Management of noninsulin-dependent diabetes mellitus (type II)

Use with caution in patients with hepatic impairment.
Elderly: Rapid and prolonged hypoglycemia (>12 hours) despite hypertonic glucose injections have been reported; age and hepatic and renal impairment are independent risk factors for hypoglycemia; dosage titration should be made at weekly intervals.

Use with caution in patients with renal and hepatic impairment, malnourished or debilitated conditions, or adrenal or pituitary insufficiency.
The administration of oral hypoglycemic drugs (ie, tolbutamide) has been reported to be associated with increased cardiovascular mortality as compared to treatment with diet alone or diet plus insulin.

Hypersensitivity to glyburide or any component, or other sulfonamides; type I diabetes mellitus, diabetic ketoacidosis with or without coma.

>10%: Central nervous system: Headache, dizziness
Gastrointestinal: Nausea, epigastric fullness, heartburn, constipation, diarrhea, anorexia
Ocular: Blurred vision
1% to 10%:Dermatologic: Pruritus, rash, urticaria, photosensitivity reaction
<1%: Hypoglycemia, nocturia, leukopenia, thrombocytopenia, hemolytic anemia, aplastic anemia, bone marrow suppression, agranulocytosis, cholestatic jaundice, arthralgia, paresthesia, diuretic effect

Decreased effect: Thiazides may decrease effectiveness of glyburide.
Increased effect: Possible interaction between glyburide and fluoroquinolone antibiotics has been reported resulting in a potentiation of hypoglycemic action of glyburide.

Increased toxicity: Since this agent is highly protein bound, the toxic potential is increased when given concomitantly with other highly protein bound drugs (ie, phenylbutazone, oral anticoagulants, hydantoins, salicylates, NSAIDs, beta-blockers, sulfonamides) - increase hypoglycemic effect.
Alcohol increases disulfiram reactions. Phenylbutazone can increase hypoglycemic effects Certain drugs tend to produce hyperglycemia and may lead to loss of control (ie, thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid)
Possible interactions between glyburide and coumarin derivatives have been reported that may either potentiate or weaken the effects of coumarin derivatives.

Symptoms of overdose include severe hypoglycemia, seizures, cerebral damage, tingling of lips and tongue, nausea, yawning, confusion, agitation, tachycardia, sweating, convulsions, stupor, and coma
Intoxications with sulfonylureas can cause hypoglycemia and are best managed with glucose administration (oral for milder hypoglycemia or by injection in more severe forms)

Adults: Initial: 2.5-5 mg/day, administered with breakfast or the first main meal of the day. In patients who are more sensitive to hypoglycemic drugs, start at 1.25 mg/day. Increase in increments of no more than 2.5 mg/day at weekly intervals based on the patient’s blood glucose response
Maintenance: 1.25-20 mg/day given as single or divided doses; maximum: 20 mg/day

Elderly: Initial: 1.25-2.5 mg/day, increase by 1.25-2.5 mg/day every 1-3 weeks
Micronized tablets (Glynase PresTab™): Adults: Initial: 1.5-3 mg/day, administered with breakfast or the first main meal of the day in patients who are more sensitive to hypoglycemic drugs, start at 0.75 mg/day. Increase in increments of no more than 1.5 mg/day in weekly intervals based on the patient’s blood glucose response.
Maintenance: 0.75-12 mg/day given as a single dose or in divided doses. Some patients (especially those receiving >6 mg/day) may have a more satisfactory response with twice-daily dosing.
Dosing adjustment/comments in renal impairment: Clcr <50 mL/minute: Not recommended
Dosing adjustment in hepatic impairment: Use conservative initial and maintenance doses and avoid use in severe disease

This medication is used to control diabetes; it is not a cure. Other components of treatment plan are important: follow prescribed diet, medication, and exercise regimen. Take exactly as directed; 30 minutes before meal(s) at the same time each day. Do not change dose or discontinue without consulting prescriber.

Avoid alcohol while taking this medication; could cause severe reaction. Inform prescriber of all other prescription or OTC medications you are taking; do not introduce new medication without consulting prescriber. Do not take other medication within 2 hours of this medication unless so advised by prescriber. If you experience hypoglycemic reaction, contact prescriber immediately. Maintain regular dietary intake and exercise routine and always carry quick source of sugar with you. You may be more sensitive to sunlight (use sunscreen, wear protective clothing and eyewear, and avoid direct sunlight). You may experience side effects during first weeks of therapy (headache, nausea); consult prescriber if these persist. Report severe or persistent side effects, extended vomiting or flu-like symptoms, skin rash, easy bruising or bleeding, or change in color of urine or stool. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Do not breast-feed.