Biguanide
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Metformin |
USA prescribing information: contraindication for men with serum creatinine ≥1.5 mg/dL and women with serum creatinine ≥1.4 mg/dL UK guideline allows metformin in patients with eGFR >30 mL/min/1.73 m2 KDIGO recommends metformin in patients with eGFR >45 mL/min/1.73 m2 |
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Sulfonylureas
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Glipizide |
No dose adjustment required |
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Glimepiride |
Initiate conservatively at 1 mg daily Avoid use if eGFR <60 mL/min/1.73 m2 |
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Gliclazide |
Reduce dose if eGFR <30 mL/min/1.73 m2. Not recommended if eGFR <15 mL/min/1.73 m2 |
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Glyburide or glibenclamide |
Avoid use in patients with eGFR <60 mL/min/1.73 m2 |
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Meglitinides
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Repaglinide |
Initial dose of 0.5 mg before meals when eGFR <30 mL/min/1.73 m2 |
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Nateglinide |
Caution when used with eGFR <30 mL/min/1.73 m2. Initiate with 60 mg before meals |
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a-Glucosidase inhibitors
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Acarbose |
Avoid if eGFR <30 mL/min/1.73 m2 |
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Miglitol |
Avoid if eGFR <30 mL/min/1.73 m2 |
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TZDs (Glitazones)
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Pioglitazone |
No dose adjustment required. Use with caution in patients with CKD and hypervolemia |
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GLP-1 receptor agonists
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Exenatide |
Avoid if eGFR <30 mL/min/1.73 m2. When eGFR between 30 and 50 mL/min/1.73 m2 dose should not exceed 5 mcg |
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Lixisenatide |
Avoid if eGFR <50 mL/min/1.73 m2 |
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Liraglutide |
Avoid if eGFR <60 mL/min/1.73 m2 |
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DPP-4 inhibitors
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Sitagliptin |
100 mg daily if eGFR <50 mL/min/1.73 m2 |
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50 mg daily if eGFR 30–50 mL/min/1.73 m2 |
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25 mg daily if eGFR <30 mL/min/1.73 m2 |
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Saxagliptin |
5 mg daily if eGFR <50 mL/min/1.73 m2 |
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2.5 mg daily if eGFR <50 mL/min/1.73 m2 |
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Alogliptin |
1.25 mg per day when eGFR 30–60 mL/min/1.73 m2, and for those patients with eGFR <30 mL/min/1.73 m2 or hemodialysis, the dose should not exceed 6.25 mg/day |
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Linagliptin |
No dose adjustment required |
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SGLT2 inhibitors
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Canagliflozin |
No dose adjustment required if eGFR <60 mL/min/1.73 m2 |
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100 mg daily if eGFR 45–59 mL/min/1.73 m2 |
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Dapagliflozin |
Avoid use if eGFR <60 mL/min/1.73 m2, and discontinue use if eGFR <45 mL/min/1.73 m2 |
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