Oral Hypoglycaemic Agents OHAs

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Oral Hypoglycaemic Agents (OHAs)
July 2006
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Oral hypoglycaemic agents (OHAs)

• Session outline
• Metformin
• Sulphonylurea
• Acarbose
• Glitazone
• Repaglinide

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Metformin

• Trade names
• Diabex, Diaformin, Glucophage
• Modes of action
• Reduces glucose production from the liver.
• Increases absorption of glucose in muscle fat
  tissue.
• Lessens amount of insulin needed to absorb excess
  glucose.

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Metformin

• Precautions
• Chronic renal or cardiac failure.
• Hepatic impairment.
• Elderly / frail.
• Excessive alcohol intake.
• Side effects
• Gastrointestinal disturbances.
• Metallic taste.
• Malabsorption of B12.
• Administer
• With meals.

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Sulphonylurea

• Generic Trade
• Glimepiride Amaryl, Dimirel
• Glipizide Minidiab, Melizide
• Glicazide Diamacron, Glyade, Nidem,
• Diamacron MR, Mellihexal
• Glibenclamide Daonil, Semi Daonil,
• Glimel, Glucovance
• (combined with metformin)

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Sulphonylureas

• Mode of action
• Increase insulin secretion by the pancreas.

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Sulphonylureas

• Contra-indications
• Pregnancy
• Surgery
• Severe renal failure
• Type 1
• Hypersensitivity
• Side effects
• Hypoglycaemia
• Weight gain

• Precautions
• Renal impairment
• Hepatic impairment
• Elderly
• Administer
• With meals

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Acarbose

• Trade names
• Glucobay
• Modes of action
• Delays breakdown of CHO
• such as starch sucrose.
• Contra-indications
• Pregnancy
• Renal impairment
• Gastrointestinal disorders

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Acarbose

• Contra-indications
• Pregnancy
• Renal impairment
• Gastrointestinal disorders
• Side effects
• Gastrointestinal
• Rash
• Erythema (redness of the skin)

• Precautions
• High sucrose diet
• Administer
• Take directly before or with first spoon of meal
• Start with a low dose

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Repaglinide

• Trade name
• NovoNorm
• Modes of action
• Short acting oral hypoglycaemic agent
• Stimulates pancreatic insulin release

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Repaglinide

• Contra-indications
• Type 1 diabetes
• Pregnancy
• Lactation (breast feeding)
• Children lt12 years
• Precautions
• Imparied renal or hepatic function

• Side effects
• Hypoglycaemia, gastrointestinal upset, abnormal
  LFTs (liver function test), hepatitis / jaundice
• Administer
• With meals

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Glitazones

• Trade names
• Rosiglitazone (Avandia)
• Pioglitazone (Actos)
• Mode of action
• Improves sensitivity to insulin in skeletal
  muscle and adipose (fat) tissue
• Inhibits glucose release from the liver

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Glitazones

• Contra-indications
• Heart failure
• Moderate to severe hepatic impairment
• Precautions
• Oedema or heart failure
• Non-ovulating pre-menopausal women with insulin
  resistance as ovulation may resume (consider
  contraception).

• Side effects
• Increase subcutaneous fat / fluid
• Decreased haemoglobin levels
• Increased LDL cholesterol (Rosiglitazone)
• Abnormal liver function tests
• Administer
• Without regard to meals