Paterson KR, Wilson M, Kesson CM, et al. Comparison of basal and prandial insulin therapy in patients with secondary failure of sulphonylurea therapy. Diabet Med 1991; 81: 40-3. Then, your doctor may change your dose a little at a time if needed. The dose is usually not more than 40 mg a day. If your dose is 15 mg or more, the dose is usually divided into two doses. These doses are taken thirty minutes before the morning and evening meals. Diabetes Res Clin Prac 1985; Suppl 1: S522. Glyburide Apo-Glyburide, Apotex. In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 33rd ed. Ottawa: Canadian Pharmacists Association; 1998. p. 105.
Davies RR, Miller M, Turner SJ, et al. Effects of somatostatin analogue SMS 201-995 in normal man. Clin Endocrinol 1986; 24: 665-74. Jain AK, Ryan JR, McMahon FG. Potentiation of hypoglycemic effect of sulphonylureas by clofibrate. N Engl J Med 1976; 29411: 613. McMurray J, Fraser DM. Captopril, enalapril and blood glucose. Lancet 1986; 1035. Mouradian M, Abourizk N. Diabetes mellitus and thyroid disease. Diabetes Care 1983 Sep-Oct; 65: 512-20. Initial: Oral, 250 mg once a day, the dosage being increased by 250 or 500 mg every five to seven days as needed.
At first, 5 mg once a day with breakfast. Then, your doctor may change your dose a little at a time if needed. The dose is usually not more than 20 mg a day. McGavack TH, Seegers W, Haar HO, et al. Thyroid function of diabetic patients as influenced by the sulfonylureas. Ann NY Acad Sci 1957; 711: 268-74. With chronic sulfonylurea treatment, insulin production is not increased and may return to pretreatment values, but insulin efficacy continues and is thought to involve extrapancreatic mechanisms to increase insulin sensitivity in target tissues, such as liver, muscle, and fat as well as in other cells, such as monocytes and erythrocytes. This can result in a decrease in hepatic glycogenolysis and gluconeogenesis. It is unclear if the sulfonylurea's extrapancreatic actions that increase insulin's efficacy are direct or indirect effects, but it is clear that the mechanism of action is not due to a direct sulfonylurea action on the insulin receptor. Because this peripheral effect is not apparent in patients with type 1 diabetes, the evidence suggests that this may not be the clinically significant mechanism of sulfonylurea action in patients with type 2 diabetes either. However, it is clear that tissues of sulfonylurea-treated patients with type 2 diabetes become more responsive to lower concentrations of endogenous insulin. Primary failure of sulfonylurea therapy may occur if beta-cell function is severely impaired.
Upjohn. In: PDR Physicians' desk reference. 52nd ed. 1998. Montvale, NJ: Medical Economics Company; 1998. p. 2273-5. Also, using ERCP, that have passed outside the gallbladder and into the bile duct can often be removed. Is Endoscopy Safe? F unless otherwise specified by manufacturer. Store in a tight container. The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions.
Distributed into breast milk. Maintenance: Oral, 80 to 320 mg a day with meals. Wilkins; 1990. p. 208-9. Glyburide Novo-Glyburide, Novopharm. In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 33rd ed. Ottawa: Canadian Pharmacists Association; 1998. p. 1170. Takla PG. Glibenclamide. In: Florey K, editor. Analytical profiles of drug substances. New York: Academic Press, 1981; 10: 338-55. Seltzer HS. Drug-induced hypoglycemia: a review based on 1418 cases. Endocrinol Metab Clin North Am 1989 Mar; 181: 163-81. Campbell DB, Lavielle R, Nathan C. The mode of action and clinical pharmacology of gliclazide: a review. Diabetes Res Clin Pract 1991; S21-S36. Chlorpropamide crosses the placenta. Adequate and well-controlled studies have not been done in humans. Low doses 250 mg a day or less of chlorpropamide have been used in pregnant women without adverse effects. The manufacturer recommends discontinuing chlorpropamide at least 1 month before the expected delivery date.
Disulfiram-type reaction with concurrent alcohol use less likely with tolbutamide than with other antidiabetics. Also, displacement from plasma proteins by other medications is more likely than with nonionic sulfonylureas. Pogatsa G, Koltai ZM, Ballagi-Pordany G. Influence of hypoglycemic sulfonylurea compounds on the incidence of ventricular ectopic beats in non-insulin-dependent diabetic patients treated with digitalis. Curr Ther Res Clin Exp; 1993; 53: 329-39. When you become sick with a cold, fever, or the flu, you need to take your usual dose of sulfonylurea, even if you feel too ill to eat. This is especially true if you have nausea, vomiting, or diarrhea. Infection usually increases your need to produce more insulin. Sometimes you may need to be switched from your sulfonylurea to insulin for a short period of time while you are sick to properly control blood sugar. Call your doctor for specific instructions. Committee of Drugs, American Academy of Pediatrics. Transfer of drugs and other chemicals into human milk. Pediatrics 1989; 845: 924-36. For quick reference, the following sulfonylurea antidiabetic agents are numbered to match the corresponding brand names. Studies in humans have not been done. Kradjan WA, Kobayashi KA, Bauer LA, et al. Glipizide pharmacokinetics: effects of age, diabetes, and multiple dosing. J Clin Pharmacol 1989; 2912: 1121-7. Bacterial and in vivo mutagenicity testing showed no evidence of mutagenicity. Pond SM, Birkett DJ, Wade DN. Mechanisms of inhibition of tolbutamide metabolism: phenylbutazone, oxyphenbutazone, sulfaphenazole. Clin Pharmacol Ther 1977; 225 Pt 1: 573-9. Amaryl glimepiride US prescribing information. F in a tight container, unless otherwise specified by manufacturer. The amount of your diabetes medicine in your blood may decrease and it may not work as well.
Initial: Oral, 1 to 2 mg once a day with breakfast or the first main meal. Chlorpropamide Apo-Chlorpropamide, Apotex. In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association; 1994. It has been suggested by some studies, including the University Group Diabetes Program UGDP that certain sulfonylurea antidiabetic agents increase cardiovascular mortality in diabetic patients, a population that already has a greater risk of cardiovascular disease and mortality when blood glucose is not controlled. Other studies have not reached a similar conclusion and have in fact suggested that control of elevated blood glucose with sulfonylurea antidiabetic agents may lessen the danger of cardiovascular disease and mortality. Despite questions regarding the interpretation of the results and the adequacy of the experimental design, the findings of the UGDP study provide an adequate basis for caution, especially for certain high risk patients with coronary artery disease, congestive heart failure, or angina pectoris. If sulfonylurea treatment is necessary, glyburide or gliclazide may be the preferred sulfonylureas for use in patients at risk for conditions causing cardiac hypoxia. The patient should be informed of the potential risks and advantages of sulfonylurea antidiabetic agents and of alternative modes of therapy. Bouchard P, Sai P, Reach G, et al. Diabetes mellitus following pentamidine-induced hypoglycemia in humans. Diabetes 1982 Jan; 311: 40-5. Occasionally, divided doses are administered, usually twice a day before the morning and evening meals, to improve gastrointestinal tolerance. Not recommended for use in patients with renal function impairment. Sulfonylurea-induced blood dyscrasias and dermatologic conditions generally occur within the initial six weeks of therapy and are thought to be hypersensitivity reactions. Studies in rats and rabbits given up to 500 times the human dose have produced no evidence of teratogenicity. The following information includes only the average doses of these medicines. Phillips RE, Looaressuwan S, White NJ, et al. Hypoglycaemia and antimalarial drugs: quinidine and release of insulin. BMJ 1986; 292: 1319-21. Haymond MW. Hypoglycemia in infants and children. Endocrinol Metab Clin North Am 1989 Mar; 181: 211-53. Studies in male mice and male and female rats given more than 1700 times and approximately 4000 times, respectively, the maximum recommended human dose based on body surface area showed no evidence of impaired fertility. Other supportive measures should also be employed as needed. Judis J. Displacement of sulfonylureas from human serum proteins by coumarin derivatives and cortical steroids. J Pharm Sci 1973; 622: 232-7. During conversion from insulin therapy to glyburide therapy, no gradual dosage adjustment usually is required for patients using less than 40 USP Units of insulin daily. Patients requiring more than 40 USP Units should receive a 50% reduction of insulin the first day with initiation of 3 mg of micronized glyburide or 5 mg of nonmicronized glyburide as a single dose and gradual dosage adjustments of glyburide as needed. Hospitalization for some patients on a higher insulin dosage may be required for uneventful conversion.
Chlorpropamide and tolbutamide are distributed into human breast milk and potentially may cause hypoglycemia in the infant. Glimepiride is distributed into the milk of rats. It is not known whether acetohexamide, gliclazide, glipizide, glyburide, or tolazamide is distributed into breast milk. Ferner RE, Chaplin S. The relationship between the pharmacokinetics and the pharmacodynamic effects of oral hypoglycaemic drugs. Clin Pharmacokinet 1987 12: 379-401. Kolterman OG. Glyburide in non-insulin-dependent diabetes: an update. Clin Ther 1992; 142: 196-213. Food delays absorption of gliclazide up to 187 minutes; may be best taken 30 minutes before or with a meal. Lower initial doses may be required in patients with medical problems that make them more sensitive to the effects of tolazamide. Floxin ofloxacin US prescribing information. Product Information: Amaryl, glimepiride. Hoechst Marion Roussel, Kansas City, MO, USA. Studies in rats and rabbits given 500 times the human dose have not shown evidence of impaired fertility. Not included in Canadian product labeling. The doctors have prescribed 5mg Glipizide Glucotrol in addition to my regular dose of 750mg of Metformin twice daily. I have been taking this cocktail for about 4 days now, and my blood glucose levels have dropped to below 150. I've also eliminated all external sugars from my diet - no fruit juices, no sweet dairy products etc - and am exercising for 30 minutes each day. I am restricting my diet to less than 250 carbs per day. Glimepiride alone: At first, 1 to 2 milligrams mg once a day with breakfast or the first main meal. The dose then may be increased by your doctor based on your blood sugar level.
Gilman AG, Rall TW, Nies AS, Taylor P, editors. Goodman and Gilman's the pharmacological basis of therapeutics. 8th ed. New York: Pergamon Press; 1990. p. 1463-95. Reduces serum uric acid concentration. Lower initial doses may be required in patients with medical problems that make them more sensitive to the effects of tolbutamide. Lancet 1991 Nov 9; 3388776: 1222. Tell your doctor if you have ever had any unusual or allergic reaction to sulfonylureas, or to sulfonamide-type sulfa medicines, including thiazide diuretics a certain type of water pill. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes. No teratogenic effects were found in studies of mice and rabbits. Embryotoxicity was not seen in studies of rats. However, a significant decrease in offspring viability at 48 hours was seen when pregnant females were treated up to delivery. It is unclear how this relates to the use of gliclazide or if it applies to humans. If you experience pale skin, blurred vision, loss of consciousness, increased thirst, increased urination, fatigue, or fast, deep breathing, check your blood sugar, stop using your antibiotic and contact your doctor right away. Brown KS, Armstrong IC, Wang A, Walker JR, Noveck RJ, Swearingen D, Allison M, Kissling JC, Kisicki J, Salazar DE. Effect of the bile acid sequestrant colesevelam on the pharmacokinetics of pioglitazone, repaglinide, estrogen estradiol, norethindrone, levothyroxine, and glyburide. Sulfonylureas may be used in conditions causing diabetes mellitus induced by hormones, medications, or chemicals in patients who have functioning pancreatic beta cells when the diabetes cannot be controlled by diet or exercise.
At some point, a sulfonylurea may stop working as well and your blood sugar level will go up. You will need to know if this happens and what to do. Instead of taking more of this medicine, your doctor may change you to another sulfonylurea. Or your doctor may have you inject small doses of insulin or take another oral antidiabetic medicine called metformin along with your sulfonylurea to help the insulin you make work better. If that does not bring down the amount of sugar in your blood, your doctor may have you stop taking the oral antidiabetic agents and begin receiving only insulin injections. Rocha AS, Ping WC, Kudo LH. Effect of chlorpropamide on water and urea transport in the inner medullary collecting duct. Kidney Int 1991 Jan; 391: 79-86. Danazol Sanofi Winthrop. In: PDR Physicians' desk reference. 48th ed. 1994. Montvale, NJ: Medical Economics Data Production Company; 1994. p. 2092-3. Chlorpropamide crosses the placenta. Sulfonylureas should not be used during pregnancy, especially when insulin is available. In the rare cases that a sulfonylurea is used, chlorpropamide and glipizide should be discontinued at least 1 month before delivery date and other sulfonylureas stopped at least 2 weeks before delivery date. Tolbutamide tablets may be dissolved in a glass of water and drunk. Additional water should then be added to the glass, stirred, and drunk to make sure all the medication is taken. Gregorio F, Ambrosi F, Cristallini S, et al. Therapeutical concentrations of tolbutamide, glibenclamide, gliclazide, and gliquidone at different glucose levels: in vitro effects on pancreatic A- and B-cell function. Diabetes Res Clin Pract; 18: 197-206.
Batch J, Ma A, Bird D, et al. The effects of ingestion time of gliclazide in relationship to meals on plasma glucose, insulin and C-peptide levels. Eur J Clin Pharmacol 1990; 385: 465-7. Reaven GM, Johnston P, Hollenbeck CB, et al. Combined metformin-sulfonylurea treatment of patients with noninsulin-dependent diabetes in fair to poor glycemic control. J Clin Endocrinol Metab 1992; 745: 1020-6. Initial: Oral, 5 mg once daily with breakfast; dosage is increased by 5 mg based on resulting hemoglobin A 1c measurements taken three months later or, less commonly, based on two or more consecutive fasting blood glucose measurements taken seven days apart. Holt RJ, Gaskins JD. Hyperglycemia associated with propranolol and chlorpropamide administration. Glyburide Nu-Glyburide, Nu-Pharm. In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 33rd ed. Ottawa: Canadian Pharmacists Association; 1998. p. 1190. Endoscopy is a nonsurgical procedure used to examine a person's digestive tract. Using an endoscope, a flexible tube with a light and camera attached to it, your doctor can view pictures of your digestive tract on a color TV monitor. Del Prato S, Vigili de Kreutzenberg S, Riccio A, et al. Partial recovery of insulin secretion and action after combined insulin-sulfonylurea treatment in Type 2 non-insulin-dependent diabetic patients with secondary failure to oral agents. Diabetologia 1990; 3311: 688-95. Large-dose studies using up to 75 times the maximum human dose in rats and in mice for 20 and 18 months, respectively, showed no evidence of drug-related carcinogenicity. F unless otherwise specified by manufacturer. Store in a well-closed container. Craig J, Abu-Saleh M, Smith B, et al. Diabetes mellitus in patients on lithium. Lancet 1977 Nov 12; 28046: 1028. Managing with potassium supplements. A1C level about 11 and the goal is to get it below 7 in the next 3 months. About 3 weeks ago, my blood sugar level was higher than 200. I admitted myself into emergency because I was experiencing symptoms that were very similar to Transient Aschemic Attack TIA - the precursor to a real stroke.
Leslie RDG, Pyke DA. Chlorpropamide-alcohol flushing: a dominantly inherited trait associated with diabetes. BMJ 1978; 2: 1519. Sometimes patients with type 2 diabetes might need to change to treatment with insulin for a short period of time during pregnancy or for a serious medical condition, such as diabetic coma; ketoacidosis; severe injury, burn, or infection; or major surgery. In these conditions, insulin and blood sugar can change fast and blood sugar can be best controlled with insulin instead of a sulfonylurea. Studies in animals have not been done. Not recommended for use in patients with renal function impairment or congestive heart failure. There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. Seltzer HS. Drug-induced hypoglycemia: a review based on 473 cases. Diabetes 1972; 21: 955-66. Emesis can be induced with ipecac syrup if sulfonylurea overdose is recent within the past 30 minutes and the patient is alert, has an intact gag reflex, and is not obtunded or convulsing. Otherwise, gastric lavage after endotracheal tube placement is required.
Canada JR, editor. USP dictionary of USAN and international drug names 1998. Rockville, MD: The United States Pharmacopeial Convention, Inc; 1997. p. 19, 159, 341, 342, 344, 744. The daily number of calories in the meal plan should be adjusted by your doctor or a registered dietitian to help you reach and maintain a healthy body weight. In addition, regular meals and snacks are arranged to meet the energy needs of your body at different times of the day. Williams G. Management of non-insulin-dependent diabetes mellitus. Lancet 1994 Jan; 343: 95-100. Maintenance: Oral, 1 to 4 mg once a day. After reaching a dose of 2 mg, increases in dosage should be made in increments of up to 2 mg every one to two weeks based on blood glucose response. The intravenous glucose therapy should not be terminated suddenly. A central venous line for long-term use 24 to 48 hours in cases of chlorpropamide overdose may be required. Oral glucose cannot be relied upon to maintain euglycemia because 60% of an oral glucose dose is stored as hepatic glycogen with only 15% left for brain utilization and 15% for insulin-dependent tissues even though 75% of oral glucose is absorbed after 150 to 180 minutes.
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Food delays absorption of immediate-release glipizide by 40 minutes; therefore, it is recommended that glipizide be taken 30 minutes before a meal. While food had no effect on the lag time of absorption 3 to 4 hours for extended-release glipizide, administration of glipizide to normal males before a meal high in fat showed a 40% increase in the time to peak serum concentrations; AUC was not affected. Tolbutamide Apo-Tolbutamide, Apotex. In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 33rd ed. Ottawa: Canadian Pharmacists Association; 1998. p. 122. Immediately treating with 50 mL of 50% dextrose injection given intravenously to stabilize the patient.
Chronic toxicity studies in dogs treated for 6, 13, and 20 months with doses of chlorpropamide greater than 20 times the human dose showed no histological or pathological abnormalities. Chlorpropamide seems to potentiate the effect of minimal concentrations of antidiuretic hormone present in patients with partial central diabetes insipidus. Jaakkola T, Backman JT, Neuvonen M, Laitila J, Neuvonen PJ. Effect of rifampicin on the pharmacokinetics of pioglitazone.
Symptoms of high include thirst, increased urination, confusion, drowsiness, flushing, rapid breathing, and fruity breath odor. If these symptoms occur, tell your doctor right away. Your dosage may need to be increased. Short-term administration of a sulfonylurea or insulin for transient loss of blood glucose control may be sufficient for patients with type 2 diabetes whose blood glucose levels are normally well-controlled with diet. Switching to another sulfonylurea agent may be beneficial if one particular sulfonylurea does not optimally control the diabetes mellitus; however, use of a sulfonylurea should be discontinued if satisfactory reduction of blood glucose concentration is not achieved.
Lewis-Hall F. Dear Healthcare Provider letter. Prolonged severe hypoglycemia lasting for 4 to 10 days has been reported in neonates born to mothers who were receiving a sulfonylurea antidiabetic agent at the time of delivery. This effect has been reported more frequently with those agents with longer half-lives, such as chlorpropamide. If sulfonylureas are used during pregnancy, they should be discontinued according to the manufacturer's labeling. Totterman KJ, Groop LC. No effect of propranolol and metoprolol on the tolbutamide-stimulated insulin-secretion in hypertensive diabetic and non-diabetic patients. Ann Clin Res 1982; 14: 190-3.