Class: Second-Generation Sulfonylurea, Antidiabetic
Dosage Forms. Tablet: 1.25 mg, 2.5 mg, 5 mg; Tablet [Micronized]: 1.5 mg, 3 mg, 6 mg
Common FDA Label Indication, Dosing, and Titration.
1. Diabetes mellitus, Type II: 1.25-20 mg po daily; titrate to effect, max dose 20 mg daily
Off-Label Uses. None
MOA. Sulfonylureas enhance insulin secretion from pancreatic β-cells and potentiate insulin action on several extrahepatic tissues. Long-term sulfonylureas increase peripheral utilization of glucose, suppress hepatic gluconeogenesis, and possibly increase the sensitivity and/or number of peripheral insulin receptors.
Drug Characteristics: Glyburide
Medication Safety Issues: Glyburide
Drug Interactions: Glyburide
Adverse Reactions: Glyburide
Efficacy Monitoring Parameters. Preprandial blood glucose between 70 and 130 mg/dL, HbA1c <7%.
Toxicity Monitoring Parameters. Symptoms of hypoglycemia include nausea, sweating, and loss of consciousness. Seek medical attention if yellowing of skin or eyes, severe skin rash, unusual bruising, or bleeding.
Key Patient Counseling Points. Monitor blood glucose in frequent intervals (2-4 times per day); if <70 mg/dL, eat candy or sugar and contact prescriber. Use a sunscreen and avoid sunlamps and tanning beds. Do not drink alcohol, may cause a disulfiram reaction. Take 30 min before morning meal.
Clinical Pearls. Metformin is first-line therapy for Type II diabetes. A sulfonylurea may be added if HbA1c goals are not achieved with metformin alone. Not for use in children. Hemolytic anemia is most likely to occur in patients with G6PD deficiency. Patients on insulin: when switching patients from insulin to glyburide-insulin <20 units daily, use glyburide 2.5-5 mg daily; insulin 20-40 units daily, use glyburide 5 mg daily; insulin >40 units daily, use glyburide 5 mg daily, and 50% insulin dose reduction over a transition period. Glynase is the micronized formulation.