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Containdications, Precautions and Interactions of Oral Anti-Diabetic Drugs ( Accordinf to the British National Formulary BNF March 2010) Breast Feeding Renal Imp. Hypoglycemia With Other Antidiabetic Drugs Hepatic Weight Gain Diabetic KA Pregnancy eGFR Sulphonylurea Impairmernt Elderly With Insulin Repaglinide Active 2 Natiglinide ml/min/1.73m Metformin Sitagliptin Acarbose Glitazone Observations & Other Contra-indications Principle Severe Severe Moder. Mod Mild <90 <60 <30 Mild 1- With Insulin weight gain & hypoglycaemia may occur.2- Contraindicated with Iodine -containing X ray contrast media,with General anaesthia NO No Metformin (Suspendon the morning of surgery) and with tisuue hypoxia (dehyderation, severe infection, shock, sepsis. Acute HF, & recent MI ) Flatulance Wight Gain From w 11 1- Can be used from 11 weeks of pregnancy. 2- +++ +++Glibenclamide With Insulin weight gain & hypoglyc. may occur. 3- With Acarbose flatulence can be a problem. Gliclazide + Glipizide + Glimerpride Repaglinide + Natiglinide Nateglinide is licensed only for use with metformin. Contraindicated in :- 1-inflammatory bowel disease. Acarbose 2- pre-disposition to partial intestinal obstruction. 3- - hernia. 4-Previous abdominal surgery 1- Contraindicated in Cardio-vascular disease & history of HF .2- Monitor liver function 3- +++ Pioglitazone Combination with insulin (risk of HF). 4- Increased risk of bone fractures,Femael > Male. Sitagliptin Contraindicated Use with Caution Legand Safe Not Mentioned