Tolazamide dosing

Insulin dose Initial tolazamide dose Insulin withdrawal... 

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. 

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. 

Because smoking increases corticosteroid release, smokers may require higher doses of tolazamide. 

The first-generation sulfonylureas vary considerably in their half-lives and extents of metabo-hsm. The tj of acetohexamide is short, but it is reduced to an active compound whose tj is similar to those of tolbutamide and tolazamide (4-7 hours). These drugs may require divided daily doses. Chlorpropamide has a long (24-48 hours). The second-generation agents are approximately... 

Mechanism of Action. Based on the radiactive studies it has been observed that nearly 85% of an oral dose usually appears in the urine as its corresponding metabolites which were certainly more water-soluble than the parent tolazamide itself. 

A patient taking tolazamide became hypoglycaemic 11 days after starting to take doxepin 250 mg daily. The patient was eventually stabilised on a daily dose of tolazamide that was only 10% of that used before the doxepin was given. ... 

Large and toxic doses of phenytoin have been observed to cause hyperglycaemia, but normal therapeutic doses do not usually affect the control of diabetes. Two isolated cases of phenytoin toxicity have been attributed to the use of tolazamide or tolbutamide. Miglitol does not affect the bioavailability of phenytoin. 

Tolbutamide 500 mg two or three times daily was given to 17 patients taking phenytoin 100 to 400 mg daily. The patients had a transient 45% rise in the amount of non-protein-bound phenytoin by day 2, which had disappeared by day 4. The introduction to this report briefly mentions a man given phenytoin and tolazamide who developed phenytoin toxicity, which disappeared when the tolazamide was replaced by insulin. A woman previously uneventfully treated with phenytoin and tolbutamide developed toxicity on a later occasion when she took tolbutamide with twice the previous dose of phenytoin. One study in healthy subjects found that miglitol 100 mg three times daily for 5 days did not affect the bioavailability of a single 400-mg dose of phenytoin. ... 

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