For quick reference, the following sulfonylurea antidiabetic agents are numbered to match the corresponding brand names. Sulfonylurea antidiabetic agents also known as sulfonylureas are used to treat a certain type of diabetes mellitus sugar diabetes called type 2 diabetes. When you have type 2 diabetes, insulin is still being produced by your pancreas. Sometimes the amount of insulin you produce may not be enough or your body may not be using it properly and you may still need more. Sulfonylureas work by causing your pancreas to release more insulin into the blood stream. All of the cells in your body need insulin to help turn the food you eat into energy. This is done by using sugar or glucose in the blood as quick energy. Or the sugar may be stored in the form of fats, sugars, and proteins for use later, such as for energy between meals. synthroid
Patients with renal function impairment should receive an initial dose of 1 mg once a day. Symptoms of severe high blood sugar called ketoacidosis or diabetic coma that need immediate hospitalization include: flushed dry skin, fruit-like breath odor, ketones in urine, passing out, troubled breathing rapid and deep. Beta-adrenergic blocking agents may increase the chance that high or low blood sugar can occur. Also, they can hide symptoms of low blood sugar such as fast heartbeat. Young DS. Implementation of SI units for clinical laboratory data: Style specifications and conversion tables. Ann Intern Med 1987; 106: 114-29.
Rarely, some patients who take chlorpropamide may retain keep more body water than usual. This happens even less often with tolbutamide. Know what to do if symptoms of low blood sugar occur. Eating some form of quick-acting sugar when symptoms of low blood sugar first appear will usually prevent them from getting worse. Burghen G, Pui CH, Yasuda K, et al. Decreased insulin binding and production: probable mechanism for hyperglycemia due to therapy with prednisone PRED and l-asparaginase ASP. If a snack is not scheduled for an hour or more you should also eat a light snack, such as crackers or a half sandwich, or drink an 8-ounce glass of milk.
Other than the above information, there is no additional information relating to its proper use, precautions, or side effects for this use. Store away from heat and direct light. 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. F in a tight container, unless otherwise specified by manufacturer.
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. USP DI Volume III, Approved drug products and legal requirements. 18th ed. Rockville, MD: The United States Pharmacopeial Convention, Inc; 1998. Tolbutamide Mobenol, Horner. In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association; 1994. p. 796. Consult your doctor or pharmacist about the safe use of alcohol. When low blood sugar occurs, it may last longer than usual if more than a small amount of alcohol is taken, especially on an empty stomach. Small amounts of alcohol at mealtime usually do not cause problems with your blood sugar but may cause a redness called flushing in the face, arms, and neck that can be uncomfortable. At first, 1000 to 2000 milligrams mg a day. Some elderly people may need lower doses to start. The dose is usually divided into two doses. These doses are taken before the morning and evening meals. Your doctor may change your dose a little at a time if needed. The dose is usually not more than 3000 mg a day. RxList is part of the WebMD Health Network. The opinions expressed in the WebMD User Reviews are solely those of the User, who may or may not have medical or scientific training, and do not represent the opinions of WebMD. These member reviews have not been reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other purpose except for compliance with our Terms and Conditions. Pharmaceuticals, Inc. July, 2016. Avoid too much sun.
There is an increased chance of hypoglycemia occurring if more than one hypoglycemia-causing agent is used concurrently with sulfonylureas. If the need exists to administer any medications that may affect metabolic or glycemic control of type 2 diabetes, blood glucose concentrations should be monitored by the patient or health care professional. This is particularly important when any medication is added to or removed from an established drug regimen. Subsequent adjustments in diet or antidiabetic agent dosage or both may be necessary; these adjustments may differ depending on the severity of the diabetes. When adjusting the dose in the elderly, consider that steady-state concentrations for glipizide extended-release tablets may be delayed by approximately one or two days as compared to other age groups. Galloway JA, McMahon RE, Culp HW, et al. Metabolism, blood levels and rate of excretion of acetohexamide in human subjects. Diabetes 1967; 162: 118-27. Kemball ML, McIver C, Milner RDG, et al. Neonatal hypoglycemia in infants of diabetic mothers given sulphonylurea drugs in pregnancy. Arch Dis Child 1970; 45: 696-701. Too much of a sulfonylurea can cause low blood sugar also called hypoglycemia. Chlorpropamide seems to potentiate the effect of minimal concentrations of antidiuretic hormone present in patients with partial central diabetes insipidus. epogen
Food delays absorption of chlorpropamide. In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. It is unknown if this medication passes into milk. However, similar drugs pass into milk. Consult your doctor before breast-feeding. Moderate. These medicines may cause some risk when taken together. Specific carcinogenicity studies have not been done in animals; however, long-term toxicity studies have not shown any evidence of drug-related carcinogenicity. 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. First generation: Acetohexamide, chlorpropamide, tolazamide, tolbutamide. No teratogenic effects were found in studies in rats and rabbits. When these two medicines are taken together, rifamycins may cause your body to process your diabetes medicine more quickly. Park JY, Kim KA, Park PW, Park CW, Shin JG. Effect of rifampin on the pharmacokinetics and pharmacodynamics of gliclazide. 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. You may sometimes notice what looks like a tablet in your stool. Do not worry. After you swallow the tablet, the medicine in the tablet is absorbed inside your body. Then the tablet passes into your stool without changing its shape. The medicine has entered your body and will work properly. Lithium these medications have intrinsic hyperglycemic activity in both diabetic and nondiabetic patients; dosage of the sulfonylurea may need to be modified during and after treatment. Palmer KJ, Brogden RN. Gliclazide: an update of its pharmacological properties and therapeutic efficacy in non-insulin-dependent diabetes mellitus. Drugs 1993; 461: 92-125. omur.info ranolazine
Bouchard P, Sai P, Reach G, et al. Diabetes mellitus following pentamidine-induced hypoglycemia in humans. Diabetes 1982 Jan; 311: 40-5. TEQUIN gatifloxacin and serious hypoglycemia and hyperglycemia. Bristol-Myers Squibb Canada May 12, 2006. Studies in female rats and the first generation offspring of treated male and female rats showed no evidence of impaired fertility. Have a glucagon kit and a syringe and needle available in case severe low blood sugar occurs. Check and replace any expired kits regularly. Know what to do if high blood sugar occurs. Your doctor may recommend changes in your sulfonylurea dose or meal plan to avoid high blood sugar. Symptoms of high blood sugar must be corrected before they progress to more serious conditions. Reynolds, JEF, editor. Martindale: the extra pharmacopeia. 28th ed. London: The Pharmaceutical Press; 1982. what is generic bupropion called
Salicylates, in large doses these medications have intrinsic hypoglycemic activity in both diabetic and nondiabetic patients, possibly severe with quinine, quinidine, or salicylates in high doses but unlikely with low doses of salicylates. Also, salicylates may interfere with chlorpropamide's renal excretion. Do not use chocolate because its fat slows down the sugar entering the bloodstream. Maintenance: Oral, 80 to 320 mg a day with meals. The effectiveness of sulfonylureas in controlling blood glucose can decrease over time. If maximum doses of a sulfonylurea fail to control blood glucose, switching to another sulfonylurea or adding metformin to a sulfonylurea treatment regimen may be beneficial in increasing glycemic control and lipoprotein metabolism and may help avoid initiation of insulin therapy. This is especially successful in patients with type 2 diabetes whose blood sugar levels are poorly controlled by insulin alone, in short-term diabetics, or in patients who are 120 to 160% over ideal baseline body weight but who are not excessively insulin-resistant. Glimepiride and metformin may be used concomitantly when diet, exercise and glimepiride or metformin alone do not adequately control blood glucose levels. Combined use of glimepiride and metformin may increase the potential for hypoglycemia. Alternatively, low-dose insulin in conjunction with sulfonylureas can help to avoid using large doses of insulin, especially for patients with type 2 diabetes who are obese. However, complications, such as weight gain, the effects of hyperinsulinemia, and an increased risk of hypoglycemia need to be considered. Some patients with type 2 diabetes who are nonobese and who are experiencing secondary sulfonylurea failure may be best treated with insulin. A sulfonylurea should be discontinued any time it fails to contribute to the lowering of plasma glucose in a patient for whom compliance with proper diet and sulfonylurea dosing has been determined to be adequate. Tolbutamide Orinase, Hoechst Marion Roussel. In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 33rd ed. Ottawa: Canadian Pharmacists Association; 1998. p. 1232. Not commercially available in Canada. Crockett SE, Marsh D, Lewis RP, et al. Lack of cardiac inotropic effect of tolbutamide in intact man. Metabolism 1974; 823: 763-9. nizoral
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. Lewis-Hall F. Dear Healthcare Provider letter. Your doctor may want you to check your blood sugar more often while taking your antibiotic. If you experience a sudden onset of chills, cold sweat, blurred vision, dizziness, drowsiness, shaking, rapid heart rate, weakness, headache, fainting, tingling of the hands or feet, or hunger, check your blood sugar if possible and treat yourself for low blood sugar by eating a quick source of glucose such as glucose tablets or gel, table sugar, honey, candy, orange juice, or non-diet soda. Stop using your antibiotic and contact your doctor right away. Protective activity for some cardiac arrhythmias; also, reduces platelet adhesiveness and aggregation and has fibrinolytic activity. Jain AK, Ryan JR, McMahon FG. Potentiation of hypoglycemic effect of sulphonylureas by clofibrate. N Engl J Med 1976; 29411: 613. The amount of your diabetes medicine in your blood may decrease and it may not work as well. Daubresse JC, Daigneux D, Bruwler M, et al. Clofibrate and diabetes control in patients treated with oral hypoglycaemic agents. Br J Clin Pharmacol 1979; 7: 599-603.
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. Studies in male and female rats given 75 times the maximum human dose showed no evidence of impaired fertility. Beyer WF, Jensen EH. Tolbutamide. In: Florey K, editor. Analytical profiles of drug substances. New York: Academic Press, 1974; 3: 513-43. Monitoring vital signs, arterial blood gases, blood glucose, and serum electrolytes especially calcium, potassium, and sodium as required. Initially, blood glucose concentrations should be monitored as frequently as every 1 to 3 hours. Blood urea nitrogen and serum creatinine concentrations should also be obtained. Has mild antidiuretic activity. Long-term studies in rats and mice showed no evidence of carcinogenicity. High blood sugar hyperglycemia is another problem related to uncontrolled diabetes. 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. Acetohexamide and its more potent major metabolite, hydroxyhexamide, have uricosuric properties. Gliclazide, at therapeutic doses, reduces platelet adhesiveness and aggregation by inhibiting arachidonic acid release and thromboxane synthesis, and increasing production of prostacyclin PGI 2 and release of plasminogen activator, which increases fibrinolysis. It is also thought that gliclazide and glyburide have protective activity against cardiac arrhythmias because they can stabilize potassium and calcium concentrations by inhibition of the sodium-potassium-ATPase pump transport system. Tolbutamide and chlorpropamide decrease free water clearance while glyburide, glipizide, and tolazamide produce a mild diuresis effect by enhancement of renal free water clearance. In contrast to glyburide, tolazamide and tolbutamide increase hexose uptake in adipocytes and myocytes. Sulfonylureas directly increase the secretion of pancreatic and gastric somatostatin and do not seem to have a direct effect on glucagon. how to order tindamax europe
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. Check with your doctor or pharmacist to find out what you should do if you miss a meal. Niemi M, Backman JT, Neuvonen M, Neuvonen PJ, Kivisto KT. Rifampin decreases the plasma concentrations and effects of repaglinide. Self TH, Morris T. Interaction of rifampin and chlorpropamide. At first, 250 milligrams mg once a day. Some elderly people may need a lower dose of 100 to 125 mg a day at first. Then, your doctor may change your dose a little at a time if needed. The dose is usually not more than 750 mg a day. 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. Glucagon, 1 to 2 mg administered intramuscularly, is useful for fast onset of action to mobilize hepatic glucose stores but may be ineffective or variable in its effect if glycogen stores are depleted and must follow the use of glucose. The effect on the nursing infants is not known. The American Academy of Pediatrics considers tolbutamide to be compatible with breast-feeding. Kihara Y, Otsuki M. Interaction of gliclazide and rifampicin. Dolger H. Experience with the tolbutamide treatment of 500 cases of diabetes on an ambulatory basis. Ann NY Acad Sci 1957; 711: 275-9. Hartling SG, Faber OK, Wegmann ML, et al. Interaction of ethanol and glipizide in humans. Diabetes Care 1987; 106: 683-6. The majority of a single dose of tolazamide is eliminated in urine within 24 hours and elimination is complete after 5 days. Less active metabolites include carboxytolazamide, hydroxytolazamide, and p-toulene sulfonamide. can you buy cyclophosphamide online
Similarly, endoscopes can be passed into the large intestine through the rectum to examine this area of the intestine. This procedure is called or depending on how far up the colon is examined. Surekha V, Peter JV, Jeyaseelan L, Cherian AM. Drug interaction: rifampicin and glibenclamide. There is little information about the use of sulfonylureas in children. Type 2 diabetes is unusual in this age group. Treating with immediate ingestion of a source of sugar, such as glucose gel, glucose tablets, fruit juice, corn syrup, nondiet soft drinks, honey, sugar cubes, or table sugar dissolved in water. A frequently used source of sugar is a glassful of orange juice. How this interaction occurs is not known. Oral, 8 mg once a day with breakfast or the first main meal. Weight gain is greater with combination use of insulin and sulfonylureas than with sulfonylurea therapy alone. Gliclazide alone, or metformin in combination with sulfonylureas, usually results in less weight gain than other sulfonylureas and has exhibited a weight loss effect. Luntz GRWN, Smith SG. Effect of isoniazid on carbohydrate metabolism in controls and diabetics. BMJ 1953; 1: 296-99. Secondary failure of oral antidiabetic therapy may occur in certain patients. This may be due to increasing severity of diabetes or to diminished responsiveness to the medication. Endoscopic or combines upper endoscopy and examination to obtain images and information about various parts of the digestive tract. Why Do I Need an Endoscopy? Tolbutamide interferes with thyroidal uptake of I 123 and I 131. MacWalter RS, Debani AH, Feeley J, et al. Potentiation by ranitidine of the hypoglycaemic response to glipizide in diabetic patients. Br J Clin Pharmacol 1985; 21: 121-2. Lebovitz HE. Glipizide: a second-generation sulfonylurea hypoglycemic agent. Pharmacotherapy 1985; 5: 63-7. Hoescht Marion Roussel produces DiaBeta and its own generic, which is distributed by Copley, under the same NDA. If any of these effects persist or worsen, tell your doctor or promptly. Pugh JA, Wagner ML, Sawyer J, et al. Is combination sulfonylurea and insulin therapy useful in NIDDM patients? buy isoxsuprine northern ireland
FDA Pregnancy Category B Micronase, Glynase PresTab. Glyburide Gen-Glybe, Genpharm. In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 33rd ed. Ottawa: Canadian Pharmacists Association; 1998. p. 668. Rado JP, Szende L, Marosi J, et al. Inhibition of the diuretic action of glibenclamide by clofibrate, carbamazepine and 1-deamino-8-D-arginine-vasopressin DDAVP in patients with pituitary diabetes insipidus. Acta Diabetol Lat 1974; 11: 179. Lower initial dose may be required. 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. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment. This is the best way to tell whether your diabetes is being controlled properly. Blood sugar testing helps you and your health care team adjust the dose of your medicine, meal plan, or exercise schedule. Welchol colesevelam hydrochloride US prescribing information. Daiichi Sankyo, Inc. June, 2013. May be preferred for those patients with moderate renal function impairment; should not be used with severe renal failure. Noroxin norfloxacin US prescribing information. Fluconazole severe hypoglycemia has been reported shortly after concurrent use of tolbutamide, glyburide, and glipizide with these oral azole antifungal agents. Symptoms of low blood sugar can include: anxious feeling, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty in concentrating, drowsiness, excessive hunger, fast heartbeat, headache, nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, and unusual tiredness or weakness. lioresal
Documenting blood glucose and rechecking in 15 minutes. Reduces serum uric acid concentration. Pharmaceutical, Inc. February, 2011. 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. Diabetes Care 1986; 93: 320-2. If high blood sugar is not treated, it can cause serious problems, such as heart failure, blood vessel disease, eye disease, or kidney disease. To do so may increase the chance of serious side effects. Remember that this medicine will not cure your diabetes but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood sugar and keep it low. Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor. Melander A, Bitzen P-O, Faber O, et al. Sulphonylurea antidiabetic drugs: an update of their clinical pharmacology and rational therapeutic use. Drugs 1989; 371: 58-72. Kristensen M, Hansen JM. Potentiation of the tolbutamide effect by dicoumarol. Diabetes 1967; 16: 211-4. Sometimes insulin that is being produced by the body is not able to help sugar get inside the body's cells. Sulfonylureas help insulin get into the cells where it can work properly to lower blood sugar. In this way, sulfonylureas will help lower blood sugar and help restore the way you use food to make energy. Glyburide general monograph, CPhA. In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association; 1994. p. 525-6. However, the advice about hypoglycemia low blood sugar does apply to you. Call your doctor right away if you feel any of the symptoms described. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 32914: 977-86.
Riddle MC, Hart JS, Bouma DJ, et al. Efficacy of bedtime NPH insulin with daytime sulfonylurea for subpopulation of type II diabetic subjects. Diabetes Care 1989 Oct; 129: 623-9. Pond SM, Birkett DJ, Wade DN. Mechanisms of inhibition of tolbutamide metabolism: phenylbutazone, oxyphenbutazone, sulfaphenazole. Clin Pharmacol Ther 1977; 225 Pt 1: 573-9. Groop L, Schalin C, Franssila-Kallunki A, et al. Characteristics of non-insulin-dependent diabetic patients with secondary failure to oral antidiabetic therapy. Am J Med 1989; 872: 183-90. Test your blood sugar level at least every 4 hours while you are awake and check your urine for ketones. If ketones are present, call your doctor at once. If you have severe or prolonged vomiting, check with your doctor. Even when you start feeling better, let your doctor know how you are doing. McMurty RJ. Propranolol, hypoglycemia, and hypertensive crisis. Ann Intern Med 1974; 80: 669-70. Chlorpropamide Apo-Chlorpropamide, Apotex. In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association; 1994. Has mild diuretic effect. Using an in vitro method and whole embryo mouse culture, one study compared growth differences between untreated embryos and those bathed in hypoglycemic and euglycemic chlorpropamide-treated rat serums. The teratologic evaluation of the treated early somite mouse embryos showed malformations and growth retardation at doses similar to human therapeutic concentrations, which suggested that the teratogenicity was due to chlorpropamide and not to hypoglycemia; untreated mouse embryos showed normal development. Wickstrom L, Pettersson K. Treatment of diabetics with monoamine-oxidase inhibitors. Lancet 1964 Nov 7; 995-7. When patients are transferred to glimepiride from another sulfonylurea antidiabetic medication with the exception of chlorpropamide no transition period is required. When transferring patients from chlorpropamide, caution should be exercised during the first 1 to 2 weeks because of the prolonged retention of chlorpropamide in the body. Maintenance: Oral, 250 to 1000 mg once a day before breakfast or 1000 to 1500 mg divided into two doses taken before breakfast and evening meals. When adding a sulfonylurea to maximum doses of metformin or metformin to maximum doses of a sulfonylurea, even if primary or secondary failure of a sulfonylurea has occurred, the new medication should be added gradually and titrated to the lowest effective dose. Both agents should be discontinued and insulin should be initiated if the patient does not respond to maximum doses within 3 months or less, depending on clinician's decision. No transition time is needed when transferring between sulfonylureas, metformin, or insulin, except with chlorpropamide, which may require a 2-week transition because of chlorpropamide's prolonged duration of action. Do not take other medicines unless they have been discussed with your doctor. This especially includes nonprescription medicines, such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems. generic zoloft order online canada
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It occurs more often with long-acting sulfonylureas, such as chlorpropamide or glyburide, when other predisposing factors or conditions are present, and can be relapsing and prolonged; glyburide results in a higher fatality rate than does chlorpropamide. 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. For a listing of dosage forms and brand names by country availability, see Dosage Forms sections. This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Use this medicine only as directed even if you feel well and do not notice any signs of high blood sugar. Hospitalization for 6 to 91 hours mean, 24 hours because the hypoglycemia may be recurrent and prolonged; for chlorpropamide this period may be extended to 3 to 5 days or longer. Swallow tablet whole. Do not break, crush, or chew. AUC by 8% and 9%, respectively and increases the mean time to reach C max T max by 12% in healthy volunteers. It is recommended that glimepiride be taken with breakfast or the first main meal.
Initial: Oral, 250 mg once a day, the dosage being increased by 250 or 500 mg every five to seven days as needed. Groop L, Totterman KJ, Harno K, et al. Influence of beta-blocking drugs on glucose metabolism in patients with non-insulin dependent diabetes. Acta Med Scand 1982; 211: 7-12. An attempt to control diabetes through changes in diet and level of physical activity is usually first-line management before beginning pharmacologic treatment. Patients not responding adequately to diet alone or patients who require diet plus insulin, especially if they require 40 USP Units or less of insulin a day, may be candidates for therapy with a sulfonylurea as monotherapy or combination therapy.
Note: Glynase PresTab is formulated to divide easily in even halves by pressing gently on the scored area of the tablet. Sylvalahti E, Pihlajamki K, Iisalo E. Effect of tuberculostatic agents on the response of serum growth hormone and immunoreactive insulin to intravenous tolbutamide, and on the half-life of tolbutamide. Int J Clin Pharmacol 1976; 13: 83-9. The use of sulfonylurea antidiabetic agents has been reported, but not proven in all studies, to increase the risk of death from heart and blood vessel disease. Patients with diabetes are already more likely to have these problems if they do not control their blood sugar. Some sulfonylureas, such as glyburide and gliclazide, can have a positive effect on heart and blood vessel disease. It is important to know that problems can occur, but it is also not known if other sulfonylureas, particularly tolbutamide, help to cause these problems. It is known that if blood sugar is not controlled, such problems can occur.