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Diaeta®; Glynase® PresTab®; Micronase®
Diabeta; Glibenclamide; Glybenclamide; Glybenzcyclamide
Albert® Glyburide; Apo-Glyburide®; Diaeta®; Euglucon®; Gen-Glybe; Novo-Glyburide; Nu-Glyburide; PMS-Glyburide; ratio-Glyburide
Management of type 2 diabetes mellitus (noninsulin dependent, NIDDM)
Alternative to insulin in women for the treatment of gestational diabetes (11-33 weeks gestation)
Crosses the placenta. Hypoglycemia; ear defects reported; other malformations reported but may have been secondary to poor maternal glucose control/diabetes. Insulin is the drug of choice for the control of diabetes mellitus during pregnancy.
Excretion in breast milk unknown/contraindicated
Hypersensitivity to glyburide, any component of the formulation, or other sulfonamides; type 1 diabetes mellitus (insulin dependent, IDDM), diabetic ketoacidosis with or without coma
Elderly: Rapid and prolonged hypoglycemia (>12 hours) despite hypertonic glucose injections have been reported; age and hepatic and renal impairment are independent risk factors for hypoglycemia; dosage titration should be made at weekly intervals. Use with caution in patients with renal and hepatic impairment, malnourished or debilitated conditions, or adrenal or pituitary insufficiency.
Chemical similarities are present among sulfonamides, sulfonylureas, carbonic anhydrase inhibitors, thiazides, and loop diuretics (except ethacrynic acid). Use in patients with sulfonamide allergy is specifically contraindicated in product labeling, however, a risk of cross-reaction exists in patients with allergy to any of these compounds; avoid use when previous reaction has been severe.
Product labeling states oral hypoglycemic drugs may be associated with an increased cardiovascular mortality as compared to treatment with diet alone or diet plus insulin. Data to support this association are limited, and several studies, including a large prospective trial (UKPDS) have not supported an association.
Frequency not defined.
Central nervous system: Headache, dizziness
Dermatologic: Pruritus, rash, urticaria, photosensitivity reaction
Endocrine & metabolic: Hypoglycemia, hyponatremia (SIADH reported with other sulfonylureas)
Gastrointestinal: Nausea, epigastric fullness, heartburn, constipation, diarrhea, anorexia
Hematologic: Leukopenia, thrombocytopenia, hemolytic anemia, aplastic anemia, bone marrow suppression, agranulocytosis
Hepatic: Cholestatic jaundice, hepatitis
Neuromuscular & skeletal: Arthralgia, paresthesia
Ocular: Blurred vision
Renal: Diuretic effect (minor)
Symptoms of overdose include severe hypoglycemia, seizures, cerebral damage, tingling of lips and tongue, nausea, yawning, confusion, agitation, tachycardia, sweating, convulsions, stupor, and coma. Intoxication with sulfonylureas can cause hypoglycemia and is best managed with glucose administration (oral for milder hypoglycemia or by injection in more severe forms).
Decreased effect: Thiazides may decrease effectiveness of glyburide
Increased effect: Possible interaction between glyburide and fluoroquinolone antibiotics has been reported resulting in a potentiation of hypoglycemic action of glyburide
Since this agent is highly protein bound, the toxic potential is increased when given concomitantly with other highly protein bound drugs (ie, phenylbutazone, oral anticoagulants, hydantoins, salicylates, NSAIDs, beta-blockers, sulfonamides) - increase hypoglycemic effect
Ethanol increases disulfiram reactions
Phenylbutazone can increase hypoglycemic effects
Certain drugs tend to produce hyperglycemia and may lead to loss of control (ie, thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid)
Possible interactions between glyburide and coumarin derivatives have been reported that may either potentiate or weaken the effects of coumarin derivatives
Ethanol: Caution with ethanol (may cause hypoglycemia).
Herb/Nutraceutical: Caution with chromium, garlic, gymnema (may cause hypoglycemia).
Stimulates insulin release from the pancreatic beta cells; reduces glucose output from the liver; insulin sensitivity is increased at peripheral target sites
Onset of action: Serum insulin levels begin to increase 15-60 minutes after a single dose
Protein binding, plasma: >99%
Metabolism: To one moderately active and several inactive metabolites
Half-life elimination: 5-16 hours; may be prolonged with renal or hepatic impairment
Time to peak, serum: Adults: 2-4 hours
Excretion: Feces (50%) and urine (50%) as metabolites
Initial: 2.5-5 mg/day, administered with breakfast or the first main meal of the day. In patients who are more sensitive to hypoglycemic drugs, start at 1.25 mg/day.
Increase in increments of no more than 2.5 mg/day at weekly intervals based on the patient's blood glucose response
Maintenance: 1.25-20 mg/day given as single or divided doses; maximum: 20 mg/day
Elderly: Initial: 1.25-2.5 mg/day, increase by 1.25-2.5 mg/day every 1-3 weeks
Micronized tablets (Glynase™ PresTab™): Adults:
Initial: 1.5-3 mg/day, administered with breakfast or the first main meal of the day in patients who are more sensitive to hypoglycemic drugs, start at 0.75 mg/day. Increase in increments of no more than 1.5 mg/day in weekly intervals based on the patient's blood glucose response.
Maintenance: 0.75-12 mg/day given as a single dose or in divided doses. Some patients (especially those receiving >6 mg/day) may have a more satisfactory response with twice-daily dosing.
Dosing adjustment/comments in renal impairment: Clcr<50 mL/minute: Not recommended
Dosing adjustment in hepatic impairment: Use conservative initial and maintenance doses and avoid use in severe disease
Administer with meals at the same time each day. Patients who are anorexic or NPO may need to have their dose held to avoid hypoglycemia.
Signs and symptoms of hypoglycemia, fasting blood glucose, hemoglobin A1c
Target range: Adults:
Fasting blood glucose: <120 mg/dL
Glycosylated hemoglobin: <7%
Should be taken with meals at the same time each day. Dietary modification based on ADA recommendations is a part of therapy. Decreases blood glucose concentration. Hypoglycemia may occur. Must be able to recognize symptoms of hypoglycemia (palpitations, sweaty palms, lightheadedness).
Inform prescriber of all prescriptions, OTC medications, or herbal products you are taking, and any allergies you have. Do not take any new medication during therapy unless approved by prescriber. This medication is used to control diabetes; it is not a cure. Monitor glucose as recommended by prescriber. Other important components of treatment plan may include prescribed diet and exercise regimen (consult prescriber or diabetic educator). If you experience hypoglycemic reaction, contact prescriber immediately. Always carry quick source of sugar with you. Take exactly as directed, 30 minutes before meal(s) at the same time each day. Do not change dose or discontinue without consulting prescriber. Avoid alcohol while taking this medication; could cause severe reaction. Do not take other medication within 2 hours of this medication unless advised by prescriber. You may experience more sensitivity to sunlight (use sunscreen, wear protective clothing and eyewear, and avoid direct sunlight); headache; or nausea (consult prescriber if these persist). Report severe or persistent side effects; hypoglycemia (palpitations, sweaty palms, lightheadedness); extended vomiting, diarrhea, or constipation; flu-like symptoms; skin rash; easy bruising or bleeding; or change in color of urine or stool. Inform prescriber if you are or intend to become pregnant. Do not breast-feed.Pregnancy/breast-feeding precautions:
The possibility of higher doses of sulfonylureas eliciting an increase in cardiovascular events, because of their effects on blocking potassium sensitive ATP channels, has been raised. Longer-term prospective trials of sulfonylurea therapy, such as the UKPDS, do not reveal any increased cardiovascular mortality.
The possibility of higher doses of sulfonylureas eliciting an increase in cardiovascular events, because of their effects on blocking potassium sensitive ATP channels, has been raised. However, there are presently only limited data to support this premise, particularly with newer generation agents. An early study suggested poor cardiovascular outcomes in diabetic patients treated with tolbutamide. Retrospective studies evaluating cardiovascular outcomes following angioplasty and acute myocardial infarction in diabetic patients receiving newer sulfonylureas are inconsistent. Longer-term prospective trials of sulfonylurea therapy, such as the UKPDS, do not reveal any increased cardiovascular mortality.
Glyburide-dependent diabetics (noninsulin dependent, type 2) should be appointed for dental treatment in morning in order to minimize chance of stress-induced hypoglycemia.
No information available to require special precautions
Dizziness is common
May rarely cause agranulocytosis; use caution with clozapine and carbamazepine; phenothiazines and TCAs may antagonize glimepiride hypoglycemic effects; MAO inhibitors and TCAs may enhance hypoglycemic effects
Tablet, micronized (Glynase® PresTab®): 1.5 mg, 3 mg, 6 mg
Alexander RW, "Prolonged Hypoglycemia Following Acetohexamide Administration,"Diabetes, 1966, 15(5):362-4.
"A Study of the Effects of Hypoglycemia Agents on Vascular Complications in Patients With Adult-onset Diabetes. VI. Supplementary Report on Nonfatal Events in Patients Treated With Tolbutamide. The University Group Diabetes Program,"Diabetes, 1976, 25(12):1129-53.
Brodows RG, "Benefits and Risks With Glyburide and Glipizide in Elderly NIDDM Patients,"Diabetes Care, 1992, 15(1):75-80.
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"Effect of Intensive Blood-Glucose Control With Metformin on Complications in Overweight Patients With Type 2 Diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group,"Lancet, 1998, 352(9131):854-65.
Garratt KN, Brady PA, Hassinger NL, et al, "Sulfonylurea Drugs Increase Early Mortality in Patients With Diabetes Mellitus After Direct Angioplasty for Acute Myocardial Infarction,"J Am Coll Cardiol, 1999, 33(1):119-24.
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