In addition to the above mentioned drug classes, there are 2 additional drugs on the market that have been approved for type 2 diabetes. These include bromocriptine, colesevelam and pramlintide.

Pramlintide is an synthetic analog of amylin which is co-secreted from the pancreas with insulin. Amylin acts to slow gastric emptying and decrease food intake thereby reducing insulin demand.

Colesevelam is a bile acid sequestrant which works by increasing bile acid removal from the body. It lowers blood cholesterol through the synthesis of new bile acids.

• BROMOCRIPTINE

  Tradename (s)	Cycloset™
  Company(ies)	VeroScience, LLC
  Available doses	0.8 mg tablet
  Dose per day	2 to 4 tablets once daily
  Side-effects	nausea
  Elimination half-life	6 hours
  Metabolism	extensively metabolized in the gastrointestinal tract and liver
  US patent status	expired - generic
  US FDA status	approved May 2009 for type 2 diabetes but previously approved in 1978 for other indications (see below)
  EMEA status	approved for indications other than type 2 diabetes
  Indication
  Cycloset is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
  Comments
  Cycloset contains bromocriptine mesylate, an ergot derivative that is a dopamine receptor agonist. The mechanism by which Cycloset improves glycemic control is unknown. Bromocriptine mesylate sold under the tradename Parlodel® by Novartis is indicated for the treatment of - dysfunctions associated with hyperprolactinemia including amenorrhea with or without galactorrhea, infertility or hypogonadism, - acromegaly - the signs and symptoms of idiopathic or postencephalitic Parkinson’s disease In 2008, the European Medicines Agency recommended updating the product information for ergot-derived dopamine agonists including bromocriptine with new warnings and contraindications in relation to the risk of fibrosis.

• COLESEVELAM

  Tradename (s)	Welchol™
  Company(ies)	Daiichi Sankyo , Inc.
  Available doses	625 mg
  Dose per day	6 tablets once daily or 3 tablets twice daily
  Side-effects	constipation
  Elimination half-life	not applicable
  Metabolism	not metabolized
  US patent status
  US FDA status	approved January 2008
  EMEA status	not approved for type 2 diabetes approved in March 2004 as cholesterol lowering drug
  Indication
  Colesevelam is indicated to improve glycemic control in adults with type 2 diabetes mellitus in combination with metformin, sulfonylureas, or insulin, either alone or in combination with other anti-diabetic agents.
  Comments
  Welchol was previously approved by the US-FDA in May 2000 as an adjunct to diet and exercise to reduce elevated low-density lipoprotein cholesterol (LDL-C) in patients with primary hyperlipidemia (Fredrickson Type IIa) as monotherapy or in combination with an hydroxymethyl-glutaryl-coenzym A (HMG CoA) reductase inhibitor.

• PRAMLINTIDE

  Tradename(s)	Symlin®
  Company(ies)	Amylin Pharmaceuticals, Inc.
  Available doses	15 mcg, 30 mcg, 45 mcg, 60 mcg and 120 mcg as a 1000 mcg/ml, 1.5 ml pen-injector
  Dose per day	prior to each meal
  Side-effects	nausea
  Elimination half-life	1 hour
  Metabolism	metabolized by the kidneys
  US patent status
  US FDA status	approved March 2005
  EMEA status	not approved
  Indication
  Pramlintide is indicated for: - Type 2 diabetes, as an adjunct treatment in patients who use mealtime insulin therapy and who have failed to achieve desired glucose control despite optimal insulin therapy, with or without a concurrent sulfonylurea agent and/or metformin - Type 1 diabetes, as an adjunct treatment in patients who use mealtime insulin therapy and who have failed to achieve desired glucose control despite optimal insulin therapy
  Comments
  Pramlintide is administered through subcutaneous injection. Pramlintide is a synthetic analog of human amylin.