Usual Adult Dose for Diabetes Type 2

Individualize dose based on efficacy and tolerability:

Initial dose: 25 mg orally 3 times a day

• After 4 to 8 weeks, may increase to 50 mg orally 3 times a day if needed; after 3 more months, may increase to 100 mg orally 3 times a day if needed based on glycosylated hemoglobin

• Take orally at the start (with first bite) of each main meal; patients should be adhering to a diabetic diet to minimize GI side effects.
• Some patients benefit from starting at 25 mg orally once a day with subsequent titration to 3 times a day to minimize GI side effects.
• If no further reduction in postprandial glucose or HbA1c is observed with titration to 100 mg three times a day, consider lowering the dose.

Renal Dose Adjustments

Significant renal dysfunction (CrCl less than 25 mL/min or serum creatinine greater than 2 mg/dL): Use is not recommended

Liver Dose Adjustments

No adjustment recommended

Dose Adjustments

Gastrointestinal Adverse Effects:

• If gastrointestinal symptoms persist despite following a prescribed diet, dose reduction or discontinuation may be necessary.

• When given in combination with sulfonylurea agents or insulin, hypoglycemia may occur, if this occurs, dose adjustment of the sulfonylurea agent or insulin will be necessary.

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 orally at the start of meal (with first bite)

• This drug should be titrated to reduce gastrointestinal side effects; patients should be instructed regarding the importance of following a diabetic diet.
• This drug may be used as monotherapy, or in combination with other antidiabetic agents.
• Patients receiving sulfonylureas or insulin may need a dose adjustment of these agents if hypoglycemia occurs.

• Glycemic control: During initiation and titration, 1-hour postprandial plasma glucose should be used to monitor therapeutic response; glycosylated hemoglobin levels (HbA1c) should be measured every 3 months to assess long-term glycemic control.

• Patients should understand the importance of adhering to a diabetic diet; gastrointestinal side effects are common upon treatment initiation, but should diminish with time.
• Hypoglycemia may occur, more commonly when used in combination with insulin or a sulfonylurea; patients should be instructed to treat hypoglycemia with oral glucose (dextrose) as sucrose (cane sugar) is not expected to correct hypoglycemia due to the action of this drug.
• During periods of stress such as fever, trauma, infection, or surgery, management of diabetes may change and patients should be advised to seek medical advice.