ANTIDIABETIC AGENTS

Brand & Generic Names

ACETOHEXAMIDE	GLYBURIDE
Alpha-Gilbenclamide	Micronase
Apo-Chlorpropamide	Mobenol
Apo-Tolbutamide	Novobutamide
CHLORPROPAMIDE	Novopropamide
DiaBeta	Oramide
Diabinese	Orinase
Dimelor	Storzolamide
Dymelor	Tolamide
Euglucon	TOLAZAMIDE
GLIPIZIDE	TOLBUTAMIDE
Glucamide	Tolinase
Glucotrol

Basic Information

• Habit forming? No
• Prescription needed? Yes
• Available as generic? Yes, for some.
• Drug class: Antidiabetic (oral), sulfonurea

Uses

• Treatment for diabetes in adults who can't control blood sugar by diet, weight loss and exercise.
• Treatment for diabetes insipidus.

Dosage & Usage Information

How to take:
Tablet--Swallow with liquid or food to lessen stomach irritation. If you can't swallow whole, crumble tablet and take with liquid or food.

When to take:
At the same times each day.

If you forget a dose:
Take as soon as you remember up to 2 hours late. If more than 2 hours, wait for next scheduled dose (don't double this dose).

What drug does:
Stimulates pancreas to produce more insulin. Insulin in blood forces cells to use sugar in blood.

Time lapse before drug works:
3 to 4 hours. May require 2 weeks for maximum benefit.

Don't take with:
Any other medicine without consulting your doctor or pharmacist.

Overdose

SYMPTOMS:
Excessive hunger, nausea, anxiety, cool skin, cold sweats, drowsiness, rapid heartbeat, weakness, unconsciousness, coma.

WHAT TO DO:

• Dial 911 (emergency) or O (operator) for an ambulance or medical help. Then give first aid immediately.
• See EMERGENCY Information.

Possible Adverse Reactions or Side Effects

Life-threatening:

In case of overdose, see Overdose section.

Common:

• Dizziness.
• Diarrhea, appetite loss, nausea, stomach pain, heartburn, constipation.

Infrequent:

• Low blood sugar (hunger, anxiety, cold sweats, rapid pulse), shortness of breath.
• Headache.

Rare:

Fatigue, itchy skin or rash, sore throat, fever, ringing in ears, unusual bleeding or bruising, jaundice, edema, weakness, confusion.

Warnings & Precautions

Don't take if:

• You are allergic to any sulfonurea.
• You have impaired kidney or liver function.

Before you start, consult your doctor:

• If you have a severe infection.
• If you have thyroid disease.
• If you take insulin.
• If you have heart disease.

Over age 60:
Dose usually smaller than for younger adults. Avoid episodes of low blood sugar because repeated ones can damage brain permanently.

Pregnancy:
Discuss any use of these drugs with your doctor.

Breast-feeding:
Drug filters into milk. May lower baby's blood sugar. Avoid.

Infants & children:
Don't give to infants or children.

Prolonged use:

• Adverse effects more likely.
• Talk to your doctor about the need for follow-up medical examinations or laboratory studies to check blood sugar, complete blood counts (white blood cell count, platelet count, red blood cell count, hemoglobin, hematocrit), eyes.

Skin and sunlight:
Increased sensitivity to sunlight.

Driving, piloting or hazardous work:
No problems expected unless you develop hypoglycemia (low blood sugar). If so, avoid driving or hazardous activity.

Discontinuing:
Don't discontinue without consulting doctor. Dose may require gradual reduction if you have taken drug for a long time. Doses of other drugs may also require adjustment.

Others:

• Don't exceed recommended dose. Hypoglycemia (low blood sugar) may occur, even with proper dose schedule. You must balance medicine, diet and exercise.
• May affect results in some medical tests.
• Advise any doctor or dentist whom you consult that you take this medicine.
• Warning: A large study has shown that there is an increase in death rate from heart disease among those who take oral diabetic agents.

Possible Interaction with Other Drugs

GENERIC NAME	COMBINED EFFECT
------------------------	-----------------------
Androgens*	Increased blood-sugar lowering.
Anticoagulants,	Unpredictable
oral*	prothrombin times.
Anticonvulsants,	Decreased
hydantoin*	blood-sugar lowering.
Aspirin	Increased blood-sugar lowering.
Beta-adrenergic	Increased blood-
blockers*	sugar lowering. Possible increased
	difficulty in regulating blood-
	sugar levels.
Bismuth	Increased insulin
subsalicylate	effect. May require dosage
	adjustment.
Chloramphenicol	Increased blood-sugar lowering.
Cimetidine	Increased blood-sugar lowering.
Clofibrate	Increased blood-sugar lowering.
Contraceptives,	Decreased blood-sugar lowering.
Cortisone drugs*	Decreased blood-sugar lowering.
Dapsone	Increased risk of adverse effect
	on blood cells.
Desmopressin	May increase desmopressin effect.
Dextrothyroxine	Antidiabetic may require
	adjustment.
Digoxin	Possible decreased digoxin effect.
Diuretics*	Decreased blood-sugar lowering.
Epinephrine	Increased blood-sugar lowering.
Estrogens*	Increased blood-sugar lowering.
Fluconazole	Greater than expected drop in blood
	sugar. If any oral antidiabetic
	drug is taken with fluconazole,
	blood sugars must be monitored
	carefully.
Guanethidine	Unpredictable blood-sugar lowering
	effect.
Hemolytics*	Increased risk of adverse effect
	on blood cells.
Insulin	Increased blood-sugar lowering.
Isoniazid	Decreased blood-sugar lowering.
Labetalol	Increased blood-sugar lowering, may
	mask hypoglycemia.
MAO inhibitors*	Increased blood-sugar lowering.
Nicotinic acid	Decreased blood-sugar lowering.
Non-steroidal	Increased blood-sugar lowering.
Oxyphenbutazone	Increased blood-sugar lowering.
Phenothiazines	Decreased blood-sugar lowering.
Phenylbutazone	Increased blood-sugar lowering.
Phenyramidol	Increased blood-sugar lowering.
Phenytoin	Decreased blood-sugar lowering.
Probenecid	Increased blood-sugar lowering.
Pyrazinamide	Decreased blood-sugar lowering.
Ranitidine	Increased blood-sugar lowering.
Rifampin	Decreased blood-sugar lowering.
Sulfa drugs*	Increased blood-sugar lowering.
Sulfadoxine and	Increased risk of toxicity.
Sulfaphenazole	Increased blood-sugar lowering.
Thyroid hormones*	Decreased blood-sugar lowering.

Possible Interaction with Other Substances

INTERACTS WITH	COMBINED EFFECT
---------------	---------------
Alcohol:	Disulfiram reaction*. Avoid.
Beverages:	None expected.
Cocaine:	No proven problems.
Foods:	None expected.
Marijuana:	Decreased blood-sugar lowering.
	Avoid.
Tobacco:	None expected.