Metformin
Glucophage®
500 mg - 850 mg
OD to TID
Maximum daily dose: 2550 mg
Coverage
- Relative A1C lowering:
- Hypoglycemia: Negligible risk as monotherapy
- Weight: neutral
- Effect in cardiovascular outcome trial: neutral
- Other therapeutic considerations: GI side effects
- Cost: $
Metformin ER
Glumetza®
500 mg - 1000 mg
OD
Maximum daily dose: 2000 mg
Coverage
- Relative A1C lowering:
- Hypoglycemia: Negligible risk as monotherapy
- Weight: neutral
- Effect in cardiovascular outcome trial: neutral
- Other therapeutic considerations: GI side effects
- Cost: $$ to $$$
Acarbose
GlucobayTM
50 mg - 100 mg
OD to TID
Maximum daily dose: 300 mg
How to initiate
Coverage
- Relative A1C lowering:
- Hypoglycemia: Negligible risk as monotherapy - If hypoglycemia occurs treat with milk, honey or dextrose tablets but not fructose (ex.juice).
- Weight: neutral to
- Effect in cardiovascular outcome trial: not shown
- Other therapeutic considerations: Improved postprandial control, GI side effects
- Cost: $$
1. Sitagliptin Januvia®
2. Saxagliptin Onglyza®
3. Linagliptin Trajenta®
4. Alogliptin Nesina®
: Official indication according to Health Canada
| - | 1 | 2 | 3 | 4 |
|---|---|---|---|---|
| Mono | ||||
| Metformin | ||||
| Sulfonylurea | ||||
| Met + Sulfo | ||||
| Insulin |
Alogliptin
Nesina®
6.25 mg - 12.5 mg - 25 mg
OD
Coverage
QC
- Relative A1C lowering:
- Hypoglycemia: Negligible risk as monotherapy
- Weight: neutral to
- Effect in cardiovascular outcome trial: neutral
- Other therapeutic considerations: -
- Cost: $$$
Alogliptin and Metformin
KazanoTM
12.5 mg/500 mg - 12.5 mg/850 mg - 12.5 mg/1000 mg
BID
Coverage
QC
- Relative A1C lowering:
- Hypoglycemia: Negligible risk as monotherapy
- Weight: neutral to
- Effect in cardiovascular outcome trial: neutral
- Other therapeutic considerations: -
- Cost: $$$
Linagliptin and Metformin
JentaduetoTM
2.5 mg/500 mg - 2.5 mg/850 mg - 2.5 mg/1000 mg
BID
Coverage
AB
BC
MB
NB
NL
NS
PE
QC
SK
- Relative A1C lowering:
- Hypoglycemia: Negligible risk as monotherapy
- Weight: neutral to
- Effect in cardiovascular outcome trial: neutral
- Other therapeutic considerations: -
- Cost: $$$
Saxagliptin and Metformin
Komboglyze®
2.5 mg/500 mg - 2.5 mg/850 mg - 2.5 mg/1000 mg
BID
Coverage
AB
BC
NB
NL
NS
PE
QC
SK
- Relative A1C lowering:
- Hypoglycemia: Negligible risk as monotherapy
- Weight: neutral to
- Effect in cardiovascular outcome trial: neutral
- Other therapeutic considerations: Caution with saxagliptin in heart failure
- Cost:$$$
Sitagliptin and Metformin
Janumet®
50 mg/500 mg - 50 mg/850 mg - 50 mg/1000 mg
BID
Coverage
AB
MB
NB
NL
NS
PE
QC
SK
- Relative A1C lowering:
- Hypoglycemia: Negligible risk as monotherapy
- Weight: neutral to
- Effect in cardiovascular outcome trial: neutral
- Other therapeutic considerations: -
- Cost: $$$
Sitagliptin and Metformin ER
Janumet® XR
50 mg/500 mg - 50 mg/1000 mg - 100 mg/1000 mg
OD
Coverage
AB
MB
NB
NL
PE
QC
SK
- Relative A1C lowering:
- Hypoglycemia: Negligible risk as monotherapy
- Weight: neutral to
- Effect in cardiovascular outcome trial: neutral
- Other therapeutic considerations: -
- Cost: $$$
1. Canagliflozin Invokana®
2. Dapagliflozin Forxiga®
3. Empagliflozin Jardiance®
4. Ertugliflozin SteglatroTM
: Official indication according to Health Canada.
*Please refer to Health Canada for most recent updates.
| - | 1 | 2 | 3 | 4 |
|---|---|---|---|---|
| Mono | ||||
| Metformin | ||||
| Sulfonylurea | ||||
| Met + Sulfo | ||||
| Met+TZD(pio) | ||||
| Insulin | ||||
| DPP4. inh |
Canaglifozin
Invokana®
100 mg - 300 mg
OD
Coverage
AB
MB
NB
NL
NS
PE
QC
SK
- Relative A1C lowering: to
- Hypoglycemia: Negligible risk as monotherapy
- Weight:
- Effect in cardiovascular outcome trial: Superiority (empagliflozin and canagliflozin) in patients with type 2 diabetes and established CVD
- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)
- Cost: $$$
Canaglifozin and Metformin
Invokamet®
50 mg/500 mg - 50 mg/1000 mg - 150 mg/500 mg - 150 mg/1000 mg
BID
Coverage
MB
PE
- Relative A1C lowering: to
- Hypoglycemia: Negligible risk as monotherapy
- Weight:
- Effect in cardiovascular outcome trial: Superiority (empagliflozin and canagliflozin) in patients with type 2 diabetes and established CVD
- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)
- Cost: $$$
Dapagliflozin
Forxiga®
5 mg - 10 mg
OD
Coverage
AB
MB
NB
NL
NS
PE
QC
SK
- Relative A1C lowering: to
- Hypoglycemia: Negligible risk as monotherapy
- Weight:
- Effect in cardiovascular outcome trial: Non-inferior for MACE and Superiority to reduce hospitalisations for HF and CV death for diabetic patients in primary and secondary prevention
- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)
- Cost: $$$
Dapagliflozin and Metformin
Xigduo®
5 mg/850 mg - 5 mg/1000 mg
BID
Coverage
AB
MB
NB
NL
NS
PE
QC
SK
- Relative A1C lowering: to
- Hypoglycemia: Negligible risk as monotherapy
- Weight:
- Effect in cardiovascular outcome trial: Non-inferior for MACE and Superiority to reduce hospitalisations for HF and CV death for diabetic patients in primary and secondary prevention
- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)
- Cost: $$$
Empagliflozin
Jardiance®
10 mg - 25 mg
OD
Coverage
AB
MB
NL
NS
PE
QC
SK
- Relative A1C lowering: to
- Hypoglycemia: Negligible risk as monotherapy
- Weight:
- Effect in cardiovascular outcome trial: Superiority (empagliflozin and canagliflozin) in patients with type 2 diabetes and established CVD
- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)
- Cost: $$$
Empagliflozin and Linagliptin
Glyxambi®
10 mg/5 mg - 25 mg/5 mg
OD
Coverage
- Relative A1C lowering: to
- Hypoglycemia: Negligible risk as monotherapy
- Weight:
- Effect in cardiovascular outcome trial: Superiority (empagliflozin and canagliflozin) in patients with type 2 diabetes and established CVD
- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)
- Cost: $$$
Empagliflozine and Metformin
SynjardyTM
5 mg/500 mg - 5/850 mg - 5 mg/1000 mg - 12.5 mg/500 mg - 12.5 mg/850 mg - 12.5 mg/1000 mg
BID
Coverage
NS
QC
- Relative A1C lowering: to
- Hypoglycemia: Negligible risk as monotherapy
- Weight:
- Effect in cardiovascular outcome trial: Superiority (empagliflozin and canagliflozin) in patients with type 2 diabetes and established CVD
- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)
- Cost: $$$
Ertugliflozin
SteglatroTM
5 mg - 15 mg
OD
Coverage
- Relative A1C lowering: to
- Hypoglycemia: Negligible risk as monotherapy
- Weight:
- Effect in cardiovascular outcome trial: -
- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)
- Cost: $$$
Ertugliflozin and Metformin
SeglurometTM
2.5 mg/500 mg - 2.5 mg/1000 mg - 7.5 mg/500 mg - 7.5 mg/1000 mg
BID
Coverage
- Relative A1C lowering: to
- Hypoglycemia: Negligible risk as monotherapy
- Weight:
- Effect in cardiovascular outcome trial: -
- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)
- Cost: $$$
Ertugliflozin and Sitagliptin
SteglujanTM
5 mg/100 mg - 15 mg/100 mg
DIE
Coverage
- Relative A1C lowering: to
- Hypoglycemia: Negligible risk as monotherapy
- Weight:
- Effect in cardiovascular outcome trial: -
- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)
- Cost: $$$
Gliclazide
Diamicron®
80 mg
OD to BID
Maximum daily dose: 320 mg
Coverage
BC
- Relative A1C lowering:
- Hypoglycemia: yes
- Weight:
- Effect in cardiovascular outcome trial: neutral
- Other therapeutic considerations: Gliclazide and glimepiride associated with less hypoglycemia than glyburide
- Cost: $
Gliclazide Modified Release
Diamicron®MR
30 mg - 60 mg
OD
Maximum daily dose: 120 mg
Coverage
BC
- Relative A1C lowering:
- Hypoglycemia: yes
- Weight:
- Effect in cardiovascular outcome trial: neutral
- Other therapeutic considerations: Gliclazide and glimepiride associated with less hypoglycemia than glyburide
- Cost: $
Glimepiride
Amaryl®
1 mg - 2 mg - 4 mg
OD to BID
Maximum daily dose: 8 mg
Coverage
MB
ON
QC
- Relative A1C lowering:
- Hypoglycemia: yes
- Weight:
- Effect in cardiovascular outcome trial: neutral
- Other therapeutic considerations: Gliclazide and glimepiride associated with less hypoglycemia than glyburide
- Cost: $
Glyburide
Diabeta®
2.5 mg - 5 mg
OD to BID
Maximum daily dose: 20 mg
Coverage
- Relative A1C lowering:
- Hypoglycemia: yes
- Weight:
- Effect in cardiovascular outcome trial: neutral
- Other therapeutic considerations: -
- Cost: $
Pioglitazone
Actos®
15 mg - 30 mg - 45 mg
OD
Coverage
AB
BC
MB
NB
NL
NS
ON
PE
QC
SK
- Relative A1C lowering:
- Hypoglycemia: Negligible risk as monotherapy
- Weight:
- Effect in cardiovascular outcome trial: neutral
- Other therapeutic considerations: CHF, edema, fractures, rare bladder cancer (pioglitazone), cardiovascular controversy (rosiglitazone), 6-12 weeks required for maximal effect
- Cost: $$
Rosiglitazone
Avandia®
2 mg - 4 mg - 8 mg
OD
Coverage
AB
ON
QC
SK
- Relative A1C lowering:
- Hypoglycemia: Negligible risk as monotherapy
- Weight:
- Effect in cardiovascular outcome trial: neutral
- Other therapeutic considerations: CHF, edema, fractures, rare bladder cancer (pioglitazone), cardiovascular controversy (rosiglitazone), 6-12 weeks required for maximal effect
- Cost: $$
1. Liraglutide Victoza®
2. Exenatide Byetta®
3. Exenatide (1QW) Bydureon®
4. Dulaglutide Trulicity®
5. Lixisenatide AdlyxineTM
6. Semaglutide Ozempic®
: Official indication according to Health Canada
| - | 1 | 2 | 3 | 4 | 5 | 6 |
|---|---|---|---|---|---|---|
| Mono | ||||||
| Metformin | ||||||
| Sulfonylurea | ||||||
| Met + Sulfo | ||||||
| Insulin |
Dulaglutide
Trulicity®
0.75 mg - 1.5 mg
Once-Weekly
Stability at room temperature : 14 days
Coverage
- Relative A1C lowering: to
- Hypoglycemia: Negligible risk as monotherapy
- Weight:
- Effect in cardiovascular outcome trial: -
- Other therapeutic considerations: GI side effects
- Cost: $$$$
Devices
- Pre-filled (0.5 ml) single-dose pen
- 5 mm 29G integrated and retractable needle
Start with 0.75 mg/week for 2 to 4 weeks (*) then increase to 1.5 mg/week (maximum dose recommendation).
Please note: The titration protocol depends on the patient glycemic control and the patient’s tolerance to the product.
Exenatide
Byetta®
5 µg - 10 µg
BID (60 min AC)
Stability at room temperature : 30 days
Coverage
- Relative A1C lowering: to
- Hypoglycemia: Negligible risk as monotherapy
- Weight:
- Effect in cardiovascular outcome trial: -
- Other therapeutic considerations: GI side effects
- Cost: $$$$
Devices
- Pre-filled (1.2 ml = 60 doses of 5 ug and 2.4 ml = 60 doses de 10 ug)
- 4, 5 and 6 mm pen needles are suitable for all people living with diabetes regardless of BMI. (Ref. Fit Canada)
Exenatide Sustained Release
Bydureon®
2 mg
Once-Weekly
Stability at room temperature : 4 weeks
Coverage
- Relative A1C lowering: to
- Hypoglycemia: Negligible risk as monotherapy
- Weight:
- Effect in cardiovascular outcome trial: -
- Other therapeutic considerations: GI side effects
- Cost: $$$$
Device
- Pre-filled (0.65 ml) single-dose pen (reconstitution necessary)
- 7 mm 23 G screw-on needle (included)
Please note: A nodule could appear at the injection site
Liraglutide
Victoza®
0.6 mg - 1.2 mg - 1.8 mg
OD
Stability at room temperature : 30 days
Coverage
- Relative A1C lowering: to
- Hypoglycemia: Negligible risk as monotherapy
- Weight:
- Effect in cardiovascular outcome trial: Superiority (liraglutide and semaglutide) in patients with type 2 diabetes and established CVD
- Other therapeutic considerations: GI side effects
- Cost: $$$$
Device
- Pre-filled pen (3 ml) 6 mg/ml
- 0.6 mg=30 doses, 1.2 mg=15 doses, 1.8 mg=10 doses
- 4, 5 and 6 mm pen needles are suitable for all people living with diabetes regardless of BMI. (Ref. Fit Canada)
Start with 0.6 mg/day for at least one week then increase the dosage to 1.2 mg/day for at least another week then increase to 1.8 mg/day (maximum dose recommendation)
Please note: The titration protocol depends on the patient glycemic control and the patient’s tolerance to the product.
Lixisenatide
AdlyxineTM
10 ug/dose (0.05 mg/ml)
20 ug/dose (0.1 mg/ml)
OD
Stability at room temperature : 14 days
Coverage
- Relative A1C lowering: to
- Hypoglycemia: Negligible risk as monotherapy
- Weight:
- Effect in cardiovascular outcome trial: neutral
- Other therapeutic considerations: GI side effects
- Cost: $$$$
Pre-filled pen
Devices
- Pen 1 (Starter): 14 doses of 10 ug
- Pen 2 (Maintenance): 14 doses of 20 ug
- 4, 5 and 6 mm pen needles are suitable for all people living with diabetes regardless of BMI. (Ref. Fit Canada)
Start with 10 ug/day for 14 days then increase to 20 ug/day (maximum dose recommendation)
Please note: The titration protocol depends on the patient glycemic control and the patient’s tolerance to the product.
Semaglutide
Ozempic®
0.25 mg - 0.5 mg - 1 mg
Once-Weekly
Stability at room temperature : 8 weeks
Coverage
- Relative A1C lowering: to
- Hypoglycemia: Negligible risk as monotherapy
- Weight:
- Effect in cardiovascular outcome trial: Superiority (liraglutide and semaglutide) in patients with type 2 diabetes and established CVD
- Other therapeutic considerations: GI side effects
- Cost: $$$$
Pre-filled pen ( 2 mg)
Devices
- Pen 1 (Starter) dosage of 0.25 mg (8 doses) and 0.5 mg (4 doses)
- Pen 2 (Maintenance) dosage of 1 mg ( 4 doses)
- 4, 5 and 6 mm pen needles are suitable for all people living with diabetes regardless of BMI. (Ref. Fit Canada)
Start with 0.25 mg/week for 4 weeks then increase the dosage to 0.5 mg/week for another 4 weeks then increase to 1 mg/week (maximum dose recommendation)
Please note: The titration protocol depends on the patient glycemic control and the patient’s tolerance to the product.
Glargine U100 (100 units/ml) / Lixisenatide (33 mcg/ml)
SoliquaTM
Maximum recommended daily dose is 60 units:
Glargine U100 60 units / Lixisenatide 20 mcg
Therapy Initiation and Titration
Coverage
- Stylo SoloSTAR® (pre-filled) 3 ml
- 4, 5 and 6 mm pen needles are suitable for all people living with diabetes regardless of BMI. (Ref. Fit Canada)
Degludec (100 units/ml) / Liraglutide (3.6 mg/ml)
Xultophy®
Maximum recommended daily dose is 50 units:
Degludec 50 units / Liraglutide 1.8 mg
Therapy Initiation and Titration
Coverage
- Stylo Flextouch® (pre-filled) 3 ml
- 4, 5 and 6 mm pen needles are suitable for all people living with diabetes regardless of BMI. (Ref. Fit Canada)