Usual Adult Dose for Diabetes Type 2

Initial dose: 1 to 2 mg orally once a day
Maintenance dose: Increase in 1 or 2 mg increments no more frequently than every 1 to 2 weeks based on glycemic response
Maximum dose: 8 mg per day

Comments:

• Administer with breakfast or first main meal of the day.
• In patients who are at increased risk for hypoglycemia, start with 1 mg orally once a day and titrate slowly.
• When patients are being transferred to this drug from a longer half-life sulfonylurea, monitor 1 to 2 weeks for overlapping drug effect.

Usual Geriatric Dose for Diabetes Type 2

Initial dose: 1 mg orally once a day; titrate slowly and monitor closely

Usual Pediatric Dose for Diabetes Type 2

Not recommended because of adverse effects on body weight and hypoglycemia.

Renal Dose Adjustments

Initial dose: 1 mg orally once a day; titrate slowly and monitor closely

Liver Dose Adjustments

Use with caution

Dose Adjustments

Patients who are sensitive to hypoglycemic drugs should start at 1 mg orally once a day; dose titration should be conservative.

Concomitant Use with Colesevelam:

• This drug should be administered at least 4 hours prior to colesevelam to ensure absorption

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• Take with breakfast or first main meal of the day
• When coadministered with colesevelam, this drug should be taken at least 4 hours prior

• This drug should not be used in patients with type 1 diabetes or diabetic ketoacidosis.
• Hemolytic anemia may occur in glucose 6-phosphate dehydrogenase (G6PD) deficient patients; consider a non-sulfonylurea alternative.
• Improvement in glucose tolerance may take place after a few weeks of treatment, monitor clinical status closely within the first 4 to 8 weeks and at regular intervals thereafter to ascertain whether it is possible to reduce the dose.
• During periods of stress such as fever, trauma, infection, or surgery, patients may need to temporarily switch to insulin therapy.

• Regular monitoring of blood glucose levels is necessary to ensure safety and efficacy

• Patients should understand the importance of exercise and dietary control in the management of their disease.
• Patients should understand that alcohol ingestion, intense or prolonged exercise, skipping meals, illness, or lifestyle changes may increase their risks for hypoglycemia; they should know how to recognize the symptoms of hypoglycemia and be prepared to treat it.
• Patients should be careful about driving and use of machinery, especially when at risk for hypoglycemia.
• Patients should speak with their health care provider during periods of stress such as fever, trauma, or illness, as their diabetes management may need to be changed.
• Advise patients to speak to physician or health care professional if pregnant, intend to become pregnant, or are breastfeeding.