Sulfonylureas DI Flashcards
Sulfonylurea MoA
Stimulate insulin release from beta cells
SUs site of action
Beta cells
SU products
Glyburide, glipizide, glimepiride
Glyburide brand names
DiaBeta, Micronase, Glynase Prestabs
Glipizide brand names
Glucotrol, Glucotrol XL
Glimepiride brand name
Amaryl
Glyburide dosing
1.25-20mg PO daily, MDD 20mg
Glipizide dosing
IR: 2.5-20mg PO once or twice daily, MDD 40mg
If daily dose is >15mg, divide into BID dosing
Glimepiride dosing
1-4mg PO daily, MDD 8mg
SUs on the Beers list
Glyburide, glimepiride
SU side effects
HYPOGLYCEMIA, N/V, weight gain
SU drug interaction
Alcohol- avoid alcohol!
SU contraindication
CrCl <50 mL/min (glyburide only), hypersensitivity, DKA, T1DM, glyburide and glipizide are CI’ed in pregnancy near term
SU precautions
Sulfonamide allergy, elderly, impaired liver and renal function
SU counseling points
Take first thing in the morning with breakfast or the first meal of the day
If it upsets your stomach- take it with food
Avoid alcohol
What do you ask about at every refill of a SU?
Hypoglycemia and weight gain
SU A1C lowering
High (0.8-2%)
SU effect on ASCVD, CKD, HF
Neutral, don’t affect HF, CKD, ASCVD
SU monitoring
Hypoglycemia, FBG, A1C, weight gain, allergic reactions, sun sensitivity
SU time to full effect
4-6 weeks
ADA guidelines for SUs
Use when cost is a major issue
AACE guidelines for SUs
Last-line option for monotherapy, but somewhere in the middle for dual and triple therapy (it’s not your last-line option but it’s also not your first choice)
Renal dosing for SUs
(This dosing isn’t recommended)
Glyburide: CrCl <50
Glimepiride: eGFR <15
Glipizide: eGFR <10
