Let’s have a discussion about sulfonylurea, an antidiabetic medication for type 2 diabetic patients.
What is sulfonylurea?
It is a medication for the treatment of high blood glucose in patients suffering from type 2 diabetes mellitus.
There are two generations of this medication: the first generation includes chlorpropamide and tolbutamide.
The second generation includes glimepiride (amaryl), gliclazide (diamicron), Glibenclamide (daonil) and glipizide (minodiab).
Medications that belong to this generation are more efficient with fewer side effects than the first-generation medications.
It is an oral medication. It is taken once or twice a day before meals as follow:
Gliclazide, glibenclamide, glibizide as well as glimepride are taken once daily.
Two doses per day for tolbutamide.
Indication of sulfonylurea
Type 2 diabetes mellitus.
Mechanism of action
Sulfonylurea stimulates the pancreas to secrete insulin. It’s efficacy decrease by time because of the lowered sensitivity of the pancreas and its ability to release insulin.
It increases the sensitivity of the tissues to insulin so the peripheral organs such as the liver and muscles will be able to utilize glucose more efficiently.
Most probably, the patient will need another antidiabetic medication with sulfonylurea, namely insulin, and metformin.
This medication is metabolized in the liver and excreted from the kidneys, hence its contraindications as regards liver and kidney diseases.
Side effect of sulfonylurea
The most common and most serious side effect is the lowering of blood sugar levels secondary to the release of insulin.
This can be severe if the patient is using another antidiabetic medication simultaneously with sulfonylurea.
The first generation of sulfonylurea is not preferred secondary to its side effects such as insulin resistance and increase body weight.
Choropropamide causes abnormal secretion of antiduretic hormone.
Disturbed heart rhythm in large doses.
Glimepiride can cause cholestatic hepatitis and jaundice.
Few cases show nausea, vomiting, diarrhea or constipation.
Allergic reactions which may be severe in the form of erythema multiformis.
It is rare to cause sensitivity to light.
Decreased white blood cell as well as platelet counts.
Pancytopenia and aplastic anemia (global reduction in the count of all blood cells)
In additions, destruction of the red blood cells (hemolytic anemia).
Contraindication of sulfonylurea
Type 1 diabetes mellitus.
Severe kidneys or liver dysfunction.
Obese patients because sulfonylurea use can lead to gaining weight.
Precautions to use
The following patients may experience lowering of the blood sugar upon using sulfonylurea:
- The patients with liver or kidney impairment.
- Patients are older than 65 years because of the risk of renal and liver dysfunction.
- Those patients who eat their meals in irregular times.
- Intake of another antidiabetic medication.