The table shows a summary correlating the therapeutic class and the dose adjustment based on creatinine clearance.

Class and Medication Dose Adjustment Based on eGFR

Biguanide

  
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  

Sulfonylureas

  
Glipizide No dose adjustment required  
Glimepiride Initiate conservatively at 1 mg daily    Avoid use if eGFR <60 mL/min/1.73 m2  
Gliclazide Reduce dose if eGFR <30 mL/min/1.73 m2. Not recommended if eGFR <15 mL/min/1.73 m2  
Glyburide or glibenclamide Avoid use in patients with eGFR <60 mL/min/1.73 m2  

Meglitinides

  
Repaglinide Initial dose of 0.5 mg before meals when eGFR <30 mL/min/1.73 m2  
Nateglinide Caution when used with eGFR <30 mL/min/1.73 m2. Initiate with 60 mg before meals  

a-Glucosidase inhibitors

  
Acarbose Avoid if eGFR <30 mL/min/1.73 m2  
Miglitol Avoid if eGFR <30 mL/min/1.73 m2  

TZDs (Glitazones)

  
Pioglitazone No dose adjustment required. Use with caution in patients with CKD and hypervolemia  

GLP-1 receptor agonists

  
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  
Lixisenatide Avoid if eGFR <50 mL/min/1.73 m2  
Liraglutide Avoid if eGFR <60 mL/min/1.73 m2  

DPP-4 inhibitors

  
Sitagliptin 100 mg daily if eGFR <50 mL/min/1.73 m2  
  50 mg daily if eGFR 30–50 mL/min/1.73 m2  
  25 mg daily if eGFR <30 mL/min/1.73 m2  
Saxagliptin 5 mg daily if eGFR <50 mL/min/1.73 m2  
  2.5 mg daily if eGFR <50 mL/min/1.73 m2  
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  
Linagliptin No dose adjustment required  
   

SGLT2 inhibitors

  
Canagliflozin No dose adjustment required if eGFR <60 mL/min/1.73 m2  
  100 mg daily if eGFR 45–59 mL/min/1.73 m2  
Dapagliflozin Avoid use if eGFR <60 mL/min/1.73 m2, and discontinue use if eGFR <45 mL/min/1.73 m2