COMMON ORAL ANTIDIABETIC DRUGS AND THEIR SIDE EFFECTS

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Diabetes is a pathological condition where blood sugar is high. It is a very common endocrinological disorder prevailing all over the world. Some oral medications are used to treat diabetes(especially type 2 diabetes) and reduce blood sugar.

SULFONYLUREAS

The main mechanism of action these drugs are stimulating the pancreas to secrete insulin and thereby reducing serum glucose. These are usually metabolized by the liver.

1st GENERATION SULFONYLUREAS

Chlorpropamide, Tolbutamide, Tolazamide, Acetohexamide are 1st generation Sulfonylureas.

SIDE EFFECTS OF 1st GENERATION SULFONYLUREAS

Maximum drugs of these groups are not used due to side effects chlorpropamide causes cholestatic jaundice. Prolong hypoglycemia and weight gain are also common rare side effects includes skin rashes and thrombocytopenia.

2nd GENERATION SULFONYLUREAS

Glipizide, Gliclazide, Glimepiride, Glibenclamide, Glyburide are commonly used as 2nd generation sulfonylureas.

SIDE EFFECTS OF 2nd GENERATION SULFONYLUREAS

Old patients with cardiac diseases are usually avoided as there is a high risk of fatal hypoglycemia. Glibenclamide causes maximum hypoglycemia. Glimepiride and Gliclazide are available in modified release form with a low risk of hypoglycemia.

MEGLITINIDE ANALOGS

Drugs belong to meglitinide analogs are Repaglinide and nateglinide .

Repaglinide can be used in case of renal failure.

SIDE EFFECTS OF MEGLITINIDE ANALOGS

Weight gain and hypoglycemia are common adverse effects.

METFORMIN

This is the novel drug for type 2 diabetes Lipogenesis, Gluconeogenesis. Avoided in patients with renal failure and hepatic failure. Metformin should not be used in a patient with a high risk of lactic acidosis.

SIDE EFFECTS OF METFORMIN

  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal discomfort
  • Vitamin B12 deficiency
  • Lactic acidosis.
  • Anorexia (lack of appetite)

PIOGLITAZONE

This drug belongs to group thiazolidinediones. It does not cause hypoglycemia. Pioglitazone also helps to reduce triglyceride and increase HDL (High-Density Lipoprotein). It activates a receptor named as PPAR-γ (Peroxisome Proliferator-Activated Receptor Gamma). Clinical studies found that pioglitazone decreases the risk of cardiovascular diseases like myocardial infarction and stroke.

SIDE EFFECTS OF PIOGLITAZONE

Pioglitazone has multiple side effects like –

  • Edema and fluid retention
  • Anemia
  • Weight gain
  • Headache
  • Muscle pain
  • Toothache
  • Nausea, Vomiting
  • Heart failure
  • Increased risk of bladder cancer
  • Increase the risk of bone fracture

ACARBOSE, VOGLIBOSE, AND MIGLITOL

These drugs inhibit the absorption of glucose. They inhibit enzymes like glucoamylase and Alpha-amylase. Hence, these medications are useful to reduce postprandial blood sugar.

SIDE EFFECTS OF ACARBOSE, VOGLIBOSE AND MIGLITOL

Acarbose causes flatulence, abdominal bloating and diarrhea. Similar side effects are also found in miglitol. Miglitol is excreated without any metabolism through the kidney. For this reason, miglitol should be avoided in end-stage renal disease.

DPP 4 INHIBITORS

DPP 4 inhibitors are oral drugs. Sitagliptin, Saxagliptin, Vildagliptin, Teneligliptin, Linagliptin, Alogliptin have commonly used DPP 4 inhibitors and used to treat type 2 Diabetes. Linagliptin excreted through bile without any metabolism.

SIDE EFFECTS OF DPP 4 INHIBITORS

Sitagliptin side effects are nasopharyngitis, angioedema, pancreatitis, Steven Jhonson syndrome, etc.

Alogliptin is highly hepatotoxic and causes hepatic failure. Vildagliptin side effects include headache, dizziness and hepatitis. The liver function test should be done regularly during the use of vildagliptin and alogliptin. Linagliptin causes respiratory trace infection, angioedema, urticaria, and pancreatitis. Saxagliptin side effects include respiratory tract infection, urinary tract infection, and headache. It also increases the risk of heart failure.

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