Chlorpropamide dosing

Insulin dose Initial chlorpropamide dose Insulin withdrawal... 

In a brief report, a potential interaction between curry and chlorpropamide, leading to reduction in chlorpropamide dose in a 40-year-old woman was attributed to the garlic and karela components of this complex mixture (70). Garlic reportedly can lower blood glucose. However, there was no information provided regarding the estimated amount of garlic intake in this patient. To date, there are no formal studies that confirm the initial clinical observation or evaluate the likely mechanism. 

The recommended starting doses (see Table 19-5) should be reduced in elderly patients who may have compromised renal or hepatic function. Dosage can be titrated every 1 to 2 weeks (longer interval with chlorpropamide) to achieve glycemic goals. 

Urine alkalinization is a treatment modality that increases elimination of poisons by the intravenous administration of sodium bicarbonate to produce urine with a pH of more than or equal to 7.5 and must be supported by high urine flow. This technique might be useful for the elimination of drugs with an acid pKa such as salicylates (but not recommended for phenobarbital intoxication for which multiple-dose activated charcoal is better), chlorpropamide, 2,4-dichlorophenoyacetic acid, diflunisal, fluoride, mecoprop, methotrexate. Complications include severe alkalemia, hypokalemia, hypocalcemia and coronary vasoconstriction. 

Tolazamide is comparable to chlorpropamide in potency but has a shorter duration of action. Tolazamide is more slowly absorbed than the other sulfonylureas, and its effect on blood glucose does not appear for several hours. Its half-life is about 7 hours. Tolazamide is metabolized to several compounds that retain hypoglycemic effects. If more than 500 mg/d are required, the dose should be divided and given twice daily. 

These include mesalazine, metformin, NSAIDs, tetracyclines (except doxycycline and minocycline), chloramphenicol, lithium, methotrexate, chloroquine, fibrates, chlorpropamide and glibenclamide, Clinically, it is useful to measure urine output per hour or per 24 hours as a fall in urine output in the presence of adequate fluid intake often indicates or warns of some impairment of renal function. Furthermore, it is neither expensive nor time-consuming to perform a quick test for albumin, casts and red cells in the urine, and to measure pH. Creatinine clearance values are often used to determine the safe doses for several drugs (e.g. NSAIDs, ciclosporin). 

Following single oral doses of 250 mg to 6 subjects, peak plasma concentrations of 23.9 to 39.4 pg/ml (mean 28) were attained in 1 to 7 hours. After daily oral doses of 250 to 500 mg to 4 subjects, steady-state plasma concentrations of 75.5 to 245.5 pg/ml (mean 142) were reported plasma concentrations of 4-chlorobenzenesulphonylurea and 2-hydroxy-chlorpropamide ranged from 3 to 6 pg/ml and < 1 to 9 ig/ml, respectively (J. A. Taylor, Clin. Pharmac. Ther., 1972, 75, 710-718). 

Oral formulations of Momordica charantia (karela fruit, bitter melon) have hjrpoglycemic activity in non-insulin dependent diabetes meUitus (8,9), and can interfere with conventional treatment with diet and chlorpropamide (10). In 15 patients aged 52-65 years a soft extract of M. charantia plus half doses of metformin or glibenclamide or both in combination caused hjrpoglycemia greater than that caused by full doses during treatment for 7 days (11). Subcutaneous injection of a principle obtained from the fruit may lower blood glucose concentrations in juvenile diabetes. 

Tolazamide, U5P. Tolazamide. l-(hexahydrn-l/f-azcpin-l-yl)-3-(/r-tolylsulfonyl)urea (Tolinase). is an analogue of tolbutamide and is reported to be effective, in general, under the same eireumstanccs in which tolbutamide is useful. Tolazamide, however, appears to be more potent than tolbutamide and is nearly equal in potency to chlorpropamide. In studies with radioactive tolazamide, investigators found that 85% of an oral dose appeared in the urine as metabolites that were more soluble than tolazamide itself. 

Rats and mice exposed to chlorpropamide at doses greater than 6000 ppm for 2 years found no evidence of increased rates of tumor development. 

Sulfonylurea Tolbutamide, chlorpropamide, glyburide. Monitor blood glucose may require dose increase or change to an... 

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