Medication

Dosage

Comments

SULFONYLUREAS

Tolbutamide 

• Orinase®
• various generics

Initial: 1000-2000 mg daily 

Range: 250-3000 mg
(seldom need >2000 mg/day)

Dose: Taken two or three times daily

Side Effect (SE) : 

• Hypoglycemia
• weight gain

Preferred SFU for elderly

Must be taken 2-3 times daily

Glimepiride 

• Amaryl®
• various generics

Initial: 1-2 mg daily 

Range: 1-8 mg

Dose: Taken once daily

SE:

• Hypoglycemia
• weight gain

Need to take only once daily

Glipizide 

• Glucotrol®
• Glucotrol XL®
• various generics

Initial: 5 mg daily 

Range: 2.5-40 mg2 (20 mg for XL)

Dose: Taken once or twice (if >15 mg) daily

SE:

• Hypoglycemia
• weight gain

Preferred SFU for elderly
Extended release/take once a day

Glyburide 

• Micronase®, DiaBeta®
• various generics

Initial: 2.5-5 mg daily 

Range: 1.25-20 mg2

Dose: Taken once or twice daily

SE: 

• Hypoglycemia
• weight gain

Glyburide, micronized 

• Glynase PresTab®
• various generics

Initial: 1.5-3 mg daily 

Range: 0.75-12 mg

Dose: Taken once or twice (if >6 mg) daily

SE: 

• Hypoglycemia
• weight gain

Glinides

Repaglinide 

• Prandin®

Initial: 1-2 mg daily 

(0.5 mg if A1C <8%)

Range: 0.5-16 mg

Max dose per meal is 4 mg

Dose: Taken two, three, or four times daily

SE:

• Hypoglycemia 
• Safe for elderly
• Duration of action is only 4 hours
• Take within 15-30 minutes of meal

Nateglinide 

• Starlix®

Initial: 120 mg three times daily 

(if A1C close to goal, use 60 mg)

Range: 180-360 mg

Dose: Taken three times daily

SE:

• Hypoglycemia 
• Safe for elderly
• Duration of action is only 2 hours
• Take within 30 minutes of meal

BIGUANIDES: decreases glucose release from liver; decreases intestinal absorption of glucose; improves insulin sensitivity (increases glucose uptake and utilization)

Metformin

• Glucophage®
• Extended release (ER):
• Glucophage XR®
• Fortamet®
• Glumetza
• Riomet® (liquid, 500 mg/5ml)

Initial: 500 mg twice daily or 850 mg once daily 

Range: 500-2550 mg

Dose: Taken two or three times daily

ER: Initial: 500 mg once daily

Range: 500-2000 mg

Dosed once daily

SE: 

• Gastrointestinal symptoms (diarrhea, nausea, upset stomach), metallic taste (3%), 
• Lactic acidosis (0.03 cases/1000 people)
• Take with meals (ER with evening meal)
• Cannot use if have liver or kidney problems, take a drug to treat heart failure, or drink alcohol excessively.

ALPHA-GLUCOSIDASE INHIBITORS: STARCH BLOCKERS – delay digestion and absorption of carbohydrates

Acarbose 

• Precose®
• various generics

Initial: 25 mg three times daily 

Range: 75-300 mg

(max 150 mg if <60 kg)

Dose: Taken three times daily

SE: 

• Flatulence 
• Take with first bite of meal
• Start with low dose and slowly  to minimize GI intolerance.

THIAZOLIDINEDIONES (Glitazones or TZDs): decrease insulin resistance in the body (muscle and fat tissues)

Pioglitazone (preferred over rosiglitazone) 

• Actos®

Initial: 15-30 mg daily 

Range: 15-45 mg

Dose: Taken once daily

SE:

• Anemia, swelling (edema) from fluid retention, weight gain, macular edema (in eye), bone loss and fractures in women 
• May cause or worsen heart failure
• Cannot use if have liver problems or severe heart failure
• Requires liver monitoring

Rosiglitazone 

• Avandia®

Initial: 4 mg daily 

Range: 4-8 mg

Dose: Taken once or twice daily

SE: 

• Anemia, swelling (edema) from fluid retention, weight gain, macular edema (in eye), bone loss and fractures in women 
• May increase risk of heart problems such as heart-related chest pain (angina) or heart attack (myocardial infarction)
• May cause or worsen heart failure
• Cannot use if have liver problems or severe heart failure
• Requires liver monitoring

GLP-1 ANALOGS: increase insulin secretion, reduce glucose release from liver after meals, delay food emptying from stomach and promote satiety. "GLP-1RAs prevent albuminuria and slow the decline of renal function towards end stage renal disease in patients with diabetic kidney disease" (Granata, A., 2022).

Exenatide  

• Byetta®

Initial: 5 mcg SQ twice daily 

Range: up to 10 mcg SQ twice daily

Dose: Taken twice daily

SE: 

• Nausea, headache, hypoglycemia (when used with insulin secretagogues) 
• Rare reports of sudden pancreatitis (inflammation of pancreas)
• May cause mild weight loss

Liraglutide  

• Victoza®

Initial: 0.6 mg SQ once daily 

Range: up to 1.8 mg SQ once daily

Dose: Taken once daily

SE:

• Nausea, headache, diarrhea, hypoglycemia (when used with insulin secretagogues) 
• Rare reports of sudden pancreatitis (inflammation of pancreas). Cannot be used if have history of medullary thyroid cancer.

Albiglutide  

• Tanzeum®

Initial: 30mg once weekly

Range: can increase to 50mg once weekly if inadequate response

SE: 

• Injection site reaction, nausea, diarrhea, upper respiratory
  infection.
  
• Rare reports of pancreatitis (inflammation of pancreas);
  cannot be used if have history of medullary thyroid cancer.

Dulaglutide  

• Trulicity®

Initial: 0.75 mg once weekly

Range: may increase up to 1.5 mg once
weekly if inadequate response

SE: 

• Nausea, diarrhea, vomiting, abdominal pain
• Cannot use if family history of medullary thyroid carcinoma
  (MTC) or if have multiple endocrine neoplasia syndrome type
  2 (MEN2)
• Rare reports of pancreatitis (inflammation of pancreas);
  cannot be used if have history of medullary thyroid cancer

Semaglutide

• Ozempic®

Initial: 0.25mg SC qweek x 4 weeks; then increase to 0.5 mg qweek for 4 weeks then may increase to 1.0mg

SE:

• Nausea, vomiting, diarrhea, abdominal pain constipation.
• Cannot use if family history of medullary thyroid carcinoma
  (MTC) or if have multiple endocrine neoplasia syndrome type
  2 (MEN2)
• Rare reports of pancreatitis (inflammation of pancreas);
  cannot be used if have history of medullary thyroid cancer

Semaglutide

• Rybelsus ®
• Only oral GLP1

Initial: 3 mg Po times 30 days

Then increase does to 7mg po qd the after 30 days ma increase to 14mg

SE:

• Nausea, vomiting, diarrhea, abdominal pain constipation.
• Cannot use if family history of medullary thyroid carcinoma
  (MTC) or if have multiple endocrine neoplasia syndrome type
  2 (MEN2)
• Rare reports of pancreatitis (inflammation of pancreas); cannot be used if have history of medullary thyroid cancer

DPP-4 INHIBITORS: increase insulin secretion, reduce glucose release from liver after meals

Alogliptin  

• Nesina®

25mg PO daily.

Taken once daily.

SE:

• Stuffy or runny nose, sore throat, headache, upper respiratory infection, rare severe allergic reactions (swelling of tongue, throat, face or body; severe rash)
• Rare reports of pancreatitis
• No weight gain

Sitagliptin  

• Januvia®

Initial: 100 mg daily 

Range: 25-100 mg daily

Dose: Taken once daily

SE:

• Runny nose, upper respiratory infection, rare severe allergic reactions (swelling of tongue, throat, face or body; severe rash) 
• No weight gain; Lower doses used if kidney problems

Saxagliptin  

• Onglyza®

Initial: 2.5 or 5 mg daily 

Range: 2.5-5 mg daily

Dose: Taken once daily

SE: 

Upper respiratory infection, urinary tract infection, headache 

No weight gain; Lower doses used if kidney problems

Linagliptin  

• Tradjenta®

Initial: 5 mg daily 

Dose: Taken once daily

SE: 

Runny nose, sore throat, rare reports of pancreatitis, rare severe allergic reactions, no weight gain;

SGLT2 inhibitors: increase glucose excretion in the urine. SGLT2 inhibitors are effective at slowing the progression of kidney disease, reducing heart failure, and lowering the risk of kidney failure and death in people with kidney disease and type 2 diabetes. SGLT2 inhibitors also protect the kidneys of people with CKD who do not have diabetes (SGLT2 inhibitors, 2023).

Canagliflozin  

• Invokana®

Initial: 100mg daily

Range: 100-300mg daily

Dose: Taken once daily

SE: 

Increased urination or urgency, lower blood pressure,dizziness, genital yeast infections, urinary tract infections, increase in blood potassium; rare severe allergic reactions
(swelling of tongue, throat, face or body; severe rash)

Dapagliflozin  

• Farxiga®

Initial: 5mg once daily

Range: up to 10mg daily

SE: 

increased urination or urgency, lower blood pressure,
dizziness, genital yeast infections, urinary tract infections
increase in blood potassium; rare severe allergic reactions
(swelling of tongue, throat, face or body; severe rash)

Empagliflozin  

• Jardiance®

Initial: 10mg once daily

Range: up to 25mg daily

SE: 

increased urination or urgency, lower blood pressure,
dizziness, genital yeast infections, urinary tract infections
increase in blood potassium; rare severe allergic reactions
(swelling of tongue, throat, face or body; severe rash)

COMBINATION ORAL PILLS

Alogliptin/Metformin 

• Kazano®

Initial: 12.5mg/500mg once or twice daily

Range: up to 25/2000 Taken twice daily with food.

Same as above with alogliptin and metformin

Alogliptin/Pioglitazone 

• Oseni®

Initial: 12.5mg/15mg once daily

Range: up to 25/45 mg Taken once daily with or without food.

Same as above with alogliptin and pioglitazone

Empagliflozin/Linagliptin 

• Glyxambi®

Initial: 10mg/5mg once daily

Range: up to 25mg/5mg once daily

Same as above with empagliflozin and linagliptin

Empagliflozin/Metformin  

• Synjardy®

Initial: 5mg/500mg or 5mg/1000mg

Range: up to 25mg/2000mg
Taken in 2 divided doses

Same as above with empagliflozin and
metformin

Canagliflozin/Metformin  

• Invokamet®

Initial: 50mg/500mg or 50mg/1000mg

Range: up to 300mg/2000mg
Taken in 2 divided doses

Same as above with canagliflozin and metformin

Dapagliflozin/Metformin XR 

• Xigduo XR®

Initial: base on patient's current regimen

Range: up to 10mg/2000mg daily

Same as above with dapagliflozin and metformin

Glyburide/Metformin 

• Glucovance®
• various generics

Initial: 1.25 mg/250 mg once or twice daily 

Range: up to – 20/2000 mg

Dose: Taken once or twice daily

Same as above with glyburide and metformin

Glipizide/Metformin 

• Metaglip®
• various generics

Initial: 2.5 mg/250 mg daily or 2.5mg/500 mg twice daily 

Range: up to 20/2000 mg

Dose: Taken once or twice daily

Same as above with glipizide and metformin

Linagliptin/Metformin 

• Jentadueto®

Initial:

2.5mg/500mg twice daily with food
Range: up to 2.5mg/1000mg twice daily with food.

Same as above with linagliptin and metformin

Rosiglitazone/Metformin 

• Avandamet®
• various generics

Initial: 2 mg/5000 mg once or twice daily 

Range: up to 8 mg/2000 mg

Dose: Taken twice daily

Same as above with metformin and rosiglitazone

Pioglitazone/Metformin 

• ActoPlus Met®
• various generics

Initial: 15 mg/500 mg or 15 mg/850 mg once or twice daily 

Range: up to 45 mg/2550 mg

Dosed once or twice daily

Same as above with metformin and pioglitazone

Pioglitazone/Glimepiride 

• Duetact®

Initial: 30 mg/2 mg or 30 mg/4 mg once daily 

Range: max of one tablet daily

Dose: Taken once daily

Same as above with pioglitazone and glimepiride

Rosiglitazone/Glimepiride 

• Avandryl®
• various generics

Initial: 4 mg/1 mg or 4 mg/2 mg once daily 

Range: up to 8 mg/4 mg

Dose: Taken once daily

Same as above with rosiglitazone and glimepiride

Sitagliptin/Metformin 

• Janumet®

Initial: 50 mg/500 mg or 50 mg/1000 mg twice daily 

Range: up to 100 mg/2000 mg

Dose: Taken twice daily

Same as above/below with sitagliptin and metformin

Sitagliptin/Metformin 

• Janumet XR®

Initial: 100 mg/1000 mg daily

Range: up to 100 mg/2000 mg daily

Dose: Taken once daily

Same as above/below with sitagliptin and metformin

Repaglinide/Metformin 

• PrandiMet®

Initial: 1 mg/500 mg twice daily 

Range: 10 mg/2500 mg,
Max per dose 4 mg/1000 mg
Dose: Taken twice or three times daily

Same as above with repaglinide and metformin

Pioglitazone/Metformin XR 

• ActoPlus Met XR®

Initial: 15 mg/1000 mg or 30 mg/1000 mg once daily 

Range: up to 45 mg/2000 mg

Dose: Taken once daily

Same as above with metformin and pioglizatone

Saxagliptin/Metformin XR 

• Kombiglyze XR®

Initial: 5 mg/500 mg or 5 mg/1000 mg once daily 

Range: up to 5 mg / 2000 mg

Dose: Taken once daily

Same as above with metformin 

Adapted from Product information UCSF https://dtc.ucsf.edu/types-of-diabetes/type2/treatment-of-type-2-diabetes/medications-and-therapies/type-2-non-insulin-therapies/table-of-medications/