Sulfonylureas- include- First generation - Acetohexamide, Chlorpropamide, Tolazamide, Tobutamide Second generation - Glipizide, Glyburide ( Glibenclamide ), GlimepIride,Gliclazide Refer Chlorpropamide 

Interacting drugs- summary

+ Glibenclamide

Metformin-

 Following coadministration of single doses, decrease in glyburide AUC and Cmax were observed. In view of lack of adequate information on the pharmacolodynamic effects, the clinical significance is uncertain 

Warfarin,salicylates,sulphonamides and alcohol potentiate hypoglycaemic effect. Glucocorticoids, diuretics and oestrogen reduce hyploglycaemic effect. Beta blckrs (propanolol)mask early symptoms of hypoglycaemia. Synergestic hypoglcaemic action with metformin.

LIST OF DRUGS DURING 2004

Seen in elderly debiliterated patients with hepatic/renal diseases.

Blood dyscrasias(reversible), liver dysfunction, Hypoglycaemia

GI symptoms, Allergic skin reactions.

Juvenille diabetes, ketoacidosis, pre-coma and pre-diabetic coma, impaired renal function., adrenocortical insufficiency and pregnancy.

Special precautions:

Various factors can potentiate the action,eg.,overdosage, dietary errors,renal disorders,impaired alertness.Avoid alcohol.

Indications:

Diabetes

Dosage:

2.5 to 5mg daily administered with breakfast or the first meal. For more sensitive patients, start at 1.25mg daily.

Sulfonylureas- include- First generation - Acetohexamide, Chlorpropamide, Tolazamide, Tobutamide Second generation - Glipizide, Glyburide ( Glibenclamide ), GlimepIride,Gliclazide Refer Chlorpropamide 

1. Patients must receive full and complete instructions about the nature of diabetes.

2. Strict adherence to prescribed diet, an excercise program personal hygiene and avoidance of infection are essential

3. It is important to teach patients to self-monitor blood glucose

4. Do not discontinue medication except on advice of a physicain

5. May cause GI upset, may be taken with food. take glipizide ,30 minutes before a meal to increse effectiveness.

6. Avoid alcohol (disulfram reaction and interference with blood sugar control ) and salicylates except on professional advice

7. Monitor urine for glcose and ketones as prescribed, monitor blood glucose as prescribed.

8. Notify physician if any of the following occurs- Hypoglycemia- fatigue, excessive thirst or urination, profuse sweating, numbness of extremities Hypoglycemia- excessive thirst or urination, urinary glucose or ketones Other- sore throat, rash, unusual bruising, or bleeding