Antidiabetic agents in patients with hepatic impairment

Table 1 Use of antidiabetic agent according to the degree of hepatic impairment

Antidiabetic agent	Degree of hepatic impairment (HI)
Metformin	Avoid in severe HI
Sulfonylureas
Glimepiride	Avoid in severe HI
Gliclazide	Avoid in severe HI
Glinides
Repaglinide	Avoid in severe HI
Nateglinide	No adjustment of dosage in mild to moderate HI
Alpha-glucosidase inhibitors
Acarbose	Well tolerated
Thiazolidinediones
Pioglitazone	Safe in Child-Pugh Class A patients. Should be avoided in Class B and C patients
DPP-4 inhibitors
Sitagliptin	Well tolerated
Vildagliptin	Well tolerated
Saxagliptin	Well tolerated
Alogliptin	Well tolerated
Linagliptin	Well tolerated
GLP-1 receptor agonists
Exenatide	Well tolerated
Liraglutide	Well tolerated
Lixisenatide	Well tolerated
SGLT-2 inhibitors
Canagliflozin	Safe in Child-Pugh Class A patients. Caution is needed in Class B patients. Should better be avoided in Class C patients
Dapagliflozin	Safe in Child-Pugh Class A patients. Caution is needed in Class B patients. Should better be avoided in Class C patients
Empagliflozin	Safe in Child-Pugh Class A patients. Caution is needed in Class B patients. Should better be avoided in Class C patients
Insulin	Safe in use