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SECTION A Diabetes Medications

Table 1. Oral Agents to Treat Type 2 Diabetes

Agent Class Primary Action Typical Dosage Side Effects Precautions Critical Tests Comments
Adapted from © 2006 The Diabetes Center, Old Saybrook, CT. Used with permission. A1C = glycated hemoglobin ALT = alanine aminotransferase CHF = congestive heart failure FPG = fasting plasma glucose GI = gastrointestinal XL = TZD= thiozolidinedione, CYP 450= cytochrome P 450
*Agents in a class of medicines share mechanisms of action, require similar precautions, and generally have similar side effects.
For proper usage, please read label. Agents should not be used in patients with type 1 diabetes.
Tolbutamide (Ornase™)
Tolazamide (Tolinase™)
Chlorpropamide (Diabenese™)
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 or renal 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 wellestablished history of taking them. Second-generation sulfonylureas provide more predictable results with fewer side effects and more convenient dosing.
Glyburide (Micronase™, Diabeta™,
Glynase™)
Glipizide (Glucotrol, Glucotrol XL™)
Glimepiride (Amaryl™)
Sulfonylureas
(2nd generation)
Increases insulin production in the pancreas.Glyburide: 1.25-5 mg/once or twice a day; maximum, 20 mg/day
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: 1-8 mg/day; maximum, 8 mg/day
Hypoglycemia, weight gain, hyperinsulinemiaClearance may be diminished in patients with hepatic or renal impairment. 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™)MeglitinideIncreases insulin release from pancreas.New diagnosis or A1C <8%, 0.5 mg;
A1C >8%, 1-2 mg, 15-30 min before each meal;
increase weekly until results are obtained;
maximum, 16 mg/day
Hypoglycemia, weight gain, hyperinsulinemiaUse with caution on patient with hepatic or renal impairment. 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. Approved for use as monotherapy or in combinatin with TZD or metformin.
Nateglinide (Starlix™)Phenylalanine derivativeIncreases insulin release from pancreas.60-120 mg before each mealMinimal risk of hypoglycemiaCurrently 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. If meals are skipped or added, the medication should be skipped or added as well.
Metformin (Fortamet™,
Glumetza™, Glucophage™)
BiguanidePrimarily decreases hepatic glucose production.
Minor increase in muscle glucose uptake which may improve insulin resistance.

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

Long acting form Glucophage XR™: 500mg once/day, max dose 2000mg once/day

Nausea, diarrhea, metallic taste, possible lactic acidosisDue 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™)ThiazolidinedioneDecreases insulin resistance, increasing glucose uptake, fat redistribution; minor decrease in hepatic glucose output; preserves -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., edemaShould not be used in patients with CHF or hepatic disease. Can cause mild-to-moderate 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™)ThiazolidinedioneDecreases insulin resistance, increasing glucose uptake, fat redistribution; minor decrease in hepatic glucose output; preserves -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., edemaShould not be used in patients with CHF or hepatic disease. Can cause mild-to-moderate edema.Avoid initiation if ALT >2.5X upper limit of normal. Measure ALT periodically. Discontinue if ALT >3X upper limit of normal.Avoid initiation if ALT >2.5X upper limit of normal. Measure ALT periodically. Discontinue if ALT >3X upper limit of normal.
Acarbose (Precose™)
Miglitol (Glyset™)
Alpha-glucosidase inhibitorSlows 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 drugsShould 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 not sucrose.
Combinations
Glucovance™
(Glyburide and Metformin)
Sulfonylureas and BiguanideDecreases 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 every1-2 weeks.
Average dose 7.5/1,500.
Maximum dose should not exceed 20 mg glyburide/2,000 mg metformin daily.
Hypoglycemia, weight gain, lactic acidosisShould not be used if suspect frequent alcohol use, liver or kidney disease, or CHF.Same caveats as individual components.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™
(Glipizide and Metformin)
Sulfonylureas and BiguanideDecreases hepatic glucose production and increases insulin secretion.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 doseshould not exceed 20 mg glipizide/2,000 mg metformin daily.
Hypoglycemia, weight gain, lactic acidosisShould not be used if suspect frequent alcohol use, liver or kidney disease, or CHF.Same caveats as individual components.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™
(Rosiglitazone and Metformin)
Thiazolidinedione and BiguanideDecreases hepatic glucose production, increases glucose uptake, decreases insulin resistance, and preserves -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 acidosisShould not be used if suspect frequent alcohol use, liver or kidney disease, or CHF.Same caveats as individual components.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.
Actoplus Met™
(Pioglitazone and Metformin)
Thiazolidinedione and BiguanideDecreases hepatic glucose production, increases glucose uptake, decreases insulin.Ratios of pioglitazone and metformin: 15 mg/500 mg, 15 mg/850 mgSame caveats as individual components.Same caveats as individual components.Same caveats as individual components.Same caveats as individual components.
Avandaryl™
(Rosiglitazone and Glimepiride)
Thiazolidinedione and SulfonylureaDecreases insulin resistance and increases insulin secretion.Ratios of rosiglitazone and glimepiride: 4 mg/1 mg, 4 mg/1 mgSame caveats as individual components.Same caveats as individual components.Same caveats as individual components.Same caveats as individual components.
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Table 2. Glucose-Lowering Activity-Oral Diabetes Agent

MedicationBlood Glucose Most AffectedGreatest Risk for Hypoglycemia
Adapted from © 2002, The Diabetes Center, Old Saybrook, CT, used by permission.
SMBG = self-monitoring of blood glucose
SulfonylureasFasting and postprandialNocturnal, fasting, 4-6 hr after meals
Meglitinide or phenylalanine derivativePostprandial2-3 hr after meals
BiguanideFasting and postprandialAfter exercise if prolonged and strenuous
Alpha-glucosidase inhibitorPostprandialNone
ThiazolidinedioneFasting and postprandialNone
Glucovance™ Fasting and postprandialNocturnal, fasting, 4-6 hr after meals
Metaglip™FastingNocturnal, fasting, 4-6 hr after meals
Avandamet™Fasting and postprandialAfter exercise if prolonged and strenuous
Actoplus Met™Fasting and postprandialAfter exercise if prolonged and strenuous
Avandryl™Fasting and postprandialNocturnal, fasting, 4-6 hr after meals
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Table 3. Important Insulin Information*

tr>
InsulinOnsetPeakEffective DurationMaximal DurationComments
Adapted from © 2006 The Diabetes Center, Old Saybrook, CT. Used with permission.
*Site rotation for injections is necessary for all types of insulin.
Human
Rapid Acting
Lispro (Humalog™)< 15 min1-2 hr2-4 hr3-5 hrShould be takenjust prior to or just after eating.
Aspart (Novalog™)< 15 min1-3 hr3-5 hr4-6 hrShould be takenjust prior to or just after eating.
Glulisine (Apidra™)< 15 min0.5-1 hr3 hr3 hrShould be takenjust prior to or just after eating.
Short Acting
Regular (Novolin R™, Humulin R™)0.5-1 hr2-4 hr3-5 hr8 hrBest if taken 30 min before a meal.
Intermediate Acting
Lente (Novolin™, Humulin L™)3-4 hr4-12 hr12-18 hr16-20 hrLimited supplies.
NPH (Novolin N™, Humulin N™)2-4 hr4-10 hr10-16 hr14-18 hrBedtime dosing minimizes nocturnal hypoglycemia.
Long Acting Characterized by a “flat” or “peakless” concentration profile.
Insulin glargine
(Lantus™) analog
4-6 hrNone24 hr24 hrcannot 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.
Detemir (Levemir™)3-4 hr50% in 3-4 hr,
lasting up to 14 hr
5.7-23.2 hrDose dependent-
5.7-23.2 hr
cannot be mixed in same syringe with other insulins.
Duration of action is dose dependent: 6 hrs (0.1U/kg), 12hrs (0.2U/kg), 20 hrs (0.4U/kg), 23 hrs (0.8U/kg and 1.6U/kg).
Ultralente6-10 hrMinimal18-20 hr20-30 hrLimited supplies.
Pre-mixed Human
Humalog™ 75/25
Novolog Mix™ 70/30
<15 min1-2 hr10-16 hr14-18 hr75% NPL, 25% Lispro Should be taken just prior to or just after eating 70% NPH, 30% Aspart because of rapid onset. Caution because of name confusion with Humalog and Novolog.
Humulin™ 70/30
Novolin™ 70/30
0.5-1 hr2-10 hr10-16 hr14-18 hrHumalin and Novolin are 70% NPH and 30% regular insulin.
Animal Source
Regular0.5-2 hr3-4 hr4-6 hr6-8 hrConversion to human insulin recommended. Dose changes required (usually a 10% reduction in dose when switching to human).
NPH4-6 hr8-14 hr16-20 hr20-24 hr
Lente4-6 hr8-14 hr16-20 hr20-24 hr
Inhaled Insulin
Exubera™10-20 min30-90 min2-6 hr6 hrDosed in MG of powder, Available in 1 mg and 3 mg blisters.
1mg approx=3 IU insulin, 3mg approx=8 IU (Inhalation of 1 mg +1 mg +1 mg does not equal 3mg)
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Table 4. Recommended Insulin Storage

Insulin Type Refrigerated (36°F - 46°F) Room Temperature (59°F - 86°F)
Adapted from © 2006 The Diabetes Center, Old Saybrook, CT. Used with permission.
*Suggested, not clinically established
VialOpenedUnopenedOpenedUnopened
Humalog™, Novolog™, Humulin™, Novolin™, Apidra™28 daysuntil expiration date28 days28 days
Lantus™ (10 mL)28 daysuntil expiration date28 days28 days
Detemir (Levemir™)42 daysuntil expiration date42 days42 days
Pens/CartridgesNot in useIn use
Humalog™Until expiration date28 days
Humulin R™( available in cartridge only)Until expiration date28 days
Humulin N™Until expiration date14 days
Humulin 70/30™Until expiration date10 days
Humalog Mix 75/25™Until expiration date10 days
Novolog™Until expiration date28 days
Novolog Mix 70/30™Until expiration date14 days
Novolin R™ (prefilled and 1.5-mL cartridge)Until expiration date30 days
Novolin R™ (3-mL cartridge)Until expiration date28 days
Novolin N™ (prefilled and 1.5-mL cartridge)Until expiration date7 days
Novolin N™ (3-mL cartridge)Until expiration date14 days
Novolin 70/30™ (prefilled and 1.5-mL cartridge)Until expiration date7 days
Novolin 70/30™ (3-mL cartridge)Until expiration date10 days
Detemir (Levemir™)Until expiration date42 days
Apidra™Until expiration date28 days
Lantus™Until expiration date28 days
Self-filled syringes (Note: not recommended for glargine)14 days*7 days*
Inhale Insulin Not in use (unopened overwrap) In use (unopened overwrap)
Exubera™ (insulin blisters)Room Temperature (59° F- 86° F) Until expiration dateRoom Temperature (59° F- 86° F) 90days
Release UnitDo not refrigerateReplace every 14 days
Inhaler & ChamberReplaceYearly (Wash Weekly)
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Table 5. Incretins and Amylins

AgentPrimary ActionHow
Supplied/Storage
Typical DosageDuration
Action
Side EffectsPrecautionsComments
Adapted from © 2006 The Diabetes Center, Old Saybrook, CT. Used with permission. *DPP-4-dipeptidyl peptidase -4 GIP- glucose dependent insulinotropic polypeptide GLP-glucose like polypeptide ESRD-End Stage Renal Disease TZD-Thiazolidinedione
Exenatide
(Byetta™)
Decreases post-meal glucagon production Delays gastric emptying
Increases satiety, leading to decreased caloric intake.
Degree of response depends on plasma glucose levels
250 mcg/ml:
- 5 mcg/dose prefilled pen
- 10 mcg/dose prefilled pen
If not in use: refrigerate until expiration date.
If in use: stable at room temperature
Discard after 30 days.
5 mcg BID subcutaneous for first 1 month, then 10 mcg BID, injected within 60 minutes before morning and evening mealPeak effects in approx 2 hours with maximal duration of 10 hours.Nausea and hypoglycemia most common; occasional vomiting, diarrhea, jitters, dizziness, headache.Not for use in patients with Type 1 diabetes, severe renal disease or ESRD*, or severe GI disease.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.
Approved for use with sulfonylureas and/or metformin or in combination with a TZD* alone or with metformin.
Pramlintide
(Symlin™)
Decreases post-meal glucagon production Delays gastric emptying, Increases satiety, leading to decreased caloric intake.
Degree of response depends on plasma glucose levels
5 ml vials containing 0.6 mg/ml. Requires U-100 insulin syringe for injection If not in use: refrigerate until expiration date.
If in use: room temperature Discard after 28 days.
Type 1 diabetes: 15-60 mcg starting with 15 mcg subcutaneously before meals of 30gm or more carbohydrate. Type 2 diabetes: 60-120 mcg starting with 60 mcg subcutaneous before meals. Titrate as directed by prescriber.Maximum effect in 20 minutes with rapid elimination.
Maximum duration of 4 hours
Nausea and hypoglycemia most common. Doses are adjusted based on presentation of these side effects. Occasional vomiting, stomach pain, dizziness, indigestion.Indicated for insulin treated type 2 diabetes or for type 1 diabetes.
Contraindicated in patients with hypoglycemia unawareness, gastroparesis. Or poor adherence Should never be mixed with insulin and should be injected separately. Reduce insulin dose by 50% when starting.
Requires patient testing of blood sugars before and after meals, frequent physician follow up, and thorough understanding of how to adjust doses of insulin and pramlintide.
May reduce the rate of absorption of orally administered medication. Medications requiring threshold concentrations should be taken 1 hour prior to injection.
Sitagliptin
(Januvia™)
DPP-4 inhibitor* Inhibits the DPP-4 enzyme that degrades GLP-1 and GIP resulting in 2-3 fold increased levels of these incretins. Increases insulin secretion in presence of elevated plasma glucose. Reduces postmeal glucagon secretion .25mg, 50mg, 100mg tablets100 mg po qD
Moderate renal insufficiency
(CrCl>30 to <50mL/min): 50mg/day
Severe renal insufficiency
(CrCl <30mL/min): 25mg/day
Approximately
24 hours
Low incidence of side effects including hypoglycemia or gastrointestinal symptoms Headache, upper respiratory tract infection, nasopharyngitisNot for use in type 1 diabetes Assessment of renal function is recommended prior to initiation and periodically thereafter.May be used as monotherapy or in combination with metformin or TZDs.
Not associated with weight loss
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Table 6. Hypoglycemia Treatment

AgentPrimary
Action
How Supplied/StorageTypical
Dosage
Duration
Action
Side
Effects
PrecautionsComments
Adapted from © 2006 The Diabetes Center, Old Saybrook, CT. Used with permission.
GlucagonConverts liver glycogen to glucose1 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.0.5-2 mg subcutaneous15 min, should be followed by carbohydrate snack.Occasional nausea and vomitingMust 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.Patient should be instructed to teach colleagues, family, etc. how to give injection. Only use if patient isunconscious or unable to eat or drink. All people taking insulin should receive a prescription for glucagon kit for emergency use.
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Table 7. Recommended Control Measures

Biochemical IndexPreprandialPeak postprandialA1C (ADA)*Blood pressureLDLTGHDL
Adapted from © 2006 The Diabetes Center, Old Saybrook, CT. Used with permission. LDL=low density lipoprotein TG=triclycerides HDL=high density lipoprotein *ADA-American Diabetes Association
Goal90-130 mg/dL<180 mg/dL<7%<130/80<100<150>40
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SECTION B Medications to Lower High Blood Pressure
CategoryGeneric NameBrand NameTMMinimum Daily DoseMaximum Daily DoseSpecial Considerations for class of drugs
* Agents in a class of medicines share mechanisms of action, require similar precautions and generally have similar side effects.
CC= extended release XL=extended release SR=sustained release CR=controlled release CD=extended release XR=extended release PM=extended release, controlled onset LA = long acting HS=extended release, controlled onset Dosages based on JNC7 usual dose range.
Note: There are many combination medications for the control of blood pressure. The indications and caveats are the same for each individual component.
Angiotensin converting
enzyme (ACE) inhibitors
benazeprilLotensin™10 mg QD40 mg QD or divided

May cause cough.

May increase potassium concentrations.

Do not use potassium or salt substitutes without consulting physician.

Do not use if pregnant or if trying to conceive.

Caution if creatinine >1.5.

captoprilCapoten™25 mg divided dose100 mg divided dose
enalaprilVasotec™5 mg QD40 mg QD or divided
fosinoprilMonopril™10 mg QD40 mg QD or divided
lisinoprilPrinivil, Zestril™10 mg QD40 mg QD
moexiprilUnivasc™7.5 mg QD30 mg QD or divided
perindoprilAceon™4 mg QD8 mg QD
quinaprilAccupril™10 mg QD80 mg QD or divided
ramiprilAltace™2.5 mg QD20 mg QD or divided
Angiotensin II
receptor blockers
trandolaprilMavik™1 mg QD4 mg QD

May cause dizziness and upset stomach.

Do not use potassium or salt substitutes without consulting physician.

Do not use if pregnant or if trying to conceive.

Caution if creatinine >1.5.

candesartanAtacand™8 mg QD32 mg QD or divided
eprosartanTeveten™400 mg QD800 mg QD or divided
irbesartanAvapro™150 mg QD300 mg QD
losartanCozaar™25 mg QD100 mg QD or divided
olmesartanBenicar™20 mg QD40 mg QD
telmisartanMicardis™20 mg QD80 mg QD
valsartanDiovan™80 mg QD320 mg QD
Calcium channel blockersamlodipineNorvasc™2.5 mg QD10 mg QD

May cause constipation, dizziness, upset stomach, and flushing.

Call physician for shortness of breath, unusual heartbeat, or swelling of feet or hands.

diltiazemCardizem LA™120 mg QD540 mg QD
diltiazemCardizem CD™180 mg QD420 mg QD
diltiazemDilacor XR™*180 mg QD420 mg QD
diltiazemTiazac™180 mg QD420 mg QD
felodipinePlendil™*2.5 mg QD20 mg QD
isradipineDynaCircCR™*2.5 mg QD10 mg QD
nicardipineCardene SR™*60mg in divided dose120 mg divided dose
nifedipineAdalat CC™*30 mg QD60 mg QD
nifedipineProcardia XL™*30 mg QD60 mg QD
nisoldipineSular™*10 mg QD40 mg QD
verapamilCalan™80 mg QD in divided dose320 mg divided dose
verapamilCalan SR ™120 mg QD480 mg divided dose
verapamilCovera HS™*120 mg QD360 mg QD
verapamilIsoptin™80 mg QD in divided dose320 mg divided dose
verapamilIsoptin SR™*120 mg QD480 mg QD or divided
verapamilVerelan™80 mg QD in divided dose320 mg divided dose
verapamilVerelan PM™120 mg QD360 mg QD
Thiazides and related diureticsbedroflumethiazideNaturetin™2.5 mg QD20 mg QD

May increase blood glucose concentrations.

Take in morning to minimize diuretic effect at night.

May cause low potassium, need to monitor level.

chlorothiazideDiuril™125 mg QD500 mg QD or divided
chlorthalidoneHygroton™12.5 mg QD25 mg QD
hydrochlorothiazideHydroDIURIL™12.5 mg QD50 mg QD or divided
hydrochlorothiazideMicrozide™12.5 mg QD50 mg QD or divided
indapamideLozol™1.25 mg QD2.5 mg QD
methyclothiazideEnduron™2.5 mg QD5 mg QD
metolazoneMykrox™0.5 mg QD1.0 mg QD
metolazoneZaroxolyn™2.5 mg QD5 mg QD
Loop diureticsbumetanideBumex™0.5 mg QD2 mg QD or divided

May cause low potassium.

Need blood test to monitor level.

(Parenteral drug available) May cause photosensitivity:sunscreen recommended.

ethacrynic acidEdecrin™25 mg QD200 mg divided dose
furosemideLasix™20 mg QD80 mg QD or divided
torsemideDemadex™2.5 mg QD10 mg QD
Potassium-sparing
diuretics
amilorideMidamor™5 mg QD10 mg QDDo not use potassium or salt substitutes without consulting physician. Need to monitor potassium level.
triamtereneDyrenium™50 mg QD or divided100 mg divided dose
Aldosterone receptor
blockers
eplerenoneInspra™50 mg QD100 mg divided dose
spironolactoneAldactone™25 mg QD50 mg divided dose
ß-blockersacebutololSectral™200 mg QD800 mg divided dose

Intrinsic sympathomimetic activity.

May alter blood glucose, may mask signs of low blood.

Call physician for slow heart rate (<60), confusion, or swelling of feet or legs.

Can cause claudication.

Do not discontinue abruptly.

atenololTenormin™25 mg QD100 mg QD
betaxololKerlone™5 mg QD20 mg QD
bisoprololZebeta™2.5 mg QD10 mg QD
carteololCartol™2.5 mg QD10 mg QD
metoprololLopressor™50 mg QD100 mg QD or divided
metoprololToprol XL™*50 mg QD100 mg QD
nadololCorgard™40 mg QD120 mg QD
penbutololLevatol™10 mg QD40 mg QD
pindololVisken™10 mg in divided dose40 mg divided dose
propranololInderal™40 mg divided dose160 mg divided dose
propranololInderal LA™*60 mg QD180 mg QD
timololBlocadren™20 mg divided dose40 mg divided dose
α-blockersdoxazosinCardura™1 mg QD16 mg QDTo prevent dizziness, avoid standing up suddenly, especially with the first few doses.
prazosinMinipress™2 mg in divided dose20 mg divided dose
terazosinHytrin™1 mg QD20 mg QD
Combined α-and ß-blockerscarvedilolCoreg™12.5 mg divided dose50 mg divided dose

May mask signs of low blood glucose levels.

Take with food to avoid stomach upset.

labetalolNormodyne™200 mg divided dose800 mg divided dose
labetalolTrandate™200 mg divided dose800 mg divided dose
Direct vasodilatorshydralazineApresoline™25 mg QD100 mg divided doseMay cause headaches, fluid retention, or fast heart rate.
midoxidilLoniten™2.5 mg QD80 mg divided dose
Central α-agonistsclonidineCatapres™0.1 mg QD0.8 mg divided doseDo not discontinue drug suddenly without consulting physician.
clonidineCatapres TTS™* (patch)0.1 mg Q week0.3 mg Q week
methyldopaAldomet™250 mg divided dose1,000 mg divided dose
guanfacineTenex™0.5 mg QD2 mg QD
Peripheral Anti-adrenergicsguanadrelHylorel™10 mg in divided dose75 mg divided doseMay cause dizziness, nasal congestion, and depression.
guanethidineIsmelin™10 mg QD50 mg QD
resperine 0.1 mg divided dose0.25 mg divided dose

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: www.nhlbi.nih.gov/health/prof/heart/index.htm
Information for people with diabetes: www.nhlbi.nih.gov/hbp
Drugs used to treat high blood pressure: www.nhlbi.nih.gov/guidelines/hypertension/express.pdf

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SECTION C Medications for the Treatment of Dyslipidemia
CategoryGeneric NameBrand NameMinimum Daily DoseMaximum Daily DoseSpecial Considerations for class of drugs
HMG-Coa = 3-hydroxy-3-methylglutaryl coenzyme A LDL = low-density lipoprotein HDL = high-density lipoprotein TC = total cholesterol TG = plasma triglycerides generic = generic drug manufacturers
HMG-CoA reductase inhibitors (statins)atorvastatinLipitor™10 mg QD80 mg in divided doses

Main action: Lowers LDL (“bad”) cholesterol.
Also lowers TG and modestly raises HDL.

Have blood tests for liver enzyme concentrations.

Notify physician if muscle aches or weakness develops.

Use caution if combined with fibric acid derivatives due to the increased risk of rhabdomyolysis.

fluvastatinLescol™20 mg QD80 mg in divided doses
fluvastatinLescol XL™80 mg QD80 mg in divided doses
lovastatinMevacor™10 mg QD80 mg in divided doses
lovastatin (extended-release)Altocor™20 mg QD60 mg QD
pravastatinPravachol™10 mg QD80 mg QD
rosuvastatinCrestor™5 mg QD40 mg QD
simvastatinZocor™5 mg QD80 mg in divided doses
Cholesterol absorption inhibitorsezetimibeZetia™10 mg QD10 mg QD

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.

Nicotinic acid (niacin)nicotinic acid (extended release)Niaspan™50-100 mg QD2,000 mg QD

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.

nicotinic acid 250 mg/day QD

Titrated up to 1500mg therapeutic dose in 3 divided doses.

Maximum dose= 3000mg

Lipid combinationslovastatin-niacinAdvicor™20 mg/500 mg QD40 mg/2,000 mg QDMain action: Reduces LDL, TC , and TG and increases HDL due to the individual actions of niacin and lovastatin.
simvastatin-ezetimibeVytorin™10 mg/10 mg QD80 mg/10 mg QDMain action: Reduces LDL cholesterol.
Amlodipine+atorvastatinCaduet™2.5mg/10mg QD10 mg/80 mg QDBlood Pressure medication (Calcium channel blocker) (see Blood pressure med chart)+lipid (statin) medication. Same comments as individual
Fibric acid derivativesfenofibrateTricor™48 mg QD145 mg QD

Main action: Lowers triglycerides, increases HDL cholesterol.

Perform blood tests for liver enzyme concentrations.

Adjust dose based on age and renal impairment.

Notify physician if muscle aches or weakness develops.

fenofibrateLofibra™67 mg QD200 mg QD
fenofibrateTriglide™50 mg QD160 mg QD
fenofibrateAntara™43 mg QD130 mg QD
gemfibrozilLopid™1,200 mg BID1,200 mg BID
Bile acid sequestrantscholestyramineLoCHOLEST™4 g QD24 g in divided doses

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.

Can be combined with other agents such as statins.

cholestyramine lightLoCHOLEST light™4 g QD24 g in divided doses
cholestyramineQuestran™4 g QD24 g in divided doses
cholestyramine lightQuestran light™4 g QD24 g in divided doses
cholestyraminePrevalite™4 g QD24 g in divided doses
cholestipolColestid™2g QD or BID6g QD or BID
colesevelamWelchol™1,875 mg (3 tablets) QD4,375 mg (7 tabs) QD or BID

Revised March 2007

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From the NDEP
http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=112


 

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