Comprehensive Pharmacology and Counseling Points for Diabetes and Vitamin D Medications

Calcitriol

Vitamin D analogs (D3) used in the treatment of hypocalcemia or secondary hyperparathyroidism.

Usual dosing range for Calcitriol

0.5-2 mcg daily.

Counseling Points for Calcitriol

Do not take OTC vitamin D or magnesium during therapy. Do not exceed prescribed amounts of calcium.

Adverse Effects of Calcitriol

Vitamin D toxicity, hypercalcemia, weakness, headache, nausea, vomiting, dry mouth, constipation, muscle and bone pain.

Canagliflozin

Antidiabetic sodium-glucose co-transporter 2 (SGLT2) inhibitor.

Usual dosing for Canagliflozin

Start with 100 mg before the first meal of the day.

Indication for Canagliflozin

Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

Adverse Effects of Canagliflozin

UTIs, genital mycotic infections, increased urination, increased thirst, constipation, nausea, vulvovaginal pruritus, systemic hypotension, risk of bone fractures, hyperkalemia.

Counseling Points for Canagliflozin

Take before the first meal of the day. Closely follow recommended diet and exercise. Monitor blood glucose while taking. Contact physician if side effects are severe/persistent.

Dapagliflozin

Antidiabetic SGLT2 inhibitor.

Usual dosing for Dapagliflozin

5 mg or 10 mg; one tablet once daily in the morning.

Indication for Dapagliflozin

Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes.

Adverse Effects of Dapagliflozin

UTIs, genital mycotic infections, increased urination, constipation, ketoacidosis.

Counseling Points for Dapagliflozin

May be taken without regard to meals. Closely follow diet/exercise recommendations. If dose is missed, take as soon as possible unless it's closer to the next dose (do NOT double doses). Quarterly HbA-1c testing performed.

Dulaglutide

Antidiabetic GLP-1 receptor agonist.

Usual dosing for Dulaglutide

Usual maintenance dose is 0.75 mg to 1.5 mg once weekly.

Indication for Dulaglutide

Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes.

Adverse Effects of Dulaglutide

GI in nature and dose-related: Nausea, diarrhea, vomiting, abdominal pain, decreased appetite, dyspepsia, and fatigue.

Counseling Points for Dulaglutide

Promptly report any symptoms of thyroid carcinoma, promptly report any symptoms of pancreatitis. If a dose is missed, administer as soon as possible if there are at least 3 days until the next scheduled dose.

Empagliflozin

Antidiabetic SGLT2 inhibitor.

Usual dosing for Empagliflozin

10 mg once daily in the morning (max: 25 mg once daily in the morning).

Indication for Empagliflozin

Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes.

Adverse Effects of Empagliflozin

UTIs, genital mycotic infections, increased urination, dyslipidemia, discomfort with urination, ketoacidosis.

Counseling Points for Empagliflozin

Reduce the risk of CV death in adults with type 2 diabetes.

CVD

May be taken without regard to meals.

Folic Acid

Vitamin B class.

Glimepiride

Amaryl, Antidiabetic KATP Channel Blocker.

Glipizide

Glucotrol, Glucotrol XL, Antidiabetic KATP Channel Blocker.

Glyburide

Micronase, Diabeta, Antidiabetic KATP Channel Blocker.

Insulin Aspart

rDNA Origin, Dosage must be individualized.

Insulin Degludec

Antidiabetic long-acting hormone used to improve glycemic control in adults with diabetes.

Tresiba

Brand name for Insulin Degludec.

Dosage

Must be individualized for each patient.

Adverse Effects

Usually mild; may include injection site reactions, lipodystrophy, weight gain, edema, nasopharyngitis, headache, upper respiratory tract infection, and diarrhea. Severe effects include hypoglycemia.

Patient Instructions

Patients should read the enclosed patient info sheet, leave the needle in the skin for 6 seconds after depressing the dose button, follow prescribed diet carefully, monitor blood/urine glucose, consult doctor during any illness, do not dilute or mix product with any other insulin/solution.

Storage Instructions

Unopened vials should be stored in fridge (36-46 F) and should not be frozen. Opened vials may be left at room temperature (<86F) for 56 days.

Diabetic ID

Wear/carry diabetic ID in case of emergencies.

Missed Dose

If a dose is missed, take as soon as possible. If closer to next dose, skip missed dose and return to dosing schedule.

Signs of Hypoglycemia

Patients should be aware of the signs of hypoglycemia; contact doctor or treat with oral glucose if two or more signs are seen.

Insulin Detemir

Antidiabetic long-acting hormone used for treatment of adult and pediatric patients with Type 1 diabetes or adult patients with Type 2 diabetes who require long-acting insulin for control.

Levemir

Brand name for Insulin Detemir.

Injection Site Pain

Pain at injection site is more prevalent with Insulin Detemir.

Adverse Effects for Detemir

Rare adverse effects include rash, edema, pruritus, bronchospasm, hypotension, and shock. Hypoglycemic reactions may occur.

Insulin Glargine

Antidiabetic long-acting hormone indicated for once daily subcutaneous administration at bedtime in the treatment of adult and pediatric patients with type 1 diabetes mellitus or adult patients with type 2 diabetes mellitus.

Lantus, Toujeo, Basaglar

Brand names for Insulin Glargine.

Injection Site Pain for Glargine

Pain at injection site is slightly more prevalent with Insulin Glargine versus NPH human insulin.

Adverse Effects for Glargine

Allergic reactions are rare and may include rash, edema, pruritus, bronchospasm, hypotension, or shock.

Insulin Lispro

Antidiabetic short-acting hormone used for treatment of Type 1 diabetes mellitus or Type 2 diabetes mellitus that cannot be properly controlled by diet, exercise, and weight reduction.

Humalog

Brand name for Insulin Lispro.

Dosage for Lispro

Must be individualized for each patient.

Injection Site Reactions for Lispro

Hypoglycemia, hypersensitivity characterized by redness, swelling, and itching at the injection site, and lipodystrophy at the injection site.

Patient Instructions for Lispro

Follow prescribed diet carefully, administer 15 minutes before eating, do not change syringe brands or doses without first notifying a physician, consult a physician during any illness.

Monitoring

Continually monitor blood or urine glucose as prescribed.

Storage for Lispro

Store in the refrigerator.

Signs of Hypoglycemia for Lispro

Patients should be aware of signs of hypoglycemia including sweating, tremor, blurred vision, weakness, hunger, and confusion.

Linagliptin

Antidiabetic DDP-4 Inhibitor

5 mg

Taken once daily

Side Effects

Nasopharyngitis, diarrhea, and cough. Rare effects include joint pain.

Indication

Adjunct to diet and exercise to improve glycemic content in patients with type 2 diabetes.

Missed Dose Instructions

If a dose is missed, take as soon as possible; do not double doses.

Victoza

Liraglutide (rDNA Origin) Antidiabetic GLP-1 receptor agonist.

Liraglutide Dosage

One dose administered once daily.

Indication for Liraglutide

Adjunct to diet and exercise to improve glycemic content in patients with type 2 diabetes mellitus.

Symptoms to Report

Promptly report any symptoms of thyroid carcinoma or pancreatitis.

Missed Dose Instructions for Liraglutide

If a dose is missed, skip it and return to once daily dosing; if more than 3 days have lapsed between doses, reinitiate with 0.6mg daily.

Storage Instructions for Liraglutide

Store unused pens in the refrigerator. Open pens may be stored below 86 degrees F. Do not store pens with needles attached.

Side Effects of Liraglutide

GI in nature and include nausea, diarrhea, vomiting, and constipation. May also cause headaches. Rare side effects include medullary thyroid carcinoma, pancreatitis, and renal impairment.

Contraindications for Liraglutide

Contraindicated in patients with a personal or family history of medullary thyroid carcinoma.

Glucophage (XR)

Metformin Hydrochloride.

Metformin Administration

Should be taken with meals; avoid excessive alcohol consumption during treatment.

Indication for Metformin

Used as adjunct to diet to lower blood glucose in patients with non-insulin dependent diabetes mellitus (NIDDM).

Common Side Effects of Metformin

Decreased vitamin B12 absorption, lactic acidosis, diarrhea, vomiting, nausea, flatulence, anorexia, bloating, and unpleasant metallic taste.

Starting Dose for Metformin

Usual starting dose is one 500 mg tablet given twice a day with meals or one 850 mg tablet given with the morning meal.

Adverse Effects of Metformin

Adverse GI effects are transient and disappear once the patient is stabilized.

Risk Factors for Lactic Acidosis

Advanced age, radiological studies with contrast, surgery, hypoxic states, excessive alcohol use, and hepatic impairment.

Methotrexate Sodium

Trexall Antimetabolite Antineoplastic agent.

Methotrexate Dosage

10 to 25 mg per week until adequate response is achieved.

Indications for Methotrexate

Treatment of gestational choriocarcinoma, choriadenoma, destruens, hydatidiform mole, advanced stage non-Hodgkin's lymphomas, breast cancer, epidermoid cancers of the head and neck, advanced mycosis fungoides, non-metastatic osteosarcoma, and lung cancer.

Serious Toxicity of Methotrexate

Methotrexate should only be used in life-threatening neoplastic diseases or in patients with psoriasis or rheumatoid arthritis with severe, recalcitrant, disabling disease.

Common Side Effects of Methotrexate

Most frequent are ulcerative stomatitis, leukopenia, nausea, and abdominal distress. Other frequent are malaise, fatigue, chills, fever, dizziness, sun sensitivity, and decreased resistance to infection.

Administration Instructions for Methotrexate

Preferably taken on an empty stomach; important to stay well hydrated while taking; avoid alcohol and salicylates while taking.

Contraceptive Measures for Methotrexate

It is important to follow appropriate contraceptive measures during therapy and for 3 months (males) and one ovulatory cycle (females) after completing.

Missed Dose Instructions for Methotrexate

If dose is missed and you are on a weekly schedule, take it as soon as possible and restart the weekly schedule from that date.

Periodic Lab Work

It is important to have periodic lab work completed during therapy.

Adipex-P

Sympathomimetic amine used as a short-term adjunct in a regime of weight reduction.

Phentermine Hydrochloride

Best if taken early in the day to avoid insomnia, may cause dizziness.

Habit-Forming Warning

WARNING: this medication may be habit-forming.

Usual Adult Dose

Usual adult dose is one tablet/capsule taken before breakfast or 1-2 hours after breakfast.

Primary Pulmonary Hypertension

Rare cases of primary pulmonary hypertension may cause dyspnea, angina pectoris, syncope, lower extremity edema.

Actos

Antidiabetic thiazolidinedione.

Pioglitazone Hydrochloride

15-30 mg given once daily.

Glycemic Control

Adjunct to diet and exercise in improving glycemic control in patients with type 2-diabetes.

Quarterly HbA-1c Testing

Quarterly HbA-1c testing should be performed.

Semaglutide

GLP-1 receptor agonist used as an adjunct to diet and exercise to improve glycemic control.

Ozempic

Brand name for Semaglutide.

Wegovy

Brand name for Semaglutide.

Injection Guidelines

Doses should be injected subcutaneously in the abdomen, thigh, or upper arm.

Missed Dose Administration

If a dose is missed, administer it at once within 5 days of the missed dose.

Sitagliptin Phosphate

Antidiabetic DDP-4 inhibitor.

Normal Adult Dose

Normal adult dose is 100 mg once daily.