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Sulfonylurea (drugs (Gliclazide (Diamicron, start: 80 mg bid, max: 320 mg)…
Sulfonylurea
drugs
Gliclazide
Diamicron
start: 80 mg
bid
max: 320 mg
Gliclazide
Diamicron
MR
start 30 mg
od
(in am)
max: 120 mg
Glimepiride, 2nd generation
Amaryl
start 1 mg od
max: 8 mg
Glyburide: 1st generation
Diabeta
start 2.5 mg od
max: 20 mg
contraindications
cautious with Glyburide at eGFR of 50
stop at eGFR of 30
avoid in hepatic failure (Glyburide)
with insulin
cautious with Gliclazide at eGFR of 30
stop at eGFR of 15
timing
onset
peak
glyburide
2-4 hrs
gliclazide
4-6 hrs
glimepiride
2-4 hrs
duration
24 hours
full effectiveness
Benefits
decr. A1C by 1-1.5%
rapid bs lowering
decr fbs by 3.3-3.9 points
decr. pc bs
Side effect
Hypoglycemia
significant in elderly (Glyburide)
weight gain
pathophysiology
stimulate beta cells
late secretion of insulin
glucose-independent
Special population
seniors
half starting dose
slow dose increases