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Oral Hypoglycaemic Agent

Oral Hypoglycaemic Agents

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Acarbose / Alpha-glucosidase inhibitors (Gucobay)

Glibenclamide (Daonil)

(Diabex, Diaformin, Glucohexal, Glucomet, Glucophage,NovoMet)

Repaglinide (Novonorm)

Rosiglitazone (Avandia)

Gliclazide (Diamicron, Glyade)

Glimepiride (Amaryl)

Glipizide (Melizide, Minidiab)

Agen Oral Hypoglycaemic

  • Sulfonilurea
  • Biguanida
  • Thiazolidinedione
  • Meglitinides
  • Aplha-glucosidase inhibitors

Sulphonylurea

Types

Sulphonylurea agents:

Chlorpropamide (Obsolete In Older People, Please Mention This), Glibenclamide (Daonil), Gliclazide ( Diamicron, Glyade),

Glimepiride ( Amaryl), Glipizide ( Melizide, Minidiab),

Tolbutamide ( Rastinon) Not In Blue Book

Action

Stimulate your pancreas to release insulin.

Side Effects

Occasional:

Mild skin reactions

  • allergic skin rash (itch or hives)
  • Some people become more sensitive to sunlight when taking sulphonylureas so use a high strength sunscreen (Factor 15 or above) to protect yourself from sunburn.

Gastrointestinal disturbances

  • weight gain
  • constipation,
  • diarrhoea,
  • indigestion,
  • a feeling of fullness,
  • nausea or reduced appetite.

Rarely:

Cardiovascular

  • fluid retention,
  • reduced production of blood cells by bone marrow

Endocrinological

  • severe low blood sugar ( hypoglycaemia )

General

  • allergic reaction (difficulty in breathing, fever, hives, skin rash, swollen face, lips and tongue)
  • fatigue,
  • weakness

Psychiatric

  • confusion,
  • disorientation.

Special Precautions

Avoid use in

  • pregnancy
  • breastfeeding
  • insulin dependant diabetes (IDDM) patients,
  • severe non-insulin dependent diabetes (NIDDM) patients, and
  • patients who are allergic to sulphonamide antibiotics.

Use under medical supervision in patients suffering from

  • liver impairment
  • kidney impairment
  • failure of thyroid function.

Biguanides

Types

Biguanides agents:

Metformin (Diabex, Diaformin, Glucohexal, Glucomet, Glucophage, Novomet).

Action

  • Works mainly by inhibiting glucose production and reducing its absorption in the gut, hence lowering the blood sugar levels in diabetics
  • Drug of choice in overweight patients in whom strict dieting has been unsuccessful or has failed to control diabetes.
  • Hypoglycemia (low blood sugar levels) is not a problem with this medicine, and it has a lower incidence of weight gain compared with other oral antidiabetic agents (e.g. sulphonylureas).

Side Effects

Occasional:

  • stomach upset (nausea, diarrhea),
  • weight loss,
  • decreased vitamin B12 absorption.

Rarely: Lactic acidosis

  • abdominal pain,
  • drowsiness,
  • malaise,
  • nausea,
  • no appetite,
  • fainting,
  • rapid weight loss,
  • vomiting.

Note lactic acidosis occurs due to the accumulation of metformin – those patients especially at risk include

  • the elderly,
  • patients with renal impairment and
  • patients taking high doses of metformin .

Special Precautions

Avoid use in

  • liver and kidney impairment
  • predisposition to lactic acidosis
  • heart failure
  • dehydration (maintain adequate fluid intake)
  • alcoholics (restrict alcohol consumption)
  • recent infection
  • trauma
  • surgery
  • pregnancy and breastfeeding

Thiazolidinedione

Types

Thiazolidinedione

Rosiglitazone ( Avandia).

Action

Make your body cells, especially muscle cells, more sensitive to the effects of insulin

Side Effects

Occasional:

General:

  • increased blood cholesterol,
  • weight gain.

Rarely

Cardiovascular:

  • anaemia (reduced red blood cells),
  • fluid retention ( oedema )

Endocrinological liver impairment

  • abdominal pain,
  • dark urine,
  • fatigue,
  • jaundice,
  • loss of appetite,
  • nausea,
  • vomiting

General:
Stimulation of ovulation in women with anovulatory (absence of ovulation) conditions, such as polycystic ovary syndrome.

Special Precautions

Avoid use in patients with moderate to severe liver impairment.

Use under medical supervision in

  • pregnancy
  • breastfeeding and
  • in patients with
    • heart failure, or
    • liver or
    • kidney impairment.

Meglitinides

 

Meglitinides

Repaglinide (Novonorm) 

Action

Stimulate your pancreas to release insulin and it is most effective if taken on an empty stomach.

Repaglinide offers the potential for good control of blood glucose levels after eating, whilst allowing for more flexibility in terms of mealtimes. In some people, the more flexible approach to eating may also help with weight loss.

Side Effects

Occasional:

low blood glucose levels( hypoglycaemia ).

Alpha-glucosidase inhibitors

Types

Alpha-glucosidase inhibitors

Acarbose (Gucobay).

Action

It reduces the demand for insulin after a meal. It does this by inhibiting the digestion of carbohydrates, which in turn reduces the rise in blood glucose level that would usually occur after eating.

Acarbose is only effective it is taken at the same time as food is eaten. The drug needs to reach the intestine at the same time as the carbohydrates to do its job.

Side Effects

Minor:

Dermatological: allergic skin rash (itch or hives), skin redness; Gastrointestinal: bloating, diarrhea, flatulence, nausea, vomiting.

Major:

Endocrinological: liver impairment (abdominal pain, dark urine, fatigue, jaundice, loss of appetite, nausea, vomiting).

Special Precautions

Avoid use in

  • pregnancy
  • breastfeeding
  • patients suffering from
    • severe kidney impairment,
    • gastrointestinal disorders associated with malabsorption (such as Crohn’s disease and ulcerative colitis)
    • intestinal obstruction.

Acarbose is often associated with a lot of flatulence. This because undigested food passes on through the gut and is fermented by bacteria, producing large volumes of gas if taken with diets high in sucrose (can be minimised by starting on a very low dose, gradually increasing the dose over a number of weeks).

Last Reviewed : 10 July 2008
Writer : Dr. Nour Hanah Othman
  : Hadijah bt. Mohd Taib
  : Rosidah bt. Din
  : Nor Eizlin bt. Mohd Helmi