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Antidiabetic Medications: Hypoglycemic Potential in Overdose

2016-11-11T19:22:28+00:00

antidiabetic medicationsWith several new diabetes medications available, it is important to know which ones are likely to cause hypoglycemia after overdose. Based on mechanism of action and reported cases, the likelihood of hypoglycemia after overdose is listed below by drug class. 1

Keep in mind that other drugs can interact with antidiabetic medications resulting in hypoglycemia. The following table applies only to single agent ingestion/administration.

Drug Class Examples Hypoglycemic Potential
Insulins Glargine, Aspart, Detemir High
Sulfonylureas Glyburide, Glipizide, Glimepiride High
Meglitinides Nateglinide, Repaglinide High
Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists Exenatide, Albiglutide, Liraglutide Low-Moderate
Alpha-glucosidase inhibitors Acarbose, Miglitol Low
Thiazolidinediones Rosiglitazone, Piaglitazone Low
Biguanides Metformin Low
Dipeptidyl Peptidase 4 (DPP-4) Inhibitors Sitagliptin, Saxagliptin, Linagliptin Low
Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors Canagliflozin Low
Adapted from a University of Maryland Emergency Medicine (UMEM, @UMEmergencyMed) Educational Pearl.

Image credit

1.
Nelson L, Lewin N, Howland M Ann, Hoffman R, Goldfrank L, Flomenbaum N. Antidiabetics and Hypoglycemics. In: Goldfrank’s Toxicologic Emergencies. 9th ed. New York: Mcgraw-Hill; 2010:714-727.
Bryan D. Hayes, PharmD, FAACT, FASHP

Bryan D. Hayes, PharmD, FAACT, FASHP

Leadership Team, ALiEM
Creator and Lead Editor, Capsules series, ALiEMU
Attending Pharmacist, EM and Toxicology, MGH
Assistant Professor of EM, Harvard Medical School