糖尿病合併慢性腎病/腎衰竭/腎功能不良/透析患者的藥物選擇

DPP4i

Onglyza (Saxagliptin) F.C Tab. 5mg CCR<30 2.5mg QD 但洗腎患者不建議使用
Trajenta (Linagliptin)不用調整劑量
Galvus (vildagliptin)eGFR < 50 劑量 50mg qd. 

Januvia 100 mg (sitagliptin) eGFR 45-60 不用調整劑量. 

Diabetes treatment in patients with renal disease: Is the landscape clear enough?

PRESCRIBING GUIDANCE IN PATIENTS WITH RENAL IMPAIRMENT TREND-UK: the diabetes nursing pioneers WWW.TREND-UK.ORG INFO@TREND-UK.ORG  @_TRENDUK TRAINING, RESEARCH AND EDUCATION FOR NURSES IN DIABETES Kindly provided through a PCDS and TREND-UK collaboration - July 2017

2016-09-30 藥學雜誌電子報

CKD stage 4-5 eGFR <30
第四及第五期慢性腎病, 不需調整劑量的抗糖尿病藥物
Pioglitazone 腎衰竭要小心使用 
Trajenta (Linagliptin)不用調整劑量


另一篇說 Gliclazide 和  clipizide 在腎衰竭是可以用的.
Gliclazide
Gliclazide is metabolized by the liver to inactive metabolites that are eliminated in the urine. Thus, gliclazide causes less hypoglycemia than other sulfonylureas. In CKD sage 1, 2, 3 (eGFR > 30 mL/min) gliclazide can be used. There are no data in patients with severe CKD but according to its metabolism the use (in reduced dose) of gliclazide is also permitted in these subjects[19].
Glipizide
Glipizide also does not need dose adjustment in severe and moderate renal disease and can be used safely. (The only caution remains the risk of hypoglycemia).

Pioglitazone: Glitis 30 mg. Actos 15 mg. TZD. 水腫.體液滯留 Cr>4 不用調整劑量

但洗腎患者不建議使用 TZD



Onglyza (Saxagliptin) F.C Tab. 5mg CCR<30 2.5mg QD 但洗腎患者不建議使用 
Trajenta (Linagliptin) 不用調整劑量 
Galvus (vildagliptin) eGFR < 50 劑量 50mg qd. 

CANAGLU 100MG Canagliflozin eGFR < 45 需停用 (Canaglu®可拿糖膜衣錠)

FORXIGA 10MG dapagliflozin eGFR< 45 需停用

 

JARDIANCE 25MG  empagliflozin eGFR<45 需停用