Sulfonylureas (Old)

Summary

Sulfonylureas are a drug class including the drugs glimepiride, glyburide, and glipizide. These drugs are used to lower blood sugar, to treat people with type 2 diabetes. An important risk to note is the potential to lower the blood sugar levels too much and cause hypoglycemia, especially in older adults. Patients taking sulfonylureas should avoid alcohol to avoid a disulfiram-like reaction. Importantly, sulfonylureas are sulfa drugs and may therefore cause drug allergies in certain patients - be sure to look out for a history of allergic reactions before giving the drug!

Key Points

• Sulfonylureas
  • Key drugs
    • Glimepiride
    • Glipizide
    • Glyburide
  • Mechanism
    • Directly stimulates beta cells in the pancreas to release more insulin, thus decreasing blood glucose level
    • Increases tissue response to insulin
    • Decreases glucose production by the liver
  • Clinical Use
    • Hyperglycemia in Type II Diabetes Mellitus
      • Is most effective if administered 30 minutes before a meal
  • SE and AR
    • Hypoglycemia
      • Shakiness
      • Tachycardia
      • Weakness
      • Diaphoresis
      • Use extreme caution in the elderly
    • Avoid alcohol
      • When combined with alcohol, sulfonylureas may cause a disulfiram-like reaction (nausea, vomiting, chills, headache, “hangover” like symptoms)
      • Alcohol can also potentiate the hypoglycemia and lower blood glucose levels even further
    • Hypersensitivity / Allergy (Sulfa Allergy)
      • If a patient has had an allergic reaction to another sulfa-derivative drug (e.g. sulfonamides, thiazide diuretics) the order for sulfonylureas should be questioned
    • Weight gain
    • Photosensitivity