glyburide


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glyburide

 [gli´būr-īd]
a sulfonylurea compound used as a hypoglycemic in treatment of type 2 diabetes mellitus; administered orally.

glyburide (glibenclamide (UK))

Apo-Glyburide (CA), Daonil (UK), DiaBeta, Dom-Glyburide (CA), Euglucon (CA), Gen-Glybe (CA), Glynase PresTab, Micronase, Novo-Glyburide (CA), Nu-Glyburide (CA), PMS-Glyburide (CA), Ratio-Glyburide (CA), Riva-Glyburide (CA), Sandoz Glyburide (CA), Semi-Daonil (UK)

Pharmacologic class: Sulfonylurea

Therapeutic class: Hypoglycemic

Pregnancy risk category B

Action

Increases insulin binding and sensitivity at receptor sites, stimulating insulin release from beta cells in pancreas and reducing blood glucose level. Also decreases production of basal glucose in liver, enhances sensitivity of peripheral tissue to insulin, inhibits platelet aggregation, and causes mild diuresis.

Availability

Tablets: 1.25 mg, 2.5 mg, 5 mg

Tablets (micronized): 1.5 mg, 3 mg, 6 mg

Indications and dosages

To control blood glucose in type 2 (non-insulin-dependent) diabetes mellitus in patients who have some pancreatic function and don't respond to diet therapy

Adults: Initially, 2.5 to 5 mg (regular tablets) P.O. daily; range is 1.25 to 20 mg/day as a single dose or in divided doses. Or initially, 1.5 to 3 mg (micronized tablets) P.O. daily, with range of 0.75 to 12 mg/day; give dosages above 6 mg in two divided doses.

Conversion from insulin therapy

Adults: If patient takes less than 20 units of insulin daily, give 2.5 to 5 mg glyburide daily; with insulin dosage of 20 to 40 units/day, give 5 mg glyburide; with insulin dosage above 40 units/day, give 5 mg glyburide daily or 3 mg (micronized tablets) P.O. daily and reduce insulin dosage by 50%.

Dosage adjustment

• Hepatic or renal failure
• Elderly patients

Contraindications

• Hypersensitivity to drug
• Type 1 (insulin-dependent) diabetes
• Severe renal, hepatic, thyroid or other endocrine disease
• Pregnancy or breastfeeding

Precautions

Use cautiously in:
• mild to moderate hepatic, renal, or cardiovascular disease; impaired thyroid, pituitary, or adrenal function
• infection, stress, or dietary changes
• elderly patients.

Administration

Know that micronized glyburide is not bioequivalent to regular glyburide.
• Check baseline creatinine level for normal renal function before giving first dose.
• Give daily dose at breakfast; for patient receiving drug b.i.d., give second dose at dinner.
• Adjust dosage slowly if patient is taking metformin.

Adverse reactions

CNS: dizziness, drowsiness, headache, weakness

CV: increased CV mortality risk

EENT: visual accommodation changes, blurred vision

GI: nausea, vomiting, diarrhea, constipation, cramps, heartburn, epigastric distress, anorexia

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

Hepatic: cholestatic jaundice, hepatitis

Metabolic: hyponatremia, hypoglycemia

Skin: rash, pruritus, urticaria, eczema, erythema, photosensitivity, angioedema

Other: increased appetite

Interactions

Drug-drug.Androgens (such as testosterone), chloramphenicol, clofibrate, guanethidine, MAO inhibitors, nonsteroidal anti-inflammatory drugs (except diclofenac), salicylates, sulfonamides, tricyclic antidepressants: increased risk of hypoglycemia

Beta-adrenergic blockers: altered response to glyburide, requiring increased or decreased dosage; prolonged hypoglycemia (with nonselective agents)

Calcium channel blockers, corticosteroids, estrogens, hydantoins, hormonal contraceptives, isoniazid, nicotinic acid, phenothiazines, phenytoin, rifampin, sympathomimetics, thiazide diuretics, thyroid preparations: decreased hypoglycemic effect of glyburide

Warfarin: initially increased, then decreased, effects of both drugs

Drug-diagnostic tests.Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, cholesterol: increased values

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

Drug-herbs.Agoral marshmallow, aloe (oral), bitter melon, burdock, chromium, coenzyme Q10, dandelion, eucalyptus, fenugreek: increased hypoglycemic effect

Glucosamine: impaired glycemic control

Drug-behaviors.Alcohol use: disulfiram-like reaction

Patient monitoring

• Monitor blood glucose level, especially during periods of increased stress.
• Monitor CBC and renal function test results.
• If patient is ill or has abnormal laboratory findings, monitor electrolyte, ketone, glucose, pH, lactate dehydrogenase, and pyruvate levels.
• Evaluate cardiovascular status.

Patient teaching

• Advise patient to take daily dose with breakfast (and second dose, if prescribed, with dinner).
• Teach patient how to self-monitor his glucose level as prescribed; tell him to report significant changes.
• Inform patient that he may need supplemental insulin during times of stress or when he can't maintain adequate oral intake.
• Teach patient how to recognize signs and symptoms of hypoglycemia and hyperglycemia.
• Instruct patient to keep sugar source available at all times.
• Encourage patient to drink plenty of fluids.
• Stress importance of diet and exercise in helping to control diabetes.
• Advise patient to wear or carry medical identification stating he has diabetes.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Tell patient he'll undergo regular blood testing during therapy.
• 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.

glyburide

/gly·bur·ide/ (gli´būr-īd) a sulfonylurea used as a hypoglycemic in the treatment of type 2 diabetes mellitus.

glyburide

(glī′byo͝or-īd′)
n.
A sulfonylurea drug, C23H28ClN3O5S, used to treat type 2 diabetes. Also called glibenclamide.

glyBURIDE

[glī′bərīd]
an oral antidiabetic drug.
indications It is prescribed as an adjunct to diet and exercise to lower blood glucose levels of patients with type 2 (non-insulin-dependent) diabetes mellitus.
contraindications Because of its long duration of action, it may produce prolonged hypoglycemia; there is also a risk of severe hypoglycemia in elderly, debilitated, or malnourished patients. The dosage may require adjustment for patients taking other drugs that increase blood glucose levels.
adverse effects Among the more serious adverse effects are nausea, hypoglycemia, and skin allergies.

glyburide

Micronase Diabetology A sulfonurea used to ↓ blood glucose in Pts with type 2 DM Adverse effects Jaundice, liver function abnormalities, ↑ transaminases, nausea, bloating, heartburn. See Diabetes, Sulfonurea.

glyburide (glī´byərīd),

n brand names: Apo-Glyburide, DiaBeta, Micronase;
drug class: oral antidiabetic (second generation);
action: causes functioning cells in pancreas to release insulin, leading to a drop in blood glucose levels;
use: stable adult-onset diabetes mellitus (type 2).

glyburide

a second generation sulfonylurea used as an oral hypoglycemic agent in the treatment of diabetes mellitus.
References in periodicals archive ?
Several recent reviews of glyburide studies, such as one that looked at nine glyburide studies covering 745 patients taking glyburide and 645 patients taking insulin, also have been published (Ann.
Those taking glyburide saw only an 8% drop in their fasting blood sugar levels, from 154 mg/dL to 142 mg/ dL.
Glyburide was linked to a 59% increased risk, and glimepiride was associated with a 68% increased risk.
In these patients, we now know that glimepiride appears to be safer than the other commonly prescribed sulfonylureas, glipizide and glyburide, available in the United States," he added.
Metformin and glyburide do not adequately control the peak postprandial glucose.
Refractory hypoglycemia from ciprofloxacin and glyburide interaction.
Patients were treated with Onglyza 5 mg (n = 882) or placebo (n = 799), both alone or as add-on to metformin, glyburide or a thiazolidinedione.
We are pleased to receive approval of generic glyburide tablets, a product that was developed at our Middlesex, NJ facility," said Fred Wilkinson, President and Chief Executive Officer of Impax.
On the other hand, there have been "no long-term follow-up studies of infants whose mothers were treated with metformin, glyburide, or any of the insulin analogs," he noted, and past experience with thalidomide has shown that "what may seem safe in the present may prove to be unsafe in the future.
Subjects continued their usual doses of metformin, but the other oral agent was withdrawn during an 8-week period prior to randomization to either rosiglitazone maleate or glyburide.
Five patients were receiving glyburide and 50 were taking insulin.
Kevin Sheth from Yale University will present the outcomes of a study evaluating the role of a continuous infusion of glyburide (normally a medication to control high blood sugar) in decreasing brain swelling after a large ischemic stroke.