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Table 6 Renal function adjustments of anti-hyperglycemic drugs

From: Brazilian guidelines on prevention of cardiovascular disease in patients with diabetes: a position statement from the Brazilian Diabetes Society (SBD), the Brazilian Cardiology Society (SBC) and the Brazilian Endocrinology and Metabolism Society (SBEM)

Drug

Maximal daily dose

Estimated GFR (mL/min)

45–60

30–45

<30

Insulin

Variable

NN

NN

NN

Pioglitazone

45 mg

NN

NN

NN

Linagliptin

5 mg

NN

NN

NN

Sitagliptin (mg)

100

50

50

25

Vildagliptin

50 mg bid

50 mg

50 mg

50 mg

Saxagliptin (mg)

5

2.5

2.5

2.5

Alogliptin (mg)

25

12.5

12.5

6.25

Metformin

<2550 mg

<2000 mg/day

<1000 mg/day

NR

Glimepiride

8 mg

1 mg

1 mg

NR

Gliclazide

120 mg

NN

NN

NR

Glibenclamide

20 mg

NR

NR

NR

Nateglinide

120 mg/meal

60 mg/meal

60 mg/meal

NR

Repaglinide (mg/meal)

1

0.5

0.5

0.5

Acarbose

300 mg

150 mg

150 mg

NR

Exenatide

10 mcg bid

NN

5 mcg bid

NR

Liraglutide

1.8 mg

NN

NN

NR

Lixisenatide

20 mcg

NN

NR

NR

Dulaglutide

1.5 mg/week

NN

NN

NR

Canagliflozin

300 mg

100 mg

NR

NR

Empagliflozin

25 mg

NN

NN

NR

Dapagliflozin

10 mg

NN

NR

NR

  1. GFR glomerular filtration rate, NN not necessary, NR not recommended, bid 2 times daily
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Diabetology & Metabolic Syndrome

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