Canagliflozin

Dapagliflozin

Empagliflozin

• Major Side Effects:

  constipationurinary tract infectionsnausea and vomitingrash

• Serious Side Effects:

  urosepsisFournier's gangrenerenal impairment

Cautions:

• diabetic ketoacidosis
• eGFR < 60

Monitoring Requirement:

• ketone level
• renal function

• Remarks:
• MHRA: increased risk lower limb amputation (canagliflozin)
• Monitor ketone level (during interruption in case of major surgery or acute serious illness)

Linagliptin

Sitagliptin

Saxagliptin

Vildagliptin

• Major Side Effects:

  headacheconstipationdizzinesshepatic disorderpancreatitishypersensitivityvomitingupper respiratory infectionangioedema

• Serious Side Effects:

  Stevens-Johnson syndromerenal impairment

Cautions:

• Alogliptin: reduce dose if CrCl < 50ml/min.
• Sitagliptin: reduce dose if CrCl< 45ml/min.

Monitoring Requirement:

• renal function

• Remarks:
• sitagliptin: do not use in renal impairment
• saxagliptin: skin reactions
• vildagliptin: liver toxicity (perform liver function tests before and every 3 months)

Liraglutide

Exenatide

Lixisenatide

• Major Side Effects:

  gastrointestinal disturbanceskin reactionrenal impairmentheadachedrowsinessappetite decreasedvomitingtaste altered

• Serious Side Effects:

  acute pancreatitis

Cautions:

• MHRA: diabetic ketoacidosis

• Remarks:
• Only for BMI ≥35 + have specific psychological or medical problems associated with obesity Or
• BMI ≤35 but insulin therapy would have significant occupational implications Or
• Weight loss would benefit

Metformin

• Major Side Effects:

  nausea & vomitingabdominal paintaste disturbancevitamin B12 deficiency

• Serious Side Effects:

  lactic acidosis

Cautions:

• Stop metformin when eGFR <30 mL/min/1.73
• Symptoms and sign of lactic acidosis: abdominal pain, anorexia, hypothermia, lethargy, nausea vomiting, respiratory distress; increased risk when: renal altered function, cardiac or respiratory failure

• Remarks:
• Metformin helps weight loss, reduce risk of hypoglycaemia and long-term cardiovascular benefits

Insulin

• Major Side Effects:

  weight gaintransient altered visionoedemaskin reaction

• Serious Side Effects:

  insulin neuritis

Cautions:

• You need to tell DVLA if:
• your insulin treatment lasts (or will last) over 3 months
• you had gestational diabetes (diabetes associated with pregnancy) and your insulin treatment lasts over 3 months after the birth
• you get disabling hypoglycaemia (low blood sugar) - or a medical professional has told you that you’re at risk of developing it

Monitoring Requirement:

• blood glucose level

• Remarks:
• Leave insulin in room temperature for 30mins before using
• Soluble insulins and long-acting insulin analogues should be clear and colourless and must not be used if they appear cloudy or discoloured
• If injecting more than 50 units (0.5 mL of U100 insulin), many experts recommend splitting the injection into separate areas to facilitate absorption
• The needle should be left in the skin for 5–10 seconds (or longer for large doses) o avoid leakage
• Apply gentle pressure over the injection site for several seconds after withdrawing the needle
• Rapid-acting: onset of action 15min; duration 2-5 hours
• Intermediate-actin: onset of action 1-2 hrs; duration 11-24hrs
• Long-acting: duration of action up to 24hours

Pioglitazone

Rosiglitazone

• Major Side Effects:

  numbnessvisual impairmentweight gaininsomniainfectionbone fracture

• Serious Side Effects:

  bladder cancerhepatitis (liver toxicity)heart failure

Cautions:

• Liver toxicity
• heart failure

Monitoring Requirement:

• liver function tests

• Remarks:

Salbutamol

Terbutaline

• Major Side Effects:

  cold hands and feet

• Serious Side Effects:

• Remarks:

Amitriptyline

Lofepramine

• Major Side Effects:

  dry mouthblurred visionhypotensionsedationsexual dysfunction

• Serious Side Effects:

  extrapyramidal symptoms (tremor and dyskinesia)

Cautions:

• elderly
• history of cardiovascular disease
• epilepsy

• Remarks:

Sertraline

Fluoxetine

Citalopram

• Major Side Effects:

  Dizziness and confusionGastrointestinal disconfortDiarrhoeaConstipationQT prolongation

• Serious Side Effects:

  sexual dysfunctionSerotonin syndrome

• Remarks:
• SSRI is the most tolerated group of antidepressant, therefore considered as 1st line option for treatment of depression
• Sertraline - safe to be use in MI and Angina
• Fluoxetine is the only SSRi suitable for children <18
• Overdose: nausea, vomiting, agitation, tremor etc.