chlorpropamide, Diabinese (cont.)



PREPARATIONS: Tablets: Acetohexamide, 250 or 500 mg; chlorpropamide (Diabinese), 100 or 250 mg; (Tolinase), 100, 250 or 500 mg; and tolbutamide (Orinase), 500 mg.

STORAGE: All sulfonylureas should be stored at room temperature, 15-30°C(59-86°F) in an air-tight container.

PRESCRIBED FOR: It is believed that strict glucose control in diabetics reduces the chances of eye, kidney, and nerve damage. The first generation sulfonylureas are used in type II diabetes to help lower and control blood glucose that is not controlled by diet and exercise. They are usually tried before turning to insulin for therapy.

DOSING: Like other medications used to manage diabetes, the dose of the first generation sulfonylureas should be individualized using periodic measurements of blood glucose. Any of the first generation sulfonylureas may be taken with food, although tolbutamide is more effective if taken 30 minutes before a meal.

All sulfonylureas can lower glucose levels to the point of causing symptoms and signs (hypoglycemia). Therefore, these agents must be used carefully with patients who have other physical or medical factors that may lower their blood glucose. These factors include kidney or liver disease, poor food intake, alcohol use, or participation in heavy exercise.

DRUG INTERACTIONS: Drugs that may interact with the first generation sulfonylureas and increase the risk of hypoglycemia include blood thinning agents (Coumadin), chloramphenicol (Ak-Chlor), clofibrate (Atromid), alcohol, MAO inhibitors including tranylcypromine (Parnate), non-steroidal anti-inflammatory drugs including ibuprofen (Motrin), aspirin, sulfinpyrazone (Anturane), sulfonamides including sulfamethoxazole (Gantanol), phenylbutazone (Azolid), and drugs that make urine more acidic including ammonium chloride.

Drugs that may interact with the first generation sulfonylureas and reduce their hypoglycemic effect include diazoxide (Proglycem), rifampin (Rifadin), diuretics including hydrochlorothiazide (Hydrodiuril) and furosemide (Lasix), and drugs that make urine more basic including sodium bicarbonate (Neut).

Alcohol may interact with the first generation sulfonylureas, especially chlorpropamide, to cause moderate to severe facial flushing (increased flow of blood to the face) and an increase in facial temperature.

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