centers for Disease Control and Prevention. Working Together to Manage Diabetes:
Diabetes Medications Supplement. Atlanta, GA: U.S. Department of Health and
Human Services, Public Health Service, Centers for Disease Control and Prevention,
National Center for Chronic Disease Prevention and Health Promotion, 2004.
NDEP-54-S
9
WORKING TOGETHER TO MANAGE DIABETES