Hypoglycaemic agents sulphonylureas

Miscellaneous drugs Hypoglycaemic agents Sulphonylurea, antidiabetic drugs like chlorpropamide or tolbutamide, in the presence of the respective metabolites of either extracted in ether from acidified plasma. Partition (i Bondapak Clg 0.05M ammonium formate/acetonitrile (83 17)... 

II.f.2.1. Oral hypoglycaemic agents. There are now five groups of orally active drugs available to lower blood glucose in clinical practice (Table 2). These are sulphonylureas, biguanides, alpha-glucosidase inhibitors, thiazolidinediones, and the incretin derivatives. 

This review will concentrate on new agents or new data on older agents reported in the past 5 years, and is confined to compounds with reported hypoglycaemic activity in man and/or animal models of IDDM or NIDDM. The patent literature has been recently reviewed [6] and will not be covered here. Established agents (sulphonylureas, biguanides) have been the subject of recent reviews and the reader is referred to those [4, 7-12]. 

There are three conditions for the clinical use of metformin as a glucose-lowering agent in patients with NIDDM (1) as a primary drug, (2) in combination with other oral hypoglycaemic agents such as sulphonylureas and acarbose, and (3) together with insulin after secondary sulphonylurea failure. 

Linogliride and pirogliride are oral hypoglycaemic agents which differ in their mechanism of action from the biguanides and sulphonylureas. Both are potent enhancers of glucose-induced insulin secretion [375,376]. 

THIAZIDES SULPHONYLUREAS Hypoglycaemic efficacy is 1 Hyperglycaemia due to antagonistic effect Monitor blood glucose regularly until stable. Higher dose of oral antidiabetic agent often needed... 

SULPHONYLUREAS ANTIPLATELET AGENTS -ASPIRIN Risk of hypoglycaemia when high-dose aspirin (3.5—7.5 g/day) is given with antidiabetic drugs Additive effect aspirin has a hypoglycaemic effect Avoid high-dose aspirin... 

Exogenous insulin or insulinotropic oral agents such as sulphonylureas are not suitable for improving insulin resistance. Non-insulinotropic hypoglycaemic medication such as biguanides and/or acarbose, however, is recommended if diet alone fails to achieve sufficient metabolic control. It is still controversial, however, whether the reduction of endogenous insulin also reduces the synthesis of islet amyloid polypeptide (IAPP) sufficiently to slow down the progression of NIDDM (Clark et al., 1987). 

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