Diabetes Mellitus Drug Summary

Last updated: 02 June 2025

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Insulin Preparations

Content on this page:

Insulin Preparations

Insulin Preparations


Drug Dosage Remarks
Rapid-Acting Insulins
Insulin aspart Individualized dosing by SC injection or continuous SC pump infusion or IV
Usual dose: 0.5-1 unit/kg/day SC 5-10 minutes before meal 		Adverse Reactions
  • Most common: Hypoglycemia
    • Dependent on the type and preparation used
    • Usually secondary to high insulin dose, increased physical activity or omission of a meal
    • Symptoms may include hunger, pallor, sweating, palpitation, anxiety, headache, visual disturbance; if untreated may lead to convulsion and coma
  • GI effects (weight gain, nausea); CNS effects (transient blurred vision, headache, fatigue); CV effects (transient peripheral edema, pallor, tachycardia); Dermatologic effects (pruritus, rash, urticaria); Local effects (injection site reaction, lipoatrophy/lipohypertrophy); Hypersensitivity reactions
  • Insulin human, inhaled: Respiratory effects (bronchospasms, cough, decline in pulmonary function)
Special Instructions
  • Dose should be increased during infection, stress, trauma, puberty
  • Dose should be decreased in patients with renal or hepatic impairment
  • Avoid inadvertent change of insulin from 1 dosage type to another
  • Monitor blood or urine glucose levels and urine ketones
  • Insulin human, inhaled: Evaluate lung function using spirometry prior to and during treatment
  • Dose of short-acting insulin should be taken before each meal
  • Intermediate-acting insulin should be taken at bedtime
  • Injection site should be rotated regularly to avoid lipodystrophy
  • Insulin human, inhaled: Contraindicated in patients with chronic lung diseases
Insulin glulisine Individualized dosing by SC injection or continuous SC pump infusion or IV
Insulin human
 Individualized dosing by SC injection or IV
Usual dose: 0.3-1 IU/kg/day
or
Initial dose:
Insulin-naive: 4 units inhaled PO each meal
Adjust dose thereafter based on patient's response and glycemic goal
Patients using SC prandial Insulin: Determine appropriate dose for each meal by converting from SC dose using the dose conversion table
Patients using SC pre-mixed Insulin: Estimate injected dose per meal by dividing half of the total daily injected dose by 3 (equivalent to 3 meals/day). Convert each estimated dose to appropriate inhaled dose using the dose conversion table 
Insulin lispro
 Individualized dosing by SC injection or continuous SC pump infusion or IV 
Short-Acting Insulin
Insulin regular
(Neutral solution human monocomponent insulin/
Regular human insulin) 		Individualized dosing
Usual dose (total daily dose):
Type 1 DM (maintenance):
0.5-1 IU/kg/day SC
Type 2 DM: 0.3-0.6 IU/kg/day SC
Intermediate-Acting Insulin
Insulin NPH/Isophane (Human insulin isophane/Neutral isophane of human monocomponent insulin)
Individualized dosing by SC injection
Usual dose: 0.3-1 IU/kg/day SC 24 hourly
May increase dose as needed  		 Adverse Reactions
  • Most common: Hypoglycemia
    • Dependent on the type and preparation used
    • Usually secondary to high insulin dose, increased physical activity or omission of a meal
    • Symptoms may include hunger, pallor, sweating, palpitation, anxiety, headache, visual disturbance; if untreated may lead to convulsion and coma
  • GI effects (weight gain, nausea); CNS effects (transient blurred vision, headache, fatigue); CV effects (transient peripheral edema, pallor, tachycardia); Dermatologic effects (pruritus, rash, urticaria); Local effects (injection site reaction, lipoatrophy/lipohypertrophy); Hypersensitivity reactions
Special Instructions
  • Dose should be increased during infection, stress, trauma, puberty
  • Dose should be decreased in patients with renal or hepatic impairment
  • Avoid inadvertent change of insulin from 1 dosage type to another
  • Monitor blood or urine glucose levels urine ketones
  • Dose of short-acting insulin should be taken before each meal
  • Intermediate-acting insulin should be taken at bedtime
  • Injection site should be rotated regularly to avoid lipodystrophy

Long-Acting Insulins
Insulin degludec
 Individualized dosing
Usual starting dose:
10 units SC 24 hourly or
0.1-0.2 unit/kg SC 24 hourly at the same time daily
Insulin detemir 
Insulin glargine
Combination Insulins
Insulin aspart 30%/
Insulin aspart protamine 70%  		 Individualized dosing by SC injection
Usual starting dose: 6 units at breakfast and 6 units at dinner or 12 units 24 hourly then switch to 12 hourly dosing when 30 units is reached  
Insulin aspart 50%/
Insulin aspart protamine 50% 		 Individualized dosing by SC injection
Insulin aspart 30%/
Insulin degludec 70%
 Individualized dosing by SC injection
Usual starting dose:
Type 1 DM: 60-70% of the total daily insulin requirements
Type 2 DM: 10 units 24 hourly with main meal
Insulin lispro 25%/
Insulin lispro protamine 75%  		 Individualized dosing by SC injection 
Insulin lispro 50%/
Insulin lispro protamine 50%
Individualized dosing by SC injection 
Insulin regular 30%/
Insulin NPH 70%
Individualized dosing by SC, IM or IV injection
Usual dose: 0.5-1 unit/kg SC 24 hourly 30 minutes before meals  
Insulin regular 50%/
Insulin NPH 50%  		 Individualized dosing by SC injection

Antidiabetic Agents


Drug Dosage Remarks
Alpha-Glucosidase Inhibitors
Acarbose Initial dose: 50 mg PO 8 hourly
May be increased up to 100 mg PO 8 hourly if necessary
Max dose: 200 mg PO 8 hourly 		Adverse Reactions
  • GI effects (diarrhea, abdominal pain, flatulence); Hepatic effect (reversible increase in transaminases)
  • Rarely, can cause skin reactions or edema
  • Hypoglycemia may occur if given with sulfonylureas or insulin but may be reversed by giving rapid-acting glucose or glucagon
Special Instructions
  • Should be taken with meals
  • Contraindicated in patients with DKA, cirrhosis, inflammatory bowel disease (IBD), colonic ulceration, partial intestinal obstruction, chronic intestinal diseases, hepatic impairment
  • Use with caution in patients with renal impairment
  • Monitor liver enzymes during the first 6-12 months of high-dose therapy
Voglibose 0.2 mg PO 8 hourly
May be increased up to 0.3 mg PO 8 hourly
Biguanide
Metformin Initial dose: 500 mg PO 8-12 hourly
or 850 mg PO 8-12 hourly or 1 g PO 24 hourly
Maintenance dose: 1-1.5 g PO/day
Max dose: 2-3 g/day in divided doses

Extended-release:
Initial dose: 500 mg or 750 mg PO 24 hourly
or
2 g PO 24 hourly (with evening meals)
Max dose: 2-2.5 g/day in divided doses
Adverse Reactions
  • GI effects (anorexia, nausea/vomiting, diarrhea, taste disturbance, impaired absorption of vitamin B12); Neuromuscular effect (weakness); Hematologic effect (megaloblastic anemia); Hepatic effect (reversible cholestatic hepatitis); Hypersensitivity reactions
  • Rarely can cause skin reactions, lactic acidosis, acute pancreatitis
  • Hypoglycemia may occur in the presence of other contributing factors or drugs
Special Instructions
  • Avoid use in patients with hepatic impairment, acute HF, severe infections or illnesses, recent myocardial infarction, shock, excessive alcohol intake, severe renal impairment
    • Reduce dosage if eGFR <45 mL/min/1.73 m2; discontinue if eGFR <30 mL/min/1.73 m2
    • May increase the risk for lactic acidosis
  • Discontinue temporarily in patients who will undergo radiologic studies that will use intravascular iodinated contrast media
  • Monitor vitamin B12 concentrations yearly
  • Dose of up to 3 g/day may cause adverse GI effects thus for doses >2 g/day, it is recommended to be given in divided doses with meals for better tolerance, though some individuals also better tolerate doses ≤2 g/day when given in divided doses
Dipeptidyl Peptidase-4 (DPP-4) Inhibitors
 Alogliptin  25 mg PO 24 hourly Adverse Reactions
  • CNS effect (headache); GI effects (diarrhea, nausea, dyspepsia); Respiratory effects (upper respiratory tract infection, nasopharyngitis); Dermatologic effects (rash, urticaria, cutaneous vasculitis); Other effect (arthralgia)
  • Rarely can cause increase in liver enzyme, pancreatitis or hypersensitivity reactions (eg anaphylaxis, Stevens-Johnson syndrome)
  • Hypoglycemia may occur if given with Insulin or other oral antidiabetics (eg sulfonylureas)
  • Saxagliptin may have a risk for hospitalization due to HF
Special Instructions
  • Should not be used in patients with type 1 DM or diabetic ketoacidosis and medullary thyroid carcinoma
  • Alogliptin, Saxagliptin and Vildagliptin should be used with caution in patients with moderate to severe heart failure
  • Evogliptin and Trelagliptin should be used with caution in patients suspected of or with medical history of pancreatitis, hepatic impairment, patients requiring hemodialysis
  • Evogliptin and Gemigliptin are not recommended in patients with NYHA class II-IV heart failure
  • Vildagliptin should not be used in patients with hepatic impairment; LFT should be done prior to and every 3 months in the first year of therapy
  • Dose should be decreased in patients with renal impairment
    • No dose adjustment is needed for Gemigliptin, Linagliptin and Teneligliptin
 Evogliptin As monotherapy or combination therapy:
5 mg PO 24 hourly
Max dose: 5 mg/day
 Gemigliptin As monotherapy or in combination with Metformin or Metformin and sulfonylurea:
50 mg PO 24 hourly
 Linagliptin As monotherapy or in combination with Metformin, sulfonylurea, Insulin or thiazolidinediones:
5 mg PO 24 hourly
Saxagliptin 2.5-5 mg PO 24 hourly
Sitagliptin As monotherapy or in combination with Metformin, sulfonylurea, Insulin or thiazolidinediones:
100 mg PO 24 hourly  
Teneligliptin
 As monotherapy or in combination with other oral hypoglycemic agents and Insulin:
20 mg PO 24 hourly
Max dose: 40 mg/day
Trelagliptin
 100 mg PO weekly
Vildagliptin  As monotherapy or in combination with Metformin, Insulin or thiazolidinediones:
50 mg PO 12-24 hourly
In combination with sulfonylurea:
50 mg PO in the morning
Triple combination with Metformin and sulfonylurea: 50 mg PO 12 hourly or
100 mg PO 24 hourly
Max dose: 100 mg/day
Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists
Dulaglutide
Monotherapy: 0.75 mg SC once weekly
Add-on therapy: 1.5 mg SC once weekly
Patients ≥75 years: Initially 0.75 mg SC once weekly  		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, dyspepsia, gastroesophageal reflux, acute pancreatitis); CNS effects (nervousness, dizziness, headache); Other effects (asthenia, rash, hypersensitivity reactions)
  • Liraglutide has been reported to cause increase in blood calcitonin, goiter, thyroid neoplasms in animals
  • Hypoglycemia does not occur with monotherapy
Special Instructions
  • Avoid use in patients with type 1 DM or DKA, severe renal impairment, ESRD (CKD stages 4 and 5), gastroparesis
  • Contraindicated in patients with history or family history of medullary thyroid cancer and in patients with multiple endocrine neoplasia syndrome 2
  • Use with caution in patients with history of pancreatitis
  • Lixisenatide is given within the hour before the first meal of the day or the evening meal
  • Exenatide should be used with caution in patients with moderate renal impairment
  • Take oral Semaglutide at least 30 minutes before the first food, drink or medication of the day
  • Take one 14 mg tab to achieve the 14 mg dose of Semaglutide; taking two 7 mg tab to reach the 14 mg dose is not recommended
Exenatide  Initial dose: 5 mcg/dose SC 12 hourly for at least 1 month
May increase up to 10 mcg 12 hourly
Prolonged-release:
2 mg SC once weekly  
Liraglutide
 Initial dose: 0.6 mg SC 24 hourly
May increase dose to 1.2 mg after at least 1 week
Max dose: 1.8 mg/day  
Lixisenatide Initial dose: 10 mcg SC 24 hourly for 14 days
Maintenance dose (starts at day 15): 20 mcg SC 24 hourly  
Semaglutide
 Initial dose: 3 mg PO 24 hourly for 1 month
Maintenance dose: Increased to 7 mg PO 24 hourly for at least 1 month
May be increased to 14 mg PO 24 hourly
Max dose: 14 mg/day single dose or
Initial dose: 0.25 mg SC once weekly for 4 weeks then increase to 0.5 mg SC once weekly for at least 4 weeks
Max dose: 1 mg SC/week
GLP-1 Receptor & Glucose-dependent Insulinotropic Polypeptide (GIP) Receptor Agonist
Tirzepatide
Initial dose: 2.5 mg SC once weekly
After 4 weeks, increase to 5 mg SC once weekly
May increase dose in 2.5 mg increments after at least 4 weeks on the current dose if additional glycemic control is needed
Max dose: 15 mg SC once weekly 		 Adverse Reactions
  • GI effects (nausea/vomiting, constipation, diarrhea, decreased appetite, dyspepsia, abdominal pain)
Special Instructions
  • Administer at any time of the day once weekly, with or without meals
  • Avoid use in patients with type 1 DM or severe GI disease
  • Contraindicated in patients with personal or family history of medullary thyroid cancer and in patients with multiple endocrine neoplasia syndrome 2
  • Use with caution in patients with history of renal impairment, gallbladder disease or diabetic retinopathy
  • Discontinue immediately if pancreatitis or hypersensitivity reactions are suspected
Meglitinides
Mitiglinide
 10 mg PO 8 hourly
Adverse Reactions
  • GI effects (abdominal pain, diarrhea, nausea/vomiting)
  • Rarely can cause hypersensitivity reactions, increase in liver enzymes, severe hepatic dysfunction, transient visual disturbance
  • Hypoglycemia may occur in the presence of other contributing factors or drugs
Special Instructions
  • Combination of Repaglinide and Isophane insulin is not recommended as it has been reported to cause myocardial ischemia in controlled clinical trials
  • Avoid use in patients with type 1 DM
  • Contraindicated in patients with ketoacidosis, severe infections, trauma
  • Repaglinide should be used with caution in patients with hepatic impairment; should be avoided in patients with severe impairment
Nateglinide  60-120 mg PO 8 hourly before each main meal
Patients near HbA1c treatment goals:
60 mg PO 8 hourly
Repaglinide
 Initial dose: 0.5 mg PO before each main meal
Initial dose for patients switched from other antidiabetic agents:
1 mg PO before each main meal
Max dose: 4 mg/dose or 16 mg/day  
Monoclonal Antibody
 Teplizumab
(Teplizumab-mzwv) 		Delay onset of symptomatic disease (stage 3) of type 1 DM:
Day 1: 65 mcg/m2 IV 24 hourly
Day 2: 125 mcg/m2 IV 24 hourly
Day 3: 250 mcg/m2 IV 24 hourly
Day 4: 500 mcg/m2 IV 24 hourly
Day 5-14: 1,030 mcg/m2 IV 24 hourly 		 Adverse Reactions
  • Cytokine release syndrome; Hypersensitivity reactions (urticaria, rash, serum sickness); Hematologic effects (leukopenia, lymphocytopenia, neutropenia); Other effects (rashes, headache, diarrhea, nausea, infections)
Special Instructions
  • Premedicate with nonsteroidal anti-inflammatory drugs (NSAIDs) or Paracetamol, antihistamine and/or antiemetic prior to infusion for at least the first 5 days of treatment
  • Monitor ALT and AST during treatment
  • In case of missed dose, administer remaining doses on consecutive days to complete 14-day treatment course
  • Do not administer 2 doses on the same day
Sodium-Glucose Linked Transporter/Co-transporter 2 (SGLT2) Inhibitors
Bexagliflozin
 20 mg PO 24 hourly before breakfast   Adverse Reactions
  • GU effects (polyuria, dysuria, vulvovaginitis, balanitis, increased susceptibility to infections); Renal effect (acute kidney injury); Hematologic effect (increased hematocrit); GI effects (nausea, constipation); CV effects (hypotension, decreased blood volume); Other effects (dyslipidemia, increased creatinine and urea levels, hypoglycemia, rash, hyperhidrosis, back pain, euglycemic diabetic ketoacidosis)
  • Electrolyte disturbances (hyperphosphatemia, hypermagnesemia, hyperkalemia)
Special Instructions
  • Monitor kidney function prior to starting therapy and assess periodically during therapy
  • Use with caution in patients taking diuretics, NSAIDs and those with decreased blood volume and congestive HF
  • May need to lower doses of insulin, sulfonylurea, insulin secretagogues when used concomitantly with SGLT2 inhibitors
  • Should not be given in patients with severe renal impairment
    • Canagliflozin can be started in patients with eGFR 45 to <60 mL/min/1.73 m2
    • Dapagliflozin and Empagliflozin treatment can be initiated in patients with eGFR ≥60 mL/min/1.73 m²
    • Bexagliflozin can be initiated in patients with eGFR ≥30 mL/min/1.73 m2
    • Bexagliflozin is contraindicated in patients on dialysis
  • Current evidence suggests that patients initiated on SGLT2 inhibitor at eGFR levels of ≥20 mL/min/1.73 m², the therapy can be continued until kidney replacement therapy is initiated
  • Consider withholding SGLT2 inhibitors in events that may precipitate diabetic ketoacidosis, eg intercurrent illness, surgery (elective or emergency), trauma, severe carbohydrate restriction
  • SGLT2 inhibitors are generally safe for patients with diabetes during Ramadan but should be discontinued in select patients whose risk for adverse effects might be increased
Canagliflozin
 100 mg PO 24 hourly before breakfast
Max dose: 300 mg/day
Dapagliflozin  10 mg PO 24 hourly  
Empagliflozin
 10 mg PO 24 hourly
Max dose: 25 mg/day
Ertugliflozin
 5 mg PO 24 hourly
May increase to 15 mg PO 24 hourly if additional glycemic control is needed
Max dose: 15 mg/day  
Luseogliflozin  2.5 mg PO 24 hourly
May increase to 5 mg PO 24 hourly  
Sulfonylureas
Chlorpropamide  Initial dose: 250 mg PO 24 hourly for 5-7 days
Dose may be adjusted by 50-125
mg/day with 3-5 days interval
Max maintenance dose: 750 mg/day
Adverse Reactions
  • Dose-dependent GI effects (nausea/vomiting, heartburn, anorexia, diarrhea, metallic taste, increased appetite); Dermatologic effects (rashes, pruritus); Other effects (hypersensitivity reactions, photosensitivity, thrombocytopenia, hepatic reactions)
  • Hypoglycemia is more likely with long-acting sulfonylureas (eg Chlorpropamide, Glibenclamide)
  • Occasionally, Chlorpropamide induce a syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
    • Patients taking Chlorpropamide may also experience facial flushing when alcohol is consumed
  • Glibenclamide, Glipizide, Tolazamide may have mild diuretic actions
Special Instructions
  • Avoid use in patients with type 1 DM, porphyria
  • Contraindicated in patients with ketoacidosis, severe infection, trauma
  • Use with caution in patients with renal or hepatic impairment, adrenal or pituitary insufficiency, glucose-6-phosphate dehydrogenase (G6PD) deficiency, malnourished patients
    • If sulfonylurea is needed to be used in at-risk patients, short-acting drugs may be preferred (eg Glipizide, Tolbutamide, Gliclazide)
Glibenclamide
(Glyburide)  		 Initial dose: 2.5-5 mg PO 24 hourly
May be increased in increments of
2.5 mg/day with 1 week interval
Max dose: 20 mg/day 
Gliclazide  Initial dose: 40-80 mg PO 12-24 hourly
May be increased up to max dose with at least 2 weeks interval
Max dose: 160 mg/dose or 320 
mg/day
Extended-release:
Initial dose: 30 mg PO 24 hourly
May be increased up to max dose with at least 2-4 weeks interval
Max dose: 120 mg/day 
Glimepiride
 Initial dose: 1 mg PO 24 hourly
May be increased in increments of 1 mg with 1-2 week interval
Maintenance dose: 1-4 mg/day
Max dose: 6-8 mg/day
Glipizide Initial dose: 2.5-5 mg PO 24 hourly
Adjust dose in increments of 2.5-5 mg with several days interval
Doses >15 mg/day should be divided 12 hourly
Max dose:
40 mg/day (regular-release) or 20 mg/day (extended-release)
Gliquidone   Initial dose: 15 mg PO 24 hourly
May be increased up to 45-60 mg/day divided 8-12 hourly
Max dose: 60 mg/dose or 120 mg/day 
Tolazamide
 Initial dose: 100-250 mg PO 24 hourly
May be increased in increments of 100-250 mg weekly if necessary
Maintenance dose: 250-500 mg/day
Max dose: 1,000 mg/day
Tolbutamide
 Initial dose: 1-2 g PO as single dose or in divided doses
Maintenance dose: 0.25-3 g/day PO
Max dose: 3 g/day
Thiazolidinediones
Pioglitazone
 Initial dose: 15-30 mg PO 24 hourly
May be increased up to max dose by increments based on patient’s response
Max dose: 45 mg/day
 Adverse Reactions
  • GI effects (increased appetite, GI disturbance); CV effects (fluid retention, worsen/precipitate HF); CNS effects (headache, dizziness); Neuromuscular effects (muscle cramps, back pain, arthralgia); Skeletal effects (decreased bone mineral density, increased fracture risk in female patients); Dermatologic effect (alopecia); Hepatic effects (hepatotoxicity, changes in liver enzymes)
  • Rosiglitazone may cause hypertriglyceridemia and mild-moderate hypercholesterolemia
  • Pioglitazone may cause upper respiratory tract infections, hematuria, visual disturbances; reduces TG, increases HDL-C and little or no effect on LDL-C and total cholesterol, studies show increase in bladder cancer risk
  • Rarely can cause anaphylactic reactions, angioedema, skin reactions
  • Hypoglycemia may occur if given with sulfonylureas or insulin
Special Instructions
  • Should not be used in patients with type 1 DM or DKA
  • Contraindicated in patients with history of HF
  • Rosiglitazone is contraindicated in patients with acute coronary event, ischemic heart disease, PAD, aminotransferase concentration >2.5 times the upper limit of normal
  • Pioglitazone should not be used in patients with bladder cancer
  • Use with caution in patients with edema, mild hepatic impairment
  • Monitor LFT periodically
Rosiglitazone  Initial dose: 4 mg PO 24 hourly or divided 12 hourly
May be increased up to 8 mg PO 24 hourly or divided 12 hourly after 8-12 weeks
Other Blood Glucose Lowering Drugs
Benfluorex  150 mg PO 8 hourly   Adverse Reactions
  • GI effects (nausea, loose stools, epigastric discomfort); Other effects (drowsiness, asthenia, dizziness)
Special Instructions
  • Should be taken with meals
  • Contraindicated in patients with chronic pancreatitis
Bromocriptine
 0.8 mg PO 24 hourly
May increase as tolerated at weekly intervals in 0.8 mg increments
Max dose: 4.8 mg/day 		 Adverse Reactions
  • GI effects (constipation, nausea/vomiting, dyspepsia); CNS effects (headache, fatigue, dizziness, weakness, somnolence); CV effects (hypotension, syncope, digital vasospasm); Metabolic effect (hypoglycemia); Respiratory effects (flu-like symptoms, rhinitis); Ophthalmologic effect (amblyopia)
Special Instructions
  • To be taken in the morning within 2 hours of waking
  • Avoid use in patients with syncopal migraine, breastfeeding
  • Use with caution in patients with CV disease, dementia, psychosis, hepatic impairment, peptic ulcer disease
Colesevelam  3.75 g PO 24 hourly or
1.875 g PO 12 hourly
Max dose: 4.375 g/day  		 Adverse Reactions
  • GI effects (constipation, nausea/vomiting, dyspepsia); CNS effects (headache, fatigue, myalgia); CV effects (hypertension, bradycardia); Metabolic effects (hypertriglyceridemia, hypoglycemia); Respiratory effects (flu-like symptoms, URTI)
Special Instructions
  • Take with meals
  • Avoid use in patients with history of hypertriglyceridemia-induced pancreatitis, TG level >500 mg/dL, history of bowel obstruction
  • Use with caution in patients with TG level >300 mg/dL, patients using insulin, sulfonylureas or thiazolidinediones, patients susceptible to fat-soluble vitamin deficiencies
 Drug Available Dosage 
 Dosage
Combination Products1
Glibenclamide (Glyburide)/ Metformin
 Glibenclamide 1.25 mg/
Metformin 250 mg  		 For patients with inadequate glycemic control with diet and exercise:
1 tab PO 12-24 hourly
Max dose: Glibenclamide 20 mg/Metformin 2,000 mg/day
Glibenclamide 2.5 mg/
Metformin 400 mg		 For patients with inadequate glycemic control with diet and exercise:
1/2 tab PO 24 hourly
Max dose: Glibenclamide 20 mg/Metformin 2,000 mg/day
Glibenclamide 2.5 mg/
Metformin 500 mg
 For previously treated patients: 1 tab PO 12 hourly
May increase dose based on patient’s response
Max dose: Glibenclamide 20 mg/Metformin 2,000 mg/day  
Glibenclamide 5 mg/
Metformin 500 mg
Glibenclamide 5 mg/
Metformin 1,000 mg
Gliclazide/Metformin
 Gliclazide 80 mg/Metformin 500 mg   1-2 tab PO 12-24 hourly
Max dose: Gliclazide 320 mg/Metformin 2,000 mg/day 
Gliclazide 80 mg/Metformin 850 mg  1 tab PO 12 hourly 
Glimepiride/Metformin
 Glimepiride 1 mg/Metformin 250 mg 1 tab PO 12-24 hourly
Max dose: Glimepiride 8 mg/Metformin 2,000 mg/day
Glimepiride 1 mg/Metformin 500 mg
Glimepiride 2 mg/Metformin 500 mg
Glimepiride/Pioglitazone  Glimepiride 2 mg/Pioglitazone 15 mg
 Patients currently on Glimepiride or Pioglitazone monotherapy:
Glimepiride 2 mg/Pioglitazone 15 mg PO 24 hourly
Usual dose: Glimepiride 2 mg/Pioglitazone 30 mg PO 24 hourly
Max dose: Glimepiride 8 mg/Pioglitazone 45 mg 
Glimepiride 2 mg/Pioglitazone 30 mg
Glimepiride 4 mg/Pioglitazone 30 mg
Glipizide/Metformin  Glipizide 2.5 mg/Metformin 250 mg   For patients with inadequate glycemic control with diet and exercise:
1 tab PO 24 hourly  
Glipizide 2.5 mg/Metformin 500 mg  Patients with FPG 280-320 mg/dL:
Glipizide 2.5 mg/Metformin 500 mg PO 12 hourly
Max dose: Glipizide 10 mg/Metformin 2,000 mg/day
Patients inadequately controlled with sulfonylurea and/or Metformin:
1 tab PO 12 hourly
Max dose: Glipizide 20 mg/Metformin 2,000 mg/day
Glipizide 5 mg/Metformin 500 mg
Pioglitazone/Metformin
 Pioglitazone 15 mg/Metformin 500 mg  Pioglitazone 15 mg/Metformin 500 mg PO 12 hourly
Pioglitazone 15 mg/Metformin 850 mg PO 12-24 hourly
Dose may be titrated based on patient’s response
Max dose: Pioglitazone 45 mg/Metformin 2,550 mg/day
Pioglitazone 15 mg/Metformin 850 mg  
Pioglitazone 15 mg/Metformin (extended-release) 1,000 mg
 Pioglitazone 15 mg/Metformin 1,000 mg PO 12-24 hourly
Pioglitazone 30 mg/Metformin 1,000 mg PO 24 hourly
Dose may be titrated based on patient's response
Max dose: Pioglitazone 45 mg/Metformin 2,000 mg/day
Pioglitazone 30 mg/Metformin (extended-release) 1,000 mg
Rosiglitazone/Metformin
 Rosiglitazone 1 mg/Metformin 500 mg
 Individualized dosing
Initial therapy: Rosiglitazone 2 mg/Metformin 500 mg PO 12-24 hourly
May increase by increments of Rosiglitazone 2 mg/Metformin 500 mg/day
Patients not adequately controlled with Metformin monotherapy: Rosiglitazone 4 mg (total daily dose) plus the dose of Metformin already being taken
Patients not adequately controlled with Rosiglitazone monotherapy:
Metformin 1,000 mg (total daily dose) plus the dose of Rosiglitazone already being taken
Additional glycemic control: Daily dose may be increased by increments of Rosiglitazone 4 mg/ Metformin 500 mg up to max dose
Max dose: Rosiglitazone 8 mg/Metformin2,000 mg/day
Rosiglitazone 2 mg/Metformin 500 mg  
Rosiglitazone 2 mg/Metformin 1,000 mg
Rosiglitazone 4 mg/Metformin 500 mg 
Rosiglitazone 4 mg/Metformin 1,000 mg  
Alogliptin/Pioglitazone
 Alogliptin 25 mg/Pioglitazone 15 mg
1 tab PO 24 hourly
Max dose: Alogliptin 25 mg/Pioglitazone 45 mg/day
Alogliptin 25 mg/Pioglitazone 30 mg
Alogliptin/Metformin  Alogliptin 12.5 mg/Metformin 500 mg

Initial therapy: Should be based on current dose of Alogliptin and Metformin given PO 12 hourly
Max dose: Alogliptin 25 mg/Metformin 2,000 mg 24 hourly
Patients not adequately controlled with Metformin monotherapy:
Alogliptin 25 mg 24 hourly plus the dose of Metformin already being taken in 2 equally divided doses

Alogliptin 12.5 mg/Metformin 850 mg 
Alogliptin 12.5 mg/Metformin 1,000 mg
Gemigliptin/Dapagliflozin
 Gemigliptin 50 mg/Dapagliflozin 10 mg
1 tab PO 24 hourly
Gemigliptin/Metformin
 Gemigliptin 50 mg/Metformin 500 mg
1 tab PO 24 hourly preferably in the evening
Gemigliptin 50 mg/Metformin 1,000 mg
Linagliptin/Metformin
 Linagliptin 2.5 mg/Metformin 500 mg Individualized dosing
Initial therapy: Linagliptin 2.5 mg/Metformin 500 mg PO 12 hourly
Patients currently on Metformin: Linagliptin 2.5 mg plus current Metformin dose 12 hourly with meals
Patients currently on both Metformin and Linagliptin: Take same dose equivalent of each component
Max dose: Linagliptin 2.5 mg/Metformin 1,000 mg PO 12 hourly
Linagliptin 2.5 mg/Metformin 850 mg
Linagliptin 2.5 mg/Metformin 1,000 mg
Saxagliptin/Metformin
(extended-release)  		 Saxagliptin 2.5 mg/Metformin (extended-release) 1,000 mg
Individualized dosing
Max daily dose: Saxagliptin 5 mg and Metformin 2,000 mg extended-release
Recommended starting dose in patients who need Saxagliptin 5 mg and who are not currently treated with Metformin:
Saxagliptin 5 mg/Metformin 500 mg extended-release (with gradual dose escalation)
Patients not adequately controlled on maximal tolerated dose of Metformin monotherapy:
Saxagliptin 5 mg plus the dose of Metformin already being taken
Patients switching from separate tablets of Saxagliptin and Metformin: Should receive the doses of Saxagliptin and Metformin already being taken
Saxagliptin 5 mg/Metformin
(extended-release) 500 mg  
Saxagliptin 5 mg/Metformin
(extended-release) 1,000 mg  
Sitagliptin/Metformin  Sitagliptin 50 mg/Metformin 500 mg   Individualized dosing
Initial therapy: Sitagliptin 50 mg/Metformin 500 mg PO 12 hourly
May be increased to Sitagliptin 50 mg/Metformin 1,000 mg PO 12 hourly
Patients not adequately controlled with Sitagliptin monotherapy:
Sitagliptin 50 mg/Metformin 500 mg PO 12 hourly
May increase dose up to Sitagliptin 50 mg/Metformin 1,000 mg PO 12 hourly
Patients not adequately controlled with Metformin monotherapy:
Sitagliptin 50 mg 12 hourly plus the dose of Metformin already being taken
Patients switching from coadministration of Sitagliptin/Metformin:
May be initiated at the dose of Sitagliptin/Metformin already being taken
Max dose: Sitagliptin 100 mg/Metformin 2,000 mg/day
Sitagliptin 50 mg/Metformin 850 mg
Sitagliptin 50 mg/Metformin 1,000 mg  
Sitagliptin/Metformin
(extended-release)
Sitagliptin 50 mg/Metformin
(extended-release) 500 mg
Individualized dosing
Initial therapy: Sitagliptin 100 mg/Metformin 1,000 mg PO 24 hourly
May be increased to Sitagliptin 100 mg/Metformin 2,000 mg PO 24 hourly
Patients not adequately controlled with Sitagliptin monotherapy:
Sitagliptin 100 mg/Metformin 1,000 mg PO 24 hourly
May increase Metformin dose as needed
Patients not adequately controlled with Metformin monotherapy:
Sitagliptin 100 mg PO 24 hourly plus the dose of Metformin already being taken
Patients switching from coadministration of Sitagliptin/Metformin:
May be initiated at the previously prescribed dose of Sitagliptin/Metformin
Max dose: Sitagliptin 100 mg/Metformin 2,000 mg/day
Sitagliptin 50 mg/Metformin
(extended-release) 1,000 mg  
Sitagliptin 100 mg/Metformin (extended-release) 1,000 mg
Teneligliptin/Pioglitazone
 Teneligliptin 20mg/Pioglitazone 15 mg
  1 tab PO 24 hourly
Tenegliptin 20 mg/ Pioglitazone 30 mg
Vildagliptin/Metformin
 Vildagliptin 50 mg/Metformin 500 mg
Treatment-naive patients: May start with 50 mg/500 mg PO 24 hourly; may gradually increase to max dose of 50 mg/1,000 mg PO 12 hourly
Patients not adequately controlled with Vildagliptin monotherapy: Vildagliptin 50 mg/Metformin 500 mg PO 12 hourly or Vildagliptin 50 mg/Metformin 850 mg PO 12 hourly
Patients not adequately controlled with Metformin monotherapy:
1 tab PO 12 hourly
Max dose: Vildagliptin 100 mg/day in divided doses
Vildagliptin 50 mg/Metformin 850 mg
Vildagliptin 50 mg/Metformin 1,000 mg
Dapagliflozin/Metformin (extended-release)
Dapagliflozin 5 mg/Metformin (extended-release) 500 mg
 Individualized dosing
Starting dose: Dapagliflozin 10 mg/Metformin 500 mg PO 24 hourly
Max dose: Dapagliflozin 10 mg/Metformin 2,000 mg/day
Dapagliflozin 5 mg/Metformin (extended-release) 1,000 mg 
Dapagliflozin 10 mg/ Metformin (extended-release) 500 mg 
Dapagliflozin 10 mg/ Metformin (extended-release) 1,000 mg
Dapagliflozin/Saxagliptin
 Dapagliflozin 10 mg/ Saxagliptin 5 mg  Starting dose: Dapagliflozin 10 mg/Saxagliptin 5 mg PO 24 hourly
Dapagliflozin/Saxagliptin/ Metformin (extended-release)  Dapagliflozin 2.5 mg/ Saxagliptin 2.5 mg/Metformin (extended-release) 1,000 mg
 Individualized initial dosing
Initiation is intended only for patients currently on Metformin
Patients not currently taking Dapagliflozin:
Dapagliflozin 5 mg/Saxagliptin 5 mg/Metformin 1,000-2,000 mg PO 24 hourly Max dose: Dapagliflozin 10 mg/Saxagliptin 5 mg/Metformin 2,000 mg/day  
Dapagliflozin 5 mg/Saxagliptin 2.5 mg/Metformin (extended-release) 1,000 mg
Dapagliflozin 5 mg/Saxagliptin 5 mg/Metformin (extended-release) 1,000 mg
Dapagliflozin 10 mg/ Saxagliptin 5 mg/Metformin (extended-release) 1,000 mg
Empagliflozin/Metformin
 Empagliflozin 5 mg/Metformin 500 mg 
1 tab PO 12 hourly
Patients not adequately controlled with Metformin 12 hourly dosing alone or in combination with other products including Insulin:
Initially Empagliflozin 5 mg 12 hourly plus the dose of Metformin already being taken
Patients tolerating a total daily dose of Empagliflozin 10 mg: May increase dose to a total daily dose of Empagliflozin 25 mg
Max dose: Empagliflozin 25 mg/Metformin 2,000 mg/day
Empagliflozin 5 mg/Metformin 850 mg
Empagliflozin 5 mg/Metformin 1,000 mg
Empagliflozin 12.5 mg/Metformin 500 mg
Empagliflozin 12.5 mg/Metformin 850 mg 
Empagliflozin 12.5 mg/ Metformin 1,000 mg 
Empagliflozin/Linagliptin
Empagliflozin 10 mg/Linagliptin 5 mg
 Starting dose: Empagliflozin 10 mg/Linagliptin 5 mg PO 24 hourly in the morning
Max dose: Empagliflozin 25 mg/Linagliptin 5 mg PO 24 hourly
Empagliflozin 25 mg/Linagliptin 5 mg
Empagliflozin/Linagliptin/ Metformin (extended-release)   Empagliflozin 5 mg/Linagliptin 2.5 mg/ Metformin (extended-release) 1,000 mg  1 tab PO 24 hourly in the morning
Individualized initial dosing
Patients not on Empagliflozin and currently taking Metformin with or without Linagliptin:
Empagliflozin 10 mg/day and Linagliptin 5 mg/day plus a similar total daily dose of Metformin
Patients currently taking Empagliflozin and Metformin with or without Linagliptin:
Linagliptin 5 mg/day plus similar total daily dose of Empagliflozin and Metformin
Max dose: Empagliflozin 25 mg/Linagliptin 5 mg/Metformin 2,000 mg/day
Empagliflozin 10 mg/Linagliptin 5 mg/ Metformin (extended-release) 1,000 mg 
Empagliflozin 12.5 mg/Linagliptin 2.5 mg/Metformin (extended-release) 1,000 mg 
Empagliflozin 25 mg/Linagliptin 5 mg/ Metformin (extended-release) 1,000 mg 
Ertugliflozin/Metformin
 Ertugliflozin 2.5 mg/Metformin 500 mg  1 tab PO 12 hourly
Individualized initial dosing
Patients currently taking Metformin and starting Ertugliflozin:
Ertugliflozin 5 mg/day plus a similar total daily dose of Metformin, administered in 2 divided doses
Patients currently taking Ertugliflozin and starting Metformin:
Metformin 1,000 mg/day plus a similar total daily dose of Ertugliflozin, administered in 2 divided doses
Max dose: Ertugliflozin 15 mg/Metformin 2,000 mg/day
Ertugliflozin 2.5 mg/Metformin 1,000 mg 
Ertugliflozin 7.5 mg/Metformin 500 mg
Ertugliflozin 7.5 mg/Metformin 1,000 mg
Ertugliflozin/Sitagliptin
 Ertugliflozin 5 mg/Sitagliptin 100 mg
 Ertugliflozin 5 mg/Sitagliptin 100 mg PO 24 hourly taken in the morning
May increase dose up to
Max dose: Ertugliflozin 15 mg/Sitagliptin 100 mg PO 24 hourly
Ertugliflozin 15 mg/Sitagliptin 100 mg 
Metformin/Pioglitazone/ Glimepiride
 Metformin 500 mg/Pioglitazone 15 mg/ Glimepiride 2 mg Individualized dosing
1 tab PO 24 hourly 
Insulins & Analogs1
Insulin degludec/Liraglutide
 Per mL: Insulin degludec 100 units/Liraglutide 3.6 mg   Add-on to oral glucose-lowering drugs: Insulin degludec 10 units/Liraglutide 0.36 mg SC 24 hourly at the same time each day
Transfer from GLP-1 inhibitor or basal insulin: Insulin degludec 16 units/Liraglutide 0.58 mg SC 24 hourly at the same time each day
Max dose: Insulin degludec 50 units/Liraglutide 1.8 mg/day
Insulin glargine/Lixisenatide
 Per mL: Insulin glargine 100 units/Lixisenatide 33 mcg
 Insulin-naive patients: Insulin glargine 10 units/ Lixisenatide 5 mcg SC 24 hourly
Patients currently on ≥20 to <30 units of Insulin glargine: Insulin glargine 20 units/Lixisenatide 10 mcg SC 24 hourly
Patients currently on 30 to 60 units of Insulin glargine: Insulin glargine 30 units/Lixisenatide 10 mcg SC 24 hourly
All doses given within an hour before first meal of the day
Max dose: Insulin glargine 60 units/Lixisenatide 20 mcg/day 
Per mL: Insulin glargine 100 units/Lixisenatide 50 mcg 
1For adverse reactions and special instructions, see remarks section of each individual drug component.

Other Dermatologicals

Drug for Diabetic Foot1
Drug Dosage Remarks
Recombinant human epidermal growth factor Apply gel on the ulcer area 12 hourly x 15-20 weeks
 Special Instructions
  • Avoid use in immunocompromised patients and in patients with known hypersensitivity to its components
  • Clean ulcer area prior to application of the medication
1Other drugs for diabetic foot may be available. Refer to a specialist for further management or see Diabetic Foot Infection disease management chart for further information.

Drugs for Neuropathic Pain*

Drugs for Neuropathy (Pathogenetically - Oriented Treatment)

Drug Dosage Remarks
Duloxetine 60 mg PO 24 hourly
Max dose: 120 mg/day in divided doses 		Adverse Reactions
  • GI effects (nausea, dry mouth, constipation, decreased appetite); CNS effects (somnolence, dizziness); Other effects (hyperhidrosis, agitation, fatigue)
Special Instructions
  • Contraindicated in patients with narrow-angle glaucoma, severe renal impairment, patients concomitantly taking MAO inhibitors or within 2 weeks of discontinuing MAO inhibitors
  • Use with caution in patients with seizure disorder, renal and hepatic impairment
Gabapentin Initial dose:
Day 1: 300 mg PO 24 hourly
Day 2: 300 mg PO 12 hourly
Day 3: 300 mg PO 8 hourly
Based on patient response and tolerability, may increase dose in increments of 300 mg/day every 2-3 days up to
Max dose: 3.6 g/day		 Adverse Reactions
  • CNS effects (somnolence, dizziness, ataxia, nystagmus, headache, tremor, diplopia, amblyopia); Other effects (fatigue, nausea/vomiting)
Special Instructions
  • Use with caution in patients with history of psychotic illness, renal impairment
  • Discontinuation and/or addition or substitution of alternative therapy should be gradual over at least 1 week
  • May affect patient’s ability to drive or operate machinery
Mecobalamin 0.5 mg PO 8 hourly or
0.5 mg IM/IV 3x/week		 Adverse Reactions
  • Oral: Loss of appetite, nausea, diarrhea, GI upset
  • Injection: Hypersensitivity reactions, pain, induration at IM sites, headache, sweating
Pregabalin Initial dose: 150 mg PO 24 hourly
May be increased to 300 mg PO 24 hourly after a 3- to 7-day interval
May increase further to max dose after another 7-day interval
Max dose: 600 mg/day		 Adverse Reactions
  • CNS effects (somnolence, dizziness, confusion, euphoric mood, ataxia, attention disturbance, abnormal coordination, memory impairment, tremor, dysarthria, paresthesia, blurred vision, diplopia, vertigo, dry mouth, increased appetite, decreased libido, erectile dysfunction, irritability); GI effects (constipation, vomiting, flatulence); Other effect (fatigue)
Special Instructions
  • Use with caution in patients with galactose intolerance, lactase deficiency or glucose-galactose malabsorption, renal impairment, DM
  • May affect patients ability to drive or operate machinery
Tapentadol  Extended-release: 50 mg PO 12 hourly May increase by 100 mg every 3 days if needed
Max dose: 500 mg/day
 Adverse Reactions
  • CNS effects (dizziness, headache, drowsiness, fatigue, anxiety, insomnia, somnolence, CNS depression, seizures); GI effects (nausea/vomiting, constipation, diarrhea, xerostomia, dyspepsia, decreased appetite, dry mouth); Dermatologic effects (pruritus, hyperhidrosis); CV effects (orthostatic hypotension, syncope)
Special Instructions
  • Contraindicated in patients with respiratory depression, acute or severe asthma, GI obstruction or suspected paralytic ileus
  • Not to be used with or within 14 days of MAO inhibitors
Thioctic acid (α-lipoic acid)
 600 mg PO 24 hourly
or
600 mg slow IV infusion 24 hourly for 2-4 weeks or several times/week
 Adverse Reactions
  • GI effects (nausea/vomiting, stomach and intestinal pain, diarrhea); CNS effects (vertigo, headache); Dermatologic effects (rash, urticaria, itching); Other effects (sweating, visual disturbances)
Special Instructions
  • Should be taken 30 minutes before meals
    • Swallow whole, do not chew or crush
  • Monitor glucose levels in urine and blood regularly
    • May potentiate hypoglycemic effect of Insulin or oral antidiabetics
  • Avoid alcohol intake
*Please see the Diseases Neuropathic Pain and Diabetic Neuropathy for details of painful diabetic neuropathy management.

Vitamin B-Complex/With C*

Drugs for Neuropathy (Pathogenetically - Oriented Treatment)

Drug Dosage Remarks
Benfotiamine 100 mg PO 6 hourly or
Initial dose: 150 mg PO 8-12 hourly for 4-8 weeks
Maintenance dose: 150 mg PO 24 hourly		 Adverse Reactions
  • Rarely, hypersensitivity reactions (skin eruptions, urticaria, anaphylactic reactions)
 
Combination Products
    
Vitamin B1, B6, B12 Initial dose: 1 tab PO 8-12 hourly
Maintenance dose: 1 tab PO 24 hourly or 1 amp IM 24 hourly
Follow-up therapy/milder cases: 2-3 amp/week 		Adverse Reactions
  • GI effects (nausea/vomiting, abdominal pain, diarrhea); Hypersensitivity reactions (sweating, tachycardia, pruritus, urticaria)
Special Instructions
  • Use with caution in patients with allergy to cobalamins, intolerance to thiamine, sugars (ie glucose-galactose malabsorption, Lapp lactase deficiency, sucrose-isomaltase insufficiency)  
*Please see the Diseases Neuropathic Pain and Diabetic Neuropathy for details of painful diabetic neuropathy management.

ACE Inhibitors

Drugs for Diabetic Kidney Disease

Drug Dosage Remarks
Captopril 75-100 mg PO 24 hourly in divided doses
 Adverse Reactions
  • CV effects (hypotension, angioedema); CNS effects (fatigue, headache); GI effect (taste disturbances); Respiratory effects (persistent dry cough, upper respiratory tract symptoms); Dermatologic effects (skin rashes, erythema multiforme, toxic epidermal necrolysis); Hypersensitivity reactions; Renal effect (renal impairment); Electrolyte disturbances (hyperkalemia, hyponatremia); Blood disorders
Special Instructions
  • Patients with HF and those who may be salt or water depleted (taking diuretic or on dialysis) may experience hypotension during initial stages of ACE inhibitor therapy
    • Start treatment only under close medical supervision; in these patients use a low dose and have the patient in a supine position
  • Use with caution in patients with aortic stenosis or outflow tract obstruction
  • Avoid in patients with history of hereditary or idiopathic angioedema
  • Renal function should be assessed prior to administration of ACE inhibitors, during therapy, and over the first few days after initiation
    • Patient with renal disease or taking high doses should be monitored regularly for proteinuria
  • Combination with an ARB is not recommended
Enalapril Initial dose: 2.5-5 mg/day PO in 1-2 divided doses
Titrate slowly up to
Max dose: 40 mg/day
Imidapril
2.5 mg PO 24 hourly
Max dose: 5 mg/day
Lisinopril
 10 mg PO 24 hourly
May be increased to 20 mg PO 24 hourly if necessary
Ramipril
 1.25 mg PO 24 hourly
May be increased to
Maintenance dose: 20 mg PO 24 hourly 

Angiotensin II Antagonists

Drugs for Diabetic Kidney Disease

Drug Dosage Remarks
Irbesartan Initial dose: 150 mg PO 24 hourly Maintenance dose: 300 mg PO 24 hourly
 Adverse Reactions
  • Usually mild and transient: CNS effect (dizziness); CV effect (dose-related orthostatic hypotension which may occur particularly in patients with volume depletion); renal impairment
Special Instructions
  • Patients with volume depletion (eg high-dose diuretic therapy) may experience hypotension and should be started on low dose
  • Avoid concomitant use with Aliskiren
  • Use with caution in patients with renal artery stenosis, renal impairment or hepatic impairment
Losartan Initial dose: 50 mg PO 24 hourly
Maintenance dose: 100 mg PO 24 hourly
Telmisartan
80 mg PO 24 hourly
Valsartan
 80 or 160 mg PO 24 hourly

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women and non-elderly adults with normal renal and hepatic function unless otherwise stated. 
Not all products are available or approved for above use in all countries. 
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs. 
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

Related MIMS Drugs