Sulfonylureas dosing

Pramlintide is approved for concurrent mealtime administration in individuals with type 2 diabetes treated with insulin, metformin, or a sulfonylurea who are unable to achieve their postprandial glucose targets. Combination therapy results in a significant reduction in early postprandial glucose excursions mealtime insulin or sulfonylurea doses usually have to be reduced to prevent hypoglycemia. 

Adverse effect Hypoglycemia due to sulfonylureas Dose-relation toxic effect Time-course time-independent Susceptibility factors disease (impaired liver or kidney function, alcoholism) drug interactions reduced food intake exercise... 

Adverse effect Hypoglycemia due to sulfonylureas Dose-relation toxic effect Time-course time-independent... 

Sulfonylureas) Dose (mg) Binding (%) ty (hour) (hour) Excretion (%)... 

Relative potency alone does not determine dmg selection because maximal effectiveness is similar for all agents. A single daily dose of any sulfonylurea, except tolbutamide, is sometimes adequate to control blood glucose in NIDDM patients. 

BIGUANIDES. The nurse gives metformin two or three times a day with meals. If the patient has not experienced a response in 4 weeks using the maximum dose of metformin, the primary care giver may add an oral sulfonylurea while continuing metformin at the maximum dose. Glucophage XR (metformin extended release) is administered once daily with the evening meal. 

Sulfonylurea herbicides are generally applied to crops as an early post-emergent herbicide. Crops that are tolerant to these herbicides quickly metabolize them to innocuous compounds. At maturity, residues of the parent compound in food and feed commodities are nondetectable. Metabolites are not considered to be of concern, and their levels are usually nondetectable also. For this reason, the residue definition only includes the parent compound. Tolerances [or maximum residue limits (MRLs)] are based on the LOQ of the method submitted for enforcement purposes and usually range from 0.01 to 0.05 mg kg (ppm) for food items and up to O.lmgkg" for feed items. There is no practical need for residue methods for animal tissues or animal-derived products such as milk, meat, and eggs. Sulfonylurea herbicides are not found in animal feed items, as mentioned above. Furthermore, sulfonylurea herbicides intentionally dosed to rats and goats are mostly excreted in the urine and feces, and the traces that are absorbed are rapidly metabolized to nontoxic compounds. For this reason, no descriptions of methods for animal-derived matrices are given here. 

Sulfonylureas exert a hypoglycemic action by stimulating pancreatic secretion of insulin. All sulfonylureas are equally effective in lowering blood glucose when administered in equipotent doses. On average, the A1C will fall by 1.5% to 2% with FPG reductions of 60 to 70 mg/dL (3.3 to 3.9 mmol/L). 

Y = yes, N = no) Sulfonylureas Brand (mg) Nonetderty Elderly Dose (mg) (mg/day) Action Metabolism or Therapeutic Notes... 

In contrast to sulfonylureas and thiazolidinediones, miglitol does not enhance insulin secretion. Miglitol has minor inhibitory activity against lactase and, at recommended doses, would not be expected to induce lactose intolerance. 

Concomitant therapy When exenatide is added to sulfonylurea therapy, a reduction in the dose of sulfonylurea may be considered to reduce the risk of hypoglycemia. 

Sulfonylureas Approximate equivalent doses (mg) Doses/day Serum VA (h) Onset (h) Duration (h) ... 

If patients have not satisfactorily responded to 1 to 3 months of concomitant therapy with the maximum doses of metformin and an oral sulfonylurea, consider institution of insulin therapy and discontinuation of these oral agents. 

Combination therapy - When rosiglitazone is added to existing therapy, the current dose of sulfonylurea, insulin, or metformin can be continued upon initiation of rosiglitazone therapy. 

Sulfonylureas When used in combination with sulfonylurea, the recommended dose of rosiglitazone is 4 mg either as a single dose once daily or in divided doses twice daily. If patients report hypoglycemia. 

Sulfonylureas Initiate pioglitazone in combination with a sulfonylurea at 15 or 30 mg once daily. Decrease the dose of the sulfonylurea if patients report hypoglycemia. 

Hypoglycemia Patients receiving pioglitazone or rosiglitazone in combination with insulin or oral hypoglycemics (eg, sulfonylureas) may be at risk for hypoglycemia reduction in the dose of insulin or sulfonylureas may be necessary. 

Patients previously treated with combination therapy of glyburide (or another sulfonylurea) plus metformin, if switched to glyburide/metformin hydrochloride, the starting dose should not exceed the daily dose of glyburide (or equivalent dose of another sulfonylurea) and metformin already being taken. 

Hypoglycemia - If hypoglycemia occurs during up-titration of the dose or while maintained on therapy, a dosage reduction of the sulfonylurea component of rosiglitazone/glimepiride may be considered. 

Nephropathy in type 2 diabetes-The usual starting dose is 50 mg once daily. Increase the dose to 100 mg once daily based on blood pressure response. Losartan may be administered with insulin and other commonly used hypoglycemic agents (eg, sulfonylureas, glitazones, glucosidase inhibitors). 

Diabetic patients Weight-loss induction by orlistat may be accompanied by improved metabolic control in diabetic patients, which might require a reduction in dose of oral hypoglycemic medication (eg, sulfonylureas, metformin) or insulin. Misuse potential As with any weight-loss agent, the potential exists for misuse of orlistat in inappropriate patient populations (eg, patients with anorexia nervosa or bulimia). 

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