Details About Generic Salt ::  Tolbutam

Main Medicine Class:: Antidiabetic,sulfonylurea   

(tole-BYOO-tuh-mide)

Orinase, Orinase Diagnostic,  Apo-Tolbutamide, Novo-Butamide

Class: Antidiabetic/sulfonylurea

 

Drugs Class ::

 Action Decreases blood glucose by stimulating release of insulin from pancreas.

Indications for Drugs ::

 Indications

Oral form: 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. IV form (tolbutamide sodium): Aid in diagnosis of pancreatic islet cell adenoma.

Drug Dose ::

 Route/Dosage

ADULTS: PO Usually 1–2 g/day (range, 0.25–3 g) in 1–2 divided doses.

For Diagnostic Purposes

ADULTS: IV 1 g over 2–3 min.

Contraindication ::

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

Drug Precautions ::

 Precautions

Pregnancy: Category C. Insulin is recommended to control elevated blood glucose levels during pregnancy. Lactation: Excreted into breast milk. Children: Safety and efficacy have not been established. Elderly or debilitated patients: Particularly susceptible to hypoglycemic action. Hypoglycemia may be difficult to recognize in elderly. Disulfiram-like syndrome: Administration of drug with alcohol may induce facial flushing and breathlessness. Hepatic and renal impairment: Use drug with caution. Cardiovascular risk: Patients treated for 5 to 8 years with diet plus tolbutamide (1.5 g/day) ad a rate of cardiovascular mortality » 2.5 times that of patients treated with diet alone.

PATIENT CARE CONSIDERATIONS

Drug Side Effects ::

 Adverse Reactions

CV: Increased risk of cardiovascular mortality. CNS: Dizziness; vertigo. DERM: Allergic skin reactions; eczema; pruritus; erythema; urticaria; orbilliform or maculopapular eruptions; lichenoid reactions; porphyria; photosensitivity. EENT: Tinnitus. GI: Nausea; epigastric fullness; heartburn. HEMA: Leukopenia; thrombocytopenia; aplastic anemia; agranulocytosis; emolytic anemia; pancytopenia. HEPA: Cholestatic jaundice. META: Hypoglycemia; SIADH with water retention and dilutional hyponatremia, especially in patients with CHF or hepatic cirrhosis. OTHER: Disulfiram-like reaction; weakness; paresthesia; fatigue; malaise; light burning sensation along course of vein during IV injection; thrombophlebitis with thrombosis of injected vein.

Drug Mode of Action ::  

 Action Decreases blood glucose by stimulating release of insulin from pancreas.

Drug Interactions ::

 Interactions

Androgens, anticoagulants, azole antifungals, chloramphenicol, clofibrate, dicumarol, fenfluramine, fluconazole, gemfibrozil, histamine H₂ ntagonists, magnesium salts, methyldopa, MAO inhibitors, phenylbutazone, probenecid, salicylates, sulfinpyrazone, sulfonamides, tricyclic antidepressants, urinary acidifiers: May increase hypoglycemic effect. Beta-blockers, calcium channel blockers, cholestyramine, corticosteroids, diazoxide, estrogens, hydantoins, isoniazid, nicotinic acid, oral contraceptives, phenothiazines, rifampin, sympathomimetics, thiazide diuretics, thyroid agents, urinary alkalinizers: May decrease hypoglycemic effect. Charcoal: Charcoal can reduce the absorption of sulfonylureas; depending on the clinical situation, this will reduce their efficacy or toxicity. Digitalis glycosides: Concurrent administration may result in increased digitalis serum levels. Digoxin: May cause increased digoxin serum concentrations. Ethanol: May cause disulfiram-like reaction.

Drug Assesment ::

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note diabetes complicated by ketoacidosis, decreased renal or hepatic function or sensitivity to sulfa drugs.
• If renal or hepatic function is diminished, use cautiously and monitor function.
• Monitor elderly closely for hypoglycemic effects.
• Monitor vital signs, blood sugar, weight and I&O daily.
• If jaundice occurs, discontinue drug and notify physician.

OVERDOSAGE: SIGNS & SYMPTOMS   Hypoglycemia including symptoms of the following: Tingling of lips and tongue, nausea, lethargy, confusion, agitation, nervousness, tachycardia, sweating, tremor, hunger, convulsions, stupor, coma

Drug Storage/Management ::

 Administration/Storage

• Administer 30 min prior to meal. May administer with food if GI upset occurs.
• May administer total dose in morning or give in divided doses to decrease GI upset or to decrease blood glucose fluctuation.
• Inject at constant rate over 2–3 min.
• Refer to manufacturer’s product information for specific test methodology and interpretation of test results.
• Use within 1 hr of reconstitution but only if solution is complete and clear.

Drug Notes ::

 Patient/Family Education

• Instruct patient to follow the diet and exercise regimen prescribed by physician.
• Inform patient of symptoms of and treatment for low blood sugar and advise patient to carry source of sugar at all times.
• Instruct patient to avoid alcohol. Inform patient that alcohol may react with tolbutamide and cause antabuse-like reaction (flushing, headache, dizziness, high BP).
• Instruct patient to monitor weight and to inform physician if steady weight gain occurs.
• Inform patient that surgery, illness or trauma may require temporary use of insulin.
• Instruct patient to alert physician to following problems: Nausea, vomiting, GI distress, diarrhea, fever, sore throat, rash, itching, weakness, unusual bruising or bleeding, spilling of glucose or ketones in urine.
• Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
• Recommended that patient carry identification card (eg, Medi-Alert) indicating condition and drug therapy.

Disclaimer ::

The Information available on this site is for only Informational Purpose , before any use of this information please consult your Doctor .Price of the drugs indicated above may not match to real price due to many possible reasons may , including local taxes etc.. These are only approximate indicative prices of the drug.