Names and pronunciation
(glye′byoor-ide) DiaBeta , Glynase PresTab
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Individual generic drug information
Extracted information for glyBURIDE only.
(glye′byoor-ide) DiaBeta , Glynase PresTab
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Func. class.: Antidiabetic
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Chem. class.: Sulfonylurea (2nd generation)
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Do not confuse: glyBURIDE/Glucotrol/glipiZIDE
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ACTION: Causes functioning β cells in pancreas to release insulin, thereby lead- ing to a drop in blood glucose levels
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USES: Type 2 diabetes mellitus
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Extracted information for glyBURIDE only.
CONTRAINDICATIONS: Hypersensitivity to sulfonylureas, type 1 dia- betes, diabetic ketoacidosis, renal failure Precautions: Pregnancy, geriatric patients, cardiac/thyroid disease, severe renal/hepatic disease, severe hypoglyce- mic reactions, sulfonamide/sulfonylurea hypersensitivity, G6PD deficiency
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SIDE EFFECTS CNS: Headache, weakness, paresthesia ENDO: Hypoglycemia GI: Nausea, hepatotoxicity, cholestatic jaundice, vomiting, diarrhea, weight gain HEMA: Leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia (rare) INTEG: Rash, pruritus, photosensitivity, erythema MISC: Angioedema, serious hypersensi- tivity
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INTERACTIONS Increase: masking symptoms of hypoglycemia—β-blockers; monitor blood glucose Increase: level—digoxin Increase: hypoglycemic effects—insulin, MAOIs, oral anticoagulants, chlorampheni- col, NSAIDs, salicylates, probenecid, andro- gens, fluconazole, gemfibrozil, histamine H2 antagonists, magnesium salts, phenylbu- tazone, sulfinpyrazone, sulfonamides, tricy- clics, urinary acidifiers, β-blockers, clarith romycin, voriconazole; monitor blood glucose, use cautiously Increase: triglyceride levels—cole- sevelam Increase: action of—cycloSPORINE Increase: hyperglycemia—alcohol Decrease: both products’ effects— diazoxide Decrease: glyBURIDE action—thiazide diuretics, rifampin, carbamazepine, gluca- gon, corticosteroids, monitor blood glucose Drug/Herb Increase: antidiabetic effect—garlic, horse chestnut Decrease: hypoglycemic effect—green tea Drug/Lab Test Increase: AST, ALT, LDH, BUN, creatinine, alkaline phosphatase, cholesterol, ALP Decrease: Hb, sodium, glucose, platelets, WBC
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TREATMENT OF OVERDOSE: Use one of the following: Glucose 25 g IV via dextrose 50% sol, 1 mg glucagon, oral carbohydrate depending on severity
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Extracted information for glyBURIDE only.
DOSAGE AND ROUTES Nonmicronized • Adult: PO 1.25-5 mg initially, then increase to desired response at weekly intervals up to 20 mg/day; may be given as a single or divided dose • Geriatric: PO 1.25 mg initially, then increase to desired response; max 20 mg/day, maintenance 1.25-20 mg/day Micronized • Adult: PO 1.5-3 mg/day initially, may increase by 1.5 mg/wk, max 12 mg/day • Geriatric: PO 0.75-3 mg/day, may in- crease by 1.5 mg/wk To replace insulin • Adult: PO if insulin was <40 U/day, switch directly; if insulin was <20 U/day, give 2.5-5 mg (or 1.5-3 mg micronized); if insulin was 20-40 U/day, give 5 mg (or 3 mg micronized); if insulin was >40 U/day, give 5 mg (3 mg micronized) initially with 50% insulin dose, gradually taper insulin and increase glybURIDE
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Available forms: Tabs 1.25, 2.5, 5 mg (nonmicronized); 1.5, 3, 6 mg (micronized)
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Administer: • With breakfast as single or divided dose; hold dose if patient NPO to avoid hypogly- cemia; take at same time each day • Twice-daily dosing may be used if conven- tional doses >10 mg, micronized >6 mg • Gradual conversion from other oral hypoglycemics to product is not needed • Micronized glyBURIDE/nonmicronized glyBURIDE are not equivalent • Store in tight container in cool environ- ment
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Extracted information for glyBURIDE only.
Assess: • Hypo/hyperglycemic reaction that can occur soon after meals; for severe hypogly- cemia, give IV D50W, then IV dextrose sol • Blood glucose, A1c levels during treatment • For allergy to sulfonamides, potential for cross-reactivity • For renal, hepatic dysfunction: use dose reductions, or avoidance of use may be required; increased risk of hypoglyce- mia in hepatic failure • Blood dyscrasias: CBC at baseline, throughout treatment; report decreased blood counts • Beers: avoid in older adults; risk of severe prolonged hypoglycemia G • Pregnancy/breastfeeding: identify if pregnancy is planned or suspected; breastfed infant may be hypoglycemic; insulin should be used in pregnancy
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Evaluate: • Therapeutic response: decrease in polyuria, polydipsia, polyphagia; clear sensorium; absence of dizziness; stable gait; improved serum glucose, A1c
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To check for symptoms of cholestatic jaundice: dark urine, pruritus, jaundiced sclera; if these occur, notify prescriber • To use a blood glucose meter for test- ing while taking this product • About the symptoms of hypo/hypergly- cemia, what to do about each • That product must be continued on a daily basis; about consequences of discon- tinuing product abruptly; that in times of stress, infection, surgery, trauma, a higher dose may be needed, also may require ad- ministration of insulin during these times • To take product with breakfast or first meal of the day to prevent hypoglycemic reactions at night if taking once a day; if taking twice a day, not to take after last meal of the day • To avoid OTC medications unless or- dered by prescriber • To report bleeding, bruising, weight gain, edema, shortness of breath, weak- ness, sore throat • That diabetes is a lifelong illness; that product will not cure disease • That all food included in diet plan must be eaten to prevent hypoglycemia; to have glucagon emergency kit, sugar packets always available • To use sunscreen or stay out of the sun, wear protective clothing (photosensitivity) • To carry an emergency ID with pre- scriber and medication information • To notify prescribers of use prior to surgery • To not drive or operate machinery until response is known, dizziness may occur • That continuing follow-up exams and lab work will be needed
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Extracted information for glyBURIDE only.
PHARMACOKINETICS Completely absorbed; Nonmicronized onset 2 hr; peak 2-4 hr; duration 24 hr; Micronized: Onset 1 hr, peak 2-3 hr, dura- tion <24 hr metabolized in liver; excreted in urine, feces (metabolites); crosses placenta; 99% plasma-protein bound
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Filter the extracted dose blocks for this individual drug.
Nonmicronized
• Geriatric: PO 1.25 mg initially, then increase to desired response; max 20 mg/day, maintenance 1.25-20 mg/day Micronized
Candidate age grouping · source page 632
Nonmicronized
• Geriatric: PO 0.75-3 mg/day, may in- crease by 1.5 mg/wk To replace insulin
Candidate age grouping · source page 632