Pregnancy Risk Category B
How supplied
Tablets: 1.25 mg, 2.5 mg, 5 mg
Tablets (micronized): 1.5 mg, 3 mg, 6 mg
Action
Unknown. A sulfonylurea that probably stimulates insulin release from the pancreatic beta cells and reduces glucose output by the liver. An extrapancreatic effect increases peripheral sensitivity to insulin and causes a mild diuretic effect.
Indications & dosage
Adjunct to diet to lower blood glucose level in patients with type 2 non-insulin-dependent diabetes mellitus--
Adults: initially, 2.5 to 5 mg regular tablets P.O. once daily with breakfast or first main meal. Usual maintenance dose is 1.25 to 20 mg daily as a single dose or in divided doses. Or, micronized formulation may be used. Initial dose is 1.5 to 3 mg daily. Usual maintenance dose of micronized formulation is 0.75 to 12 mg/day. Patients receiving more than 6 mg/day may have better response with b.i.d. dosing.
Adjust-a-dose: For patients who are more sensitive to antidiabetics, initially 1.25 mg daily. Patients with adrenal or pituitary insufficiency should start with 1.25 mg daily. When using micronized tablets, patients who are more sensitive to antidiabetics should start with 0.75 mg daily.
To replace insulin therapy--
Adults: if insulin dosage is below 40 U/day, patient may be switched directly to glyburide when insulin is discontinued. If insulin dosage is 40 or more U/day, initially 5-mg regular tablets or 3-mg micronized formulation can be given P.O. once daily in addition to 50% of insulin dosage.
Adverse reactions
EENT: changes in accommodation or blurred vision.
GI: nausea, epigastric fullness, heartburn.
GU: elevated BUN levels.
Hematologic: leukopenia, hemolytic anemia, agranulocytosis, thrombocytopenia, aplastic anemia.
Hepatic: cholestatic jaundice, hepatitis, abnormal liver function, alterations in cholesterol and alkaline phosphatase levels.
Metabolic: hypoglycemia.
Musculoskeletal: arthralgia, myalgia.
Skin: rash, pruritus, other allergic reactions.
Other: angioedema.
Interactions
Drug-drug. Anabolic steroids, chloramphenicol, clofibrate, guanethidine, MAO inhibitors, salicylates, sulfonamides: increased hypoglycemic activity. Monitor blood glucose levels.
Beta blockers: prolonged hypoglycemic effect and masked symptoms of hypoglycemia. Use together cautiously.
Corticosteroids, glucagon, rifampin, thiazide diuretics: decreased hypoglycemic response. Monitor blood glucose levels.
Hydantoins: increased blood levels of hydantoins. Monitor blood levels.
Oral anticoagulants: increased hypoglycemic activity or enhanced anticoagulant effect. Monitor blood glucose levels, PT, and INR.
Drug-lifestyle. Alcohol use: altered glycemic control, most commonly hypoglycemia. May also cause disulfiram-like reaction. Discourage concomitant use.
Effects on diagnostic tests
None reported.
Contraindications
Contraindicated in patients with hypersensitivity to drug and in those with diabetic ketoacidosis with or without coma; also contraindicated in pregnant or breast-feeding women.
Nursing considerations
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING