Details About Generic Salt ::  Glyburid

Main Medicine Class:: Antidiabetic,Sulfonylurea   

(glie-BYOO-ride)
DiaBeta, Glynase Pres Tab, Micronase,  Albert Glyburide, Apo-Glyburide, Diabeta, Euglucon, Gen-Glybe, Med-Glybe, Novo-Glyburide, Nu-Glyburide, Penta-Glyburide
Class: Antidiabetic/Sulfonylurea

 

Drugs Class ::

 Action Decreases blood glucose by stimulating insulin release from pancreas. May also decrease hepatic glucose production and/or increased response to insulin.

Indications for Drugs ::

 Indications Adjunct to diet to lower blood glucose in patients with non-insulin-dependent diabetes mellitus (type II) whose hyperglycemia cannot be controlled by diet alone; in combination with metformin when diet and glyburide or diet and metformin alone do not result in adequate glycemic control.

Drug Dose ::

 Route/Dosage

Nonmicronized Form

ADULTS: PO 2.5 to 5 mg/day with breakfast or first main meal.

Patients More Sensitive to Hypoglycemic Drugs (eg, elderly or patients with renal or hepatic dysfunction)

ADULTS: PO 1.25 mg/day initially. Maintenance: 1.25 to 20 mg daily in single or divided doses (patients receiving > 10 mg/day may have better response to twice-daily dosing). Daily doses > 20 mg are not recommended.

Micronized Form (Glynase Pres Tab)

Adults: PO 1.5 to 3 mg/day with breakfast or first main meal. Maintenance: 0.75 to 12 mg/day. Patients receiving > 6 mg/day have more satisfactory response to twice-daily dosing. Daily doses > 12 mg are not recommended.

Conomitant Metformin

ADULTS: PO Add micronized glyburide gradually to the dosing regimen of patients who have not responded to the maximum dose of metformin monotherapy after 4 weeks.

Contraindication ::

 Contraindications Hypersensitivity to sulfonylureas; diabetes complicated by ketoacidosis with or without coma; sole therapy of insulin-dependent diabetes mellitus (type I); diabetes when complicated by pregnancy.

Drug Precautions ::

 Precautions

Pregnancy: Category B. Insulin is recommended to maintain blood glucose levels during pregnancy. Prolonged severe neonatal hypoglycemia can occur if sulfonylureas are administered at time of delivery. Lactation: Undetermined. Children: Safety and efficacy not established. Elderly and debilitated patients: Elderly and debilitated patients are particularly susceptible to the hypoglycemic action. Hypoglycemia may be difficult to recognize in elderly patients. Bioavailability: Micronized glyburide (Glynase Pres Tab) and conventional (nonmicronized) glyburide formulations are not equivalent. Hepatic and renal impairment: Use drug with caution; lower doses may be adequate.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

CV: Although issue is controversial, oral sulfonylureas may have increased risk of cardiovascular mortality when compared with patients treated with diet alone. CNS: Dizziness; vertigo. DERM: Allergic skin reactions; eczema; pruritus; erythema; urticaria; morbilliform or maculopapular eruptions; lichenoid reactions; photosensitivity. EENT: Tinnitus. GI: Nausea, epigastric fullness; heartburn. GU: Mild diuresis; mild to moderate elevations in BUN and creatinine. HEMA: Leukopenia; thrombocytopenia; aplastic anemia; agranulocytosis; hemolytic anemia; pancytopenia; hepatic porphyria. HEPA: Cholestatic jaundice; elevated liver function test results. META: Hypoglycemia. OTHER: Disulfiram-like reactions; weakness; paresthesia; fatigue; malaise.

Drug Mode of Action ::  

 Action Decreases blood glucose by stimulating insulin release from pancreas. May also decrease hepatic glucose production and/or increased response to insulin.

Drug Interactions ::

 Interactions

Alcohol: Produces disulfiram-like reaction (facial flushing, headache, breathlessness). Androgens, chloramphenicol, clofibrate, dicumarol, fenfluramine, fluconazole, gemfibrozil, histamine H2 antagonists, magnesium salts, methyldopa, monoamine oxidase inhibitors, phenylbutazone, probenecid, salicylates, sulfinpyrazone, sulfonamides, tricyclic antidepressants, urinary acidifiers: May increase hypoglycemic effect. Beta-blockers, cholestyramine, diazoxide, hydantoins, rifampin, thiazide diuretics, urinary alkalinizers: May decrease hypoglycemic effect. Ciprofloxacin: A possible interaction between glyburide and ciprofloxacin has been reported, resulting in a potentiation of the hypoglycemic action.

Drug Assesment ::

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Note hepatic or renal impairment and the nature of the patient’s diabetes (type I vs type II).
  • Be aware that hypoglycemia may be difficult to recognize in elderly.
  • Test urine for glucose and acetone at least 3 times daily during titration period, unless patient is already testing blood glucose. Report results to health care provider.
  • When patients with impaired liver or renal function are receiving this drug, check liver and renal function tests frequently.
  • Check blood sugars frequently and observe for symptoms of hypoglycemia or hyperglycemia and report to health care provider.
OVERDOSAGE: SIGNS & SYMPTOMS
  Hypoglycemia, tingling of lips and tongue, hunger, nausea, lethargy, yawning, confusion, agitation, nervousness, tachycardia, sweating, tremor, convulsions, stupor, coma

Drug Storage/Management ::

 Administration/Storage

  • Administer with first main meal of day; patients taking large doses may require twice-daily dosing.
  • Dose must be readjusted when switching between micronized and conventional (nonmicronized) formulations; they are not bioequivalent.
  • If administering to a pregnant patient, discontinue at least 1 mo before expected date of delivery.
  • Store in tightly capped container, and keep out of reach of children.

Drug Notes ::

 Patient/Family Education

  • Review with patient dietary guidelines for diabetes.
  • Instruct patient to take drug with meals.
  • Teach patient to self-monitor urine or blood glucose.
  • Inform patient that this drug is not substitute for exercise and diet control and that patient should follow prescribed regimens.
  • Instruct patient to inform all health care providers involved in the patient’s care that this drug is being taken and to carry medical identification (eg, Medi-Alert bracelet).
  • Instruct patient to notify health care provider if symptoms of hypoglycemia occur (fatigue, excessive hunger, profuse sweating, numbness of extremities) or if blood glucose is < 60 mg/dl.
  • Tell patient to notify health care provider if symptoms of hyperglycemia occur (excessive thirst or urination, urinary glucose or ketones).
  • Instruct patient to report these symptoms to health care provider: Nausea, vomiting, diarrhea, heartburn, sore throat, rash, unusual bruising, or bleeding or other physical complaints.
  • Advise patient not to take any medication (including otc) or alcohol without consulting health care provider.

Disclaimer ::

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