Modifications of antidiabetic drugs in patients with type 2 diabetes mellitus (adapted from the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines) Class Drug Dosing recommendation stages 3 and 4 CKD or kidney transplant First-generation Acetohexamide
, Avoid sulfonylureas tolazamide, tolbutamide Chlorpropamide Avoid when GFR < 50 mL/min/ 1.
First-generation sulfonylureas, including chlorpropamide (Diabinese[R]), tolbutamide (Orinase[R]), tolazamide (Tolinase[R]), and acetohexamide
(Dymelor[R]), have substituents that are small, polar, and hydrophilic, making them more water-soluble and less potent, in the second and third-generation sulfonylureas, (glyburide [Micronase[R]], glipizide [Glucotrol[R]], gliclazide [Diamicron[R], Dianorm-In[R]], and glimepiride [Amaryl[R], DIAPRIDE[R]]), substituents are large, nonpolar, lipophilic groups that more readily penetrate cell membranes and therefore are more potent in increasing insulin release (Spiller & Sawyer, 2006).
TABLE: SIMILAR SOUNDING DRUG NAMES THAT COULD RESULT IN A MEDICATION ERROR Drug Name Confused With Abelcet Amphotericin B Accupril Aciphex Acetazolamide Acetohexamide
Aciphex Aricept Aciphex Accupril Activase TNKase Actonel Actos Adderall Inderal Advicor Altocor Aggrastat Argatroban Adapted from Medication Safety Alert.