Treatment sulfonylureas

Sulfonylureas are accessible by the many methods that have been developed for the preparation of simpler ureas. For example, treatment of p-toluenesulfonamide (184) with butyl isocyanate (185) affords tolbutamide (186). ... 

Meglitinide contains a benzamide group. Meglitinide-related compounds such as nateglinide are non-sulfonylurea oral hypoglycemic drugs used in the treatment of type 2 (non-insulin dependent) diabetes mellitus. 

Type 2 diabetes mellitus For type 2 diabetes, as an adjunct treatment in patients who use mealtime insulin therapy and who have failed to achieve desired glucose control despite optimal insulin therapy, with or without a concurrent sulfonylurea agent and/or metformin. 

Repaglinide en nateglinide are not sulfonylurea agents but their mechanism of action is very alike. Repaglinide is the first carbamoylmethyl-benzoic acid derivative that has been registred for the treatment of diabetes mellitus. It closes ATP-dependent potassium channels in the beta cell membrane with consequent depolarization, opening of calcium channels and increased insulin release. It is rapidly absorbed with peak plasma levels after 1 hour. It has a protein binding of over 98%. 

Krentz AJ, Boyle PJ, Justice KM, Wright AD, Schade DS. Successful treatment of severe refractory sulfonylurea-induced hypoglycemia with octreotide. Diabetes Care 1993 16(l) 184-6. 

Sulfonylureas are the most widely prescribed drugs in the treatment of type 11 diabetes mellitus. The initial sulfonylureas were introduced nearly 50 years ago and... 

All sulfonamides, including antimicrobial sulfas, diuretics, diazoxide, and the sulfonylurea hypoglycemic agents, have been considered to be partially cross-allergenic. Flowever, evidence for this is not extensive. The most common adverse effects are fever, skin rashes, exfoliative dermatitis, photosensitivity, urticaria, nausea, vomiting, diarrhea, and difficulties referable to the urinary tract (see below). Stevens-Johnson syndrome, although relatively uncommon (ie, < 1% of treatment courses), is a particularly serious and potentially fatal type of skin and mucous membrane eruption associated with sulfonamide use. Other unwanted effects include stomatitis, conjunctivitis, arthritis, hematopoietic disturbances (see below), hepatitis, and, rarely, polyarteritis nodosa and psychosis. 

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