Sulfonylureas
- Common sulfonylureas prescribed are: Glipizide-Glucotrol, Glyburide-DiaBeta, Glimepiride-Amaryl
- ↓ A1C about 1-2%
- Sulfonylureas work on beta cells
- Most effective in recent onset of Type 2 DM
- Patients must be able to make their own insulin for these drugs to work
- These drugs interact with ATP-sensitive potassium channels in the beta cells to increase the secretion of insulin
- Sulfonylureas can loose their potency over time
- Do not use in patients with severe renal & hepatic disease
- Patients must not drink- may cause a disulfiram reaction
- May cause weight gain
- Cannot be used in pregnancy
- Avoid Glybride in the elderly because it has an active metabolite (Ameryl is the safest to use)
Ideal Use
- insulinopenic patients
- non-obese or mild obesity patients
- Can use in combination or monotherapy
Advantages
- cheap cost for patient
- ↓micro/macro vascular events
- Reduces glucose levels
Side effects
- Hypoglycemia (major side effect)
- Weight gain
- Glyburide has higher incidence of hypoglycemia compared to other sulfonylureas
Drug interactions with sulfonylureas (will ↑ glucose levels)
- Thiazide diuretics
- Estrogen
- Steroids
Key Notes
- Sulfonylureas and metglinides have the same MOA
- Sulfonylurea are longer acting agents and targets fasting hyperglycemia
- If a patient is taking a long-acting sulfonylurea discontinue it when adding basal insulin. (can cause severe hypoglycemia)
- Diaphoresis is a symptom of hypoglycemia that a pt should be warned about it is most likely to occur if patient is taking glyburide and propranolol
- ↓ the dose of sulfonylureas and insulin when adding a DPP-4 inhibitor agent
- Sulfonylurea are longer acting agents and targets fasting hyperglycemia
References
Edmunds, M. W., & Mayhew, M. S. (2014). Pharmacology for the primary care provider (4th ed.). St. Louis, MO: Elsevier Mosby.
Harvey, R. A., Clark, M. A., Finkel, R., Rey, J. A., & Whalen, K. (2012). Pharmacology (5th ed.). Baltimore, MD: Lippincott.