Anti-Diabetic Medications
Metformin (a Biguanide for Diabetes)
Absolute Contraindications
- Severe renal impairment (eGFR <30 mL/min)
- Acute metabolic acidosis
Main Side Effects
- GI upset (nausea, diarrhoea)
- Lactic acidosis (rare but serious)
Main Interactions
- Contrast media (risk of lactic acidosis)
Main Monitoring Requirements
- Renal function before initiation and at least annually
Pregnancy & Breastfeeding
- Can be used in pregnancy and breastfeeding
Sulfonylureas (e.g., Gliclazide)
Absolute Contraindications
- Ketoacidosis
- Severe renal or hepatic impairment
Main Side Effects
- Hypoglycaemia
- Weight gain
- GI upset
Main Interactions
- Alcohol (increased risk of hypoglycaemia)
- NSAIDs (may enhance effect)
Main Monitoring Requirements
- Blood glucose and HbA1c regularly
- Signs of hypoglycaemia
Pregnancy & Breastfeeding
- Avoid; insulin preferred
DPP-4 Inhibitors (e.g., Sitagliptin)
Absolute Contraindications
- Severe renal impairment (dose adjustments required)
Main Side Effects
- Nasopharyngitis
- GI upset
- Rare: Pancreatitis
Main Interactions
- Limited significant interactions
Main Monitoring Requirements
- HbA1c
- Renal function
Pregnancy & Breastfeeding
- Avoid; safety not established
GLP-1 Receptor Agonists (e.g., Liraglutide)
Absolute Contraindications
- Severe GI disease
- History of medullary thyroid carcinoma
Main Side Effects
- Nausea, vomiting
- Weight loss
Main Interactions
- May delay gastric emptying and absorption of oral medications
Main Monitoring Requirements
- HbA1c
- Renal function
Pregnancy & Breastfeeding
- Avoid
SGLT2 Inhibitors (e.g., Dapagliflozin)
Absolute Contraindications
- Severe renal impairment
- History of recurrent UTIs or genital infections
Main Side Effects
- Increased risk of UTIs and genital infections
- Volume depletion (hypotension)
Main Interactions
- Loop diuretics (risk of dehydration)
Main Monitoring Requirements
- Renal function
- HbA1c
Pregnancy & Breastfeeding
- Avoid