Precautions for the use of oral sulfonylureas

All oral sulfonylurea antidiabetic drugs are potential hypoglycemic agents.

SITUATIONS CREATING RISK OF HYPOglycemia:

Malnutrition (lack of calorie intake)
Long and heavy exercise
• Concomitant use of alcohol
Concomitant intake of another glucose-lowering drug (antidiabetic drug combinations)

Elderly (>80 years) (prolonged hypoglycemia lasting more than 12 hours has been reported)
• Patients with malnutrition
•Patients with renal failure (creatinine clearance < 30% ml/min)

•Patients with impaired liver function

•Herbal products (alpha alpha, bilberry, bittermelon, burdock, celery, damiana, fenugreen, garana, garlic, ginger, ginseng-American-, gymnema, marshmellow, stingingnettle)

II- HYPERSENSIVITY REACTIONS

During sulfonylurea treatment, immunological reactions such as allergy, anaphylactoid reactions, anaphylaxis, angioedema, and serum sickness may develop in people who have allergic reactions to sulfonamides.

III- AGE FACTOR

Diabetic people older than 80 years of age are at risk of drug accumulation in the blood due to both existing or developing diabetic nephropathy and decreased liver and kidney functions due to old age.

As a result of this, besides hypoglycemia due to sulfonylureas, organ and tissue toxicity, especially kidney and liver, may occur. Strict monitoring and dose titration should be performed in such patients.

IV- USE OF CHEMICALLY SIMILAR MOLECULES

Antibiotics: sulfonamides such as Co-trimoxazole
•Other sulfonylurea OADs
• Carbonic anhydrase inhibitors
Thiazides and similar diuretics
Loopdiuretics (other than ethacrylic acid)
•Antigutilacs (sulfinpyrazon), (ANTURAN is not used in our country)
• Sulfasalazine (salicylazosulfapyridine) (in the treatment of colitis ulcerosa and arthrosis)

• Concomitant use of sulfanilurea group oral antidiabetics and chemically similar drugs may lead to both an increase and a decrease in the antiglycemic effect ( hypoglycemia / hyperglycemia).

V- GLUCOSE 6 PHOSPHATE DEHYDROGENASE DEFICIENCY

•People with congenital G-6 PD deficiency may develop hemolyticanemia (sulfonamidanemia).
VI- SITUATIONS WHERE SULFONILURE THERAPY IS ACUTE CUT INTO INSULIN

• High fever
• Trauma, fall, fracture, traffic accident etc.
• Infection
• Surgical intervention
• Anesthesia

VII- DRUG INTERACTIONS

ØANTIBIOTICS

– Co-trimoxazole
– Other sulfonamide antibiotics
– Tetracycline
– Pentamidine(yb)
– Moxifloxacin
– mebendazole

ØANTIVIRALS

– nelfinavir
– Chloroquin

ØBeta blockers

– Acebutolol (OD)
– Atenolol (OD)
– Betaxolol (OD)
– Bisoprolol
– Carvedilol
– labetalol
– Pindolol (OD)
– Timolol

Ø Antidepressants

– Floxetine
– lithium
– MAO inhibitors

Ø Slimming Drugs

– Orlistat
– Sibutramine

Ø Drugs Used by Athletes

– Anabolic steroids
– Calcium
– Ferric gluconate

ØAnalgesic, Anti-inflammatory Drugs

– Aspirin
– Other salicylates
– Phenylbutazone

Ø Antihypertensive Drugs

– Guanethidine
– Enalapril

VIII- INCREASED IN CARDIOVASCULAR MORBIDITY AND MORTALITY

Risk of ventricular arrhythmia due to possible abrupt changes in action potential as a result of inhibition of cardiac muscle potassium pump.

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