Diabinese

Di·ab·i·nese (d-b-nz)

A trademark for the drug chlorpropamide.

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Diabinese,

trademark for an oral antidiabetic (chlorproPAMIDE).

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chlorpropamide Warning - High-alert drug!

Apo-Chlorpropamide (CA), Chloronase (CA), Diabinese, Novo-Propamide (CA)

Pharmacologic class: Sulfonylurea

Therapeutic class: Hypoglycemic

Pregnancy risk category C

Action

Unclear. Thought to reduce blood glucose level primarily by stimulating secretion of endogenous insulin from pancreatic beta cells.

Availability

Tablets: 100 mg, 250 mg

⊘Indications and dosages

➣ To lower glucose level in patients with non-insulin-dependent (type 2) diabetes mellitus

Adults: 250 mg P.O. daily with breakfast, increased as necessary to a maximum dosage of 750 mg daily

➣ To convert from insulin therapy to oral hypoglycemic therapy

Adults: For patient on 40 units of insulin or less, stop insulin and start chlorpropamide at 250 mg P.O. daily. If patient is receiving more than 40 units of insulin, start chlorpropamide at 250 mg P.O. daily, with insulin dosage reduced 50%; further insulin decreases depend on patient response.

Dosage adjustment

• Renal impairment
• Debilitated patients
• Elderly patients

Off-label uses

• Diabetes insipidus

Contraindications

• Hypersensitivity to drug
• Diabetic ketoacidosis
• Insulin-dependent (type 1) diabetes mellitus

Precautions

Use cautiously in:
• insulin hypersensitivity, hepatic or renal impairment, severe infection, trauma, major surgery
• elderly patients
• pregnant or breastfeeding patients.

Administration

• Give before meals for best results.
• If drug causes GI upset, give with food.
• To prevent hypoglycemia, adjust dosage during times of stress, illness, or decreased caloric intake.

Route	Onset	Peak	Duration
P.O.	1 hr	2-4 hr	24 hr

Adverse reactions

CNS: paresthesia, fatigue, dizziness, vertigo, malaise, headache

CV: increased risk of CV mortality

EENT: tinnitus

GI: nausea, heartburn, epigastric distress

GU: tea-colored urine

Hematologic: leukopenia, thrombocytopenia, aplastic anemia, agranulocytosis, hemolytic anemia

Hepatic: cholestatic jaundice

Metabolic: dilutional hyponatremia, prolonged hypoglycemia

Skin: rash, pruritus, erythema, urticaria

Other: hypersensitivity reaction, disulfiram-like reaction

Interactions

Drug-drug. Anabolic steroids, chloramphenicol, clofibrate, guanethidine, MAO inhibitors, salicylates, sulfonamides: increased hypoglycemia

Beta-adrenergic blockers: prolonged hypoglycemia

Corticosteroids, glucagons, rifampin, thiazide diuretics: decreased hypoglycemic response

Hydantoins: increased hydantoin blood level

Oral anticoagulants: increased hypoglycemic activity

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, cholesterol, creatinine, lactate dehydrogenase: increased levels

Glucose, granulocytes, hemoglobin, platelets, sodium, white blood cells: decreased values

Drug-herbs. Bitter melon, burdock, dandelion, eucalyptus, ginkgo, marshmallow: increased hypoglycemic activity

Drug-behaviors. Alcohol use: altered glycemic control (most commonly leading to hypoglycemia), disulfiram-like reaction

Patient monitoring

• Assess serum electrolyte levels before starting therapy.
☞ Watch for signs and symptoms of jaundice.
• Monitor patient for fluid and electrolyte imbalances.
• Check blood pressure frequently.
• Monitor urine for ketones and glucose.

Patient teaching

• If patient takes drug once daily, instruct him to take dose before breakfast. If he takes it more than once daily, advise him to take doses before meals.
☞ Teach patient how to recognize signs and symptoms of hypoglycemia (such as shaking, irritability, flushed skin, and inability to think clearly). Tell him to keep orange juice or other high-energy food available at all times to raise blood glucose level quickly. Instruct him to report hypoglycemia promptly.
☞ Advise patient to immediately report yellowing of eyes or skin.
• Teach patient how to test urine or blood for glucose. Stress the need for regular testing.
☞ If patient is switching from insulin, instruct him to test his urine three times a day for glucose and ketones and to immediately report positive results.
• Emphasize importance of following recommendations regarding diet, exercise, and weight loss (if needed) to help control diabetes.
• Urge patient to consult prescriber before breastfeeding. Drug may cause hypoglycemia in infant.
• Caution patient not to take over-the-counter weight-loss, cough, cold, or allergy preparations without consulting prescriber.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.