- How does this medication work? What will it do for me?
- What form(s) does this medication come in?
- How should I use this medication?
- Who should NOT take this medication?
- What side effects are possible with this medication?
- Are there any other precautions or warnings for this medication?
- What other drugs could interact with this medication?
- More Reasons to Say Goodbye to Glyburide
- About glyburide
- Before taking glyburide
- How to take glyburide tablets
- Getting the most from your treatment
- Can glyburide cause problems?
- How to store glyburide
- Important information about all medicines
- What is DiaBeta?
- Important Information
- Before taking this medicine
- How should I take DiaBeta?
- What happens if I miss a dose?
- What happens if I overdose?
- What should I avoid while taking glyburide?
- DiaBeta side effects
- What other drugs will affect DiaBeta?
- Further information
- More about DiaBeta (glyburide)
- Glyburide Side Effects
Before taking glyburide,
- tell your doctor and pharmacist if you are allergic to glyburide, any other medications, or any of the ingredients in glyburide. Ask your pharmacist for a list of the ingredients.
- tell your doctor if you are taking bosentan (Tracleer). Your doctor may tell you not to take glyburide if you are taking this medication.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril, (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik); anticoagulants (‘blood thinners’) such as warfarin (Coumadin); aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); beta blockers such as atenolol (Tenormin), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal); calcium channel blockers such as amlodipine (Norvasc), diltiazem (Cardizem, Dilacor, Tiazac, others), felodipine (Plendil), isradipine (DynaCirc), nicardipine (Cardene), nifedipine (Adalat, Procardia), nimodipine (Nimotop), nisoldipine (Sular), and verapamil (Calan, Isoptin, Verelan); chloramphenicol; clarithromycin (Biaxin); cyclosporine (Neoral, Sandimmune); disopyramide (Norpace); diuretics (‘water pills’); fluconazole (Diflucan), fluoxetine (Prozac, Sarafem); gemfibrozil (Lopid), hormone replacement therapy and hormonal contraceptives (birth control pills, patches, rings, implants, and injections); insulin or other medications to treat high blood sugar or diabetes; isoniazid (INH); MAO inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate); medications for asthma and colds; medications for mental illness and nausea; miconazole (Monistat); niacin; oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone); phenytoin (Dilantin); probenecid (Benemid); quinolone and fluoroquinolone antibiotics such as cinoxacin (Cinobac), ciprofloxacin (Cipro), enoxacin (Penetrex), gatifloxacin (Tequin), levofloxacin (Levaquin), lomefloxacin (Maxaquin), moxifloxacin (Avelox), nalidixic acid (NegGram), norfloxacin (Noroxin), ofloxacin (Floxin), sparfloxacin (Zagam), trovafloxacin and alatrofloxacin combination (Trovan); rifampin; salicylate pain relievers such as choline magnesium trisalicylate, choline salicylate (Arthropan), diflunisal (Dolobid), magnesium salicylate (Doan’s, others), and salsalate (Argesic, Disalcid, Salgesic); sulfa antibiotics such as co-trimoxazole (Bactrim, Septra); sulfasalazine (Azulfidine); and thyroid medications. Also be sure to tell your doctor or pharmacist if you stop taking any medications while taking glyburide. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have or have ever had G6PD deficiency (an inherited condition causing premature destruction of red blood cells or hemolytic anemia); if you have hormone disorders involving the adrenal, pituitary, or thyroid gland; or if you have heart, kidney, or liver disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking glyburide, call your doctor.
- talk to your doctor about the risks and benefits of taking glyburide if you are 65 years of age or older. Older adults should not usually take glyburide because it is not as safe or effective as other medications that can be used to treat the same condition.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking glyburide.
- ask your doctor about the safe use of alcoholic beverages while you are taking glyburide. Alcohol can make the side effects from glyburide worse. Consuming alcohol while taking glyburide also rarely may cause symptoms such as flushing (reddening of the face), headache, nausea, vomiting, chest pain, weakness, blurred vision, mental confusion, sweating, choking, breathing difficulty, and anxiety.
- plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Glyburide may make your skin sensitive to sunlight.
- ask your doctor what to do if you get sick, develop an infection or fever, experience unusual stress, or are injured. These conditions can affect your blood sugar and the amount of glyburide you may need.
How does this medication work? What will it do for me?
Glyburide is an antidiabetes medication that belongs to the family of medications known as sulfonylureas. It is used to treat high blood sugar (hyperglycemia) in people with type 2 diabetes.
Antidiabetes medications such as glyburide are used when diet, exercise, and weight reduction have not been found to lower blood sugar well enough on their own. Glyburide increases the release of insulin (a hormone produced by the pancreas that allows sugar to enter into cells where it is needed for energy) and helps the body use insulin more efficiently.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
ratio-Glyburide is no longer being manufactured for sale in Canada. For brands that may still be available, search under glyburide. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.
How should I use this medication?
The recommended adult starting dose of glyburide is usually 5 mg daily (2.5 mg for patients over 60 years of age) and increases or decreases by 2.5 mg every 5 to 7 days until blood sugar is controlled. The recommended adult dose of glyburide ranges from 2.5 mg once daily to 10 mg twice daily. The maximum dose of glyburide is 20 mg daily.
Glyburide should be taken during or immediately after a meal, usually with breakfast or the first main meal of the day. If you eat only a light breakfast, wait until lunchtime to take your morning dose.
Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
Low blood sugar (hypoglycemia) is an important concern if too much of this medication is taken. Ask your doctor or diabetes educator what you should do when you are not going to be eating for a long period of time or when you are going to be exercising more than usual.
It is very important to monitor blood sugar levels closely, especially when increasing and decreasing doses of medication or when exercise level or weight changes occur. Your doctor or diabetes educator will instruct you on the best use of a diabetes monitor.
It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature, protect it from light and moisture and keep it out of reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not take glyburide if you:
- are allergic to glyburide or any ingredients of the medication
- are allergic to sulfonylurea or sulphonamide medications
- are breast-feeding or pregnant
- are in a diabetic coma or pre-coma (a result of hypoglycemia – symptoms include speech and visual disturbances, flushing, trembling, headache, nausea, vomiting)
- are taking the medication bosentan
- are undergoing surgery or has recently suffered severe trauma (a loss of blood sugar control may occur and insulin administration may be required)
- have diabetic ketoacidosis with or without coma
- have a serious infection (a loss of blood sugar control may occur and insulin administration may be required)
- have jaundice
- have serious kidney or liver impairment
- have type 1 diabetes
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- difficulty in focusing the eyes
- stomach pain, fullness, or discomfort
Although most of these side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- low blood sugar, including:
- anxious feelings
- behavioural changes similar to being drunk
- blurred vision
- cold sweats
- cool, pale skin
- difficulty concentrating
- excessive hunger
- fast heartbeat
- restless sleep
- slurred speech
- unusual tiredness or weakness
- skin redness, itching, or rash
- signs of bleeding (e.g., bloody nose, blood in urine, coughing blood, bleeding gums, cuts that don’t stop bleeding)
- signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
- signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
Stop taking the medication and seek immediate medical attention if any of the following occur:
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.
Allergy: Some people who are allergic to sulfonamide antibiotics and other sulfonylurea anti-diabetes medications also experience allergic reactions to glyburide. Before you take glyburide, inform your doctor about any previous adverse reactions you have had to medications, especially sulfamethoxazole or glipizide. Contact your doctor at once if you experience signs of an allergic reaction, such as skin rash, itching, difficulty breathing or swelling of the face and throat.
Blood sugar control: For people who take glyburide, loss of blood sugar control may occur during illness or stressful situations such as trauma or surgery. Under these conditions, your doctor may consider stopping the medication and prescribing insulin until the situation improves.
Diabetes complications: The use of glyburide (or any other medication used for diabetes) will not prevent the development of complications peculiar to diabetes mellitus (e.g., kidney disease, nerve disease, eye disease).
Diet and exercise: Glyburide should be used in addition to a proper dietary regimen and exercise. If you do not follow a proper dietary and exercise regimen, it is more likely that glyburide will not work, and your diabetes will get worse.
Kidney function: If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, which will cause side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.
If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.
Low blood sugar: As with other sulfonylurea medications like gliclazide or glimepiride, hypoglycemia (low blood sugar) may occur. Situations which may bring this on include:
- advanced age
- alcohol use
- certain thyroid diseases
- exercise without adequate calorie intake
- liver disease or kidney disease
- malnutrition or irregular meals
Signs of low blood sugar include:
- lack of energy
- numbness or tingling
Monitor your blood glucose regularly and keep emergency glucose (and a glucagon kit) available in case you need to increase blood sugar levels quickly. Talk with your doctor or diabetes educator about this.
Mental or physical abilities: This medication may reduce the mental or physical abilities required for hazardous tasks such as driving or operating dangerous machinery. Use appropriate caution until you have gained control of your blood sugar, when changing doses of medication, or when the tablets have not been taken regularly.
Reduced response: Over time, glyburide may become less effective as your diabetes worsens. If glyburide fails to lower your blood glucose to target levels, it should be stopped and replaced, or another medication for diabetes should be added to it. Monitor your blood glucose levels regularly and if you notice them getting higher, contact your doctor to discuss alternatives.
Pregnancy: Glyburide should not be used during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: This medication may pass into breast milk. If you are a breast-feeding mother and are taking glyburide, it may affect your baby. Glyburide is not recommended for use by breast-feeding women.
Children: The safety and effectiveness of using this medication have not been established for children under the age of 18.
Seniors: Seniors with type 2 diabetes may be more likely to experience very low blood sugar as a result of using glyburide. Lower doses may be necessary.
What other drugs could interact with this medication?
There may be an interaction between glyburide and any of the following:
- acetylsalicylic acid (ASA)
- androgens (e.g., methyltestosterone, nandrolone, testosterone)
- angiotensin-converting enzyme inhibitors (ACEIs; captopril, ramipril)
- angiotensin receptor blockers (ARBs; e.g., candasartan, irbesartan, losartan)
- atypical antipsychotics (e.g., clozapine, olanzapine, quetiapine, risperidone)
- “azole” antifungals (e.g., fluconazole, ketoconazole, voriconazole)
- barbiturates (e.g., phenobarbital, secobarbital)
- beta-blockers(e.g. atenolol, carvedilol, propranolol)
- birth control pills
- corticosteroids (e.g., budesonide, dexamethasone, hydrocortisone, prednisone)
- diuretics (e.g., furosemide, hydrochlorothiazide, indapamide)
- estrogens (e.g., conjugated estrogen, estradiol, ethinyl estradiol)
- fenofibric acid
- HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine, nevirapine)
- HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
- milk thistle
- monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
- nicotinic acid
- other diabetes medications (e.g., chlorpropamide, glipizide, insulin, metformin, nateglinide, rosiglitazone)
- progestins (e.g., dienogest, levonorgestrel, medroxyprogesterone, norethindrone)
- quinolone antibiotics (e.g., ciprofloxacin, levofloxacin, ofloxacin)
- selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
- somatostatin acetate
- sulfonamides (e.g., asulfamethoxazole, sulfisoxazole)
- thyroid hormone
- tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/ratio-Glyburide
So the last time you were at your doctor’s office, they told you that you have diabetes and started you on metformin. You went home and started taking it, and tried to improve your diet and exercise. Now you are back in the clinic for your first lab tests. The doctor checks your A1c and it is still not to where it needs to be (less than 7% is the goal). So what do we do? Since so many problems can come from diabetes that is not under control, your doctor is going to want to start you on another medication quickly to bring your numbers down faster.
Which medication will they choose? The American Diabetes Association, as well as other medical organizations, have come up with a “roadmap” of how to treat diabetes using medication. From my blog last week on diabetes, you know that metformin, combined with lifestyle changes in diet and exercise, is our starting point on the journey. If your A1c is not low enough at the next visit, doctors have three main options: insulin, sulfonylureas, or TZDs. If you need a refresher on these categories, or if you are tuning into my blogs for the first time, please read my blog on the different classes of diabetes medications here.
Each option has its own pros and cons, but I’m going to start with the sulfonylureas, since they are the least expensive and most common options, second to metformin. The first sulfonylurea I’ll be covering is glyburide, which also goes by brand names DiaBeta, Micronase, and Glynase.
How does it lower blood sugar: Glyburide helps your body release insulin into the blood. Remember, insulin is the hormone in your body that helps take the sugar out of your blood and puts it into your cells. So glyburide puts the insulin where it needs to be – in the blood where your sugars are. In a very small way, glyburide also makes your cells more sensitive to insulin (“opening the door of the cell” for sugar to enter), but this is not the most consistent way that glyburide works. Unfortunately, as type 2 diabetes progresses, the body sometimes can no longer make its own insulin. At that point, glyburide is no longer effective because there is no more insulin there to “move.” But in newly diagnosed type 2 diabetics, glyburide can be very effective.
The effect on your numbers: Like metformin, glyburide also lowers your A1c by about 1 – 2% (a patient with an A1c of 9 could go down to an A1c of 8 or 7 when on glyburide). Glyburide really doesn’t seem to lower a patient’s cholesterol levels, which was a benefit that we saw with metformin.
Dosing: Glyburide is usually taken once daily, in doses from 2.5 to 20 mg. Usually patients are started at 2.5 or 5 mg daily and then increased as needed. Just like with metformin, your doctor can change your dose every 1-2 weeks if needed. Glyburide should always be taken with the first meal of the day (within about 30 minutes before). It is important to always take glyburide with food because otherwise the medication will cause your blood sugar to drop too low (hypoglycemia). So it’s important to state again, always take glyburide with food.
Side effects: Hypoglycemia (dangerously low blood sugar) is one of the most dangerous side effects. Weight gain can also be a possibility with glyburide (obviously not ideal in most diabetics). Glyburide is the medication in this class with the most likelihood of these side effects, since it takes the longest to leave your body once it is in there. The other side effects you might have from glyburide are a feeling of stomach fullness (as if you’ve just finished eating a big meal), heartburn, rashes/itching, and nausea. Very rarely, glyburide can cause liver problems (hepatitis).
Who should not take glyburide: Any patients with a “sulfa” allergy should not take glyburide, or any other sulfonylureas (which I will be covering in the next few weeks), because they contain the thing that you are allergic to. Because of the risk of low blood sugar if not taken correctly, anyone that has a very inconsistent diet or has a history of low blood sugar episodes might not be an ideal candidate for this medicine. Glyburide should not be used in any patient that is pregnant or breastfeeding. Also, if you have severe liver or kidney problems, your doctor will avoid using this class of medications.
Drug interactions: The most important thing that I want to stress here is that alcohol must be avoided when taking glyburide. A simplified way to look at it is that glyburide causes your body to not tolerate alcohol. You could experience side effects such as nausea, flushing of the skin, vomiting, shortness of breath, and very low blood pressure. But the most important thing that happens is that it can increase the effect of low blood sugar, which can be very dangerous. Other medications that can interact with glyburide and make it work better or worse are certain blood pressure medications, diuretics (“water pills”), blood thinners, salicylates (like aspirin), and certain antidepressants. Remember, check with your local pharmacist or doctor before starting any new medications, both prescription and over-the-counter. And make sure your pharmacy is aware of all medications that you take so that your pharmacist can check for drug interactions when you come in with a prescription.
Monitoring: Just like with metformin, your doctor is going to monitor your A1c, and you will need to monitor your blood sugar levels daily. Because of the chance of low blood sugars with this medication, you need to be even more consistent with monitoring your blood sugars, and watching if they are too low. Signs of low blood sugar include feeling like your heart is racing, headache, confusion, increased sweating, hunger, shakiness, tingling in the mouth, and a feeling of anxiety.
If you start to experience any of these, or if you just don’t “feel quite right,” check your blood sugar immediately. You will need to have a snack available right away to eat that contains at least 15 grams of carbohydrates, in order to raise your blood sugar to a safe level immediately. A list of these types of snacks, as well as other information about hypoglycemia can be found here. I’ve copied the list over for your reference, to make it easier:
- 4 oz (1/2 cup) of juice or regular soda
- 2 tablespoons of raisins
- 4 or 5 saltine crackers
- 4 teaspoons of sugar
- 1 tablespoon of honey or corn syrup
Choose what will work for you. Read labels and find something that is appropriate for your lifestyle. It needs to be something that is readily accessible by anyone, especially if you are not feeling well enough to get to it. Remember, regular soda is needed here, not diet. When we are trying to raise blood sugar quickly, we need to have sugar, not something that is “diabetes friendly.”
Once you’ve had your 15 grams of carbs, you still need to eat a meal containing complex carbs that will help your body get back up to a normal level. The foods I just mentioned are simple carbohydrates – your body processes them quickly, your blood sugars rise quickly, and then they are gone. Complex carbs are things like vegetables, brown rice, whole grain breads, and wheat pasta. Don’t stop with just the 15 gram snack or you might be in the same low blood sugar situation within a few hours.
Place in therapy for diabetes: Glyburide is considered one of the first or second choices for treating type 2 diabetics (second usually to metformin). This is because it is inexpensive, not a shot like insulin is, and only has to be taken once or twice a day. It is important to mention that some patients just don’t see any results with glyburide, or the other medications in this class, so we try it and then have to switch to something else. As diabetes progresses and your body changes, sometimes glyburide (and any of the other diabetes medications taken by mouth) does not work as well. About 5-10% of diabetics every year have this happen. If it does, we can sometimes switch you to another medication within the same class. Next week I will be talking about another one within this class, so don’t miss it!
If you want to learn more about glyburide, you can read about it here.
If this turns out to not be the right drug for you, don’t worry. As you will see, we have plenty of options. And as Phil has talked about, you do not have to be a “victim” of diabetes. You can make changes in your own life that will help to fight back the disease. They won’t cure it, but they will make our medications much more effective, and will keep you living the healthy and happy life that you deserve. I’m thinking about you, each and every one of you, and wishing you all the best in your fight! Keep up the good work!
As a disclaimer, I am your “virtual” pharmacist, here to provide you with information and answers to questions. However, I am not your local pharmacist and could, in no way, be aware of your specific medical needs. Remember to always check with your medical provider and pharmacist before stopping or starting any new medications. My posts are based on general pharmacy principles and should not considered as your “first opinion” when it comes to your health. Please consult with your doctor and pharmacist about anything regarding your health.
More Reasons to Say Goodbye to Glyburide
Sulfonylureas have been used to control hyperglycemia in type 2 diabetes longer than any class of agents except insulins. Their use early in the course of diabetes is supported by evidence of long-term medical benefit (1), and although available in generic form and thus not commercially promoted, they are widely prescribed (2). Given these facts, it is surprising that much remains unknown about these agents, notably how the various members of the class should be deployed in current treatment algorithms.
An article by Zeller et al. in this issue of JCEM (3) sheds considerable light on this question. The authors report analyses of prospectively collected data from a French registry concerning experience of patients with type 2 diabetes who were hospitalized for myocardial infarction. The question posed was what association, if any, might exist between prior use of sulfonylureas and death and other in-hospital outcomes in these patients. Analyses included comparisons between the individual sulfonylureas used in this population: glyburide (called glibenclamide in Europe), glimepiride, and gliclazide (in most cases given as an extended-acting formulation). The rationale for the study came from the known adverse effect of glyburide on cardiac ischemic preconditioning, the clinical relevance of which has been uncertain. One key finding of the French study was that, among the 1310 acutely ill patients studied, unadjusted mortality rates were lower for those whose treatment on admission included a sulfonylurea (3.9%) than for those taking insulin (9.4%), those on no antihyperglycemic drugs (8.4%), and those on oral therapies other than sulfonylureas (6.4%). Another was that when patients taking glyburide were compared with those taking gliclazide or glimepiride, two sulfonylureas that appear to lack cardiac effects, early mortality was almost 3-fold higher (7.5 vs. 2.7%) with glyburide. It is well known that epidemiological analyses of “real-world” experiences with prescribed pharmacotherapy may be confounded by incomplete collection of information on actual drug usage, concomitant therapies, and medical outcomes, in addition to biases introduced by physicians’ tendencies to assign different treatments to different kinds of patients. Many of these problems were reduced or eliminated by the prospective design of this study, which included systematic recording of detailed clinical information on all patients in a narrow window of time by a structured team of investigators. The problem of allocation bias in assignment of treatments, however, remains in this study as in others. Hence, the authors used several statistical methods to adjust for this kind of confounding, including an extensive multivariable model, further adjustment using a propensity score for assignment to glyburide treatment, and analysis of findings with glyburide vs. the other sulfonylureas by subgroups. These statistical adjustments did not alter the associations of sulfonylurea use with lower mortality than other forms of therapy, and of glyburide use with higher mortality than seen with the other sulfonylureas. The excess of mortality with glyburide vs. other sulfonylureas showed no tendency toward heterogeneity between subgroups. Thus, several approaches to testing the validity of the observations were supportive, and the magnitude of the effects was substantial. After multivariable adjustment, the risk of death accompanying use of a sulfonylurea was half that when a sulfonylurea was not used (odds ratio, 0.50; 95% confidence interval, 0.27–0.94; P = 0.03). After similar adjustment for covariates, the risk of early mortality was 85% lower with glimepiride or gliclazide than with glyburide (odds ratio, 0.15; 95% confidence interval, 0.04–0.56; P < 0.005), and with the propensity score included in the model, the risk was 87% lower (odds ratio, 0.13; 95% confidence interval, 0.21–0.72; P = 0.003). Similar patterns were apparent for nonfatal cardiovascular complications.
Among many epidemiological studies, why is this one important? First, it asks a tightly focused question: do sulfonylureas in general and glyburide in particular alter the risk of death or other complication associated with an ischemic cardiac event? Second, it includes a relatively large number of patients quite representative of the whole population of a single country. Third, data collection was prospectively designed and therefore more complete and accurate than is possible in a retrospective analysis of a database. Fourth, the analytic scheme was appropriate and detailed. Although the possibility of residual allocation bias cannot be ignored, it is a very good study. It is the latest in a series of reports showing that glyburide differs from other widely used sulfonylureas. The story goes back to the University Group Diabetes Program (UGDP) study, in which the sulfonylurea tolbutamide appeared to increase mortality in type 2 diabetes (4). Since then, tolbutamide has rarely been used. Later studies showed that some secretagogues can interact with KATP channels not only in the β-cell but also in the heart and thereby interfere with ischemic preconditioning, a normally protective adaptation to prior ischemia, providing a plausible mechanism for the UGDP results. This unwanted effect is caused by glyburide (5–8), but not by glimepiride (5, 6), gliclazide (7), or glipizide (8). The present study brings the story all the way to clinical practice, providing strong, although not conclusive, evidence of clinical risk from glyburide relative to other sulfonylureas. In this it is consistent with the results of a similar epidemiological study that used a less reliable retrospective design (9).
This additional evidence may be sufficient to call for discontinuing use of glyburide, as has previously been proposed (10, 11). Animal studies and human physiological and epidemiological data are all consistent with increased cardiovascular risk with glyburide relative to other agents in its class. In addition, glyburide differs from other sulfonylureas in another way: it causes more hypoglycemia. In the early years of the United Kingdom Prospective Diabetes Study (UKPDS), participants recently diagnosed with type 2 diabetes were randomized to treatment with diet, metformin, chlorpropamide, glyburide, or insulin. In the first year, the percentages of participants reporting hypoglycemia with these treatments were 0.6, 8, 15, 36, and 34%, respectively (12). Thus, glyburide caused as much hypoglycemia as insulin and twice as much as chlorpropamide, a sulfonylurea now rarely used due to various side effects, among them serious hypoglycemia. This pattern was the same for major hypoglycemia and persisted over the first 3 yr. Higher risk of hypoglycemia with glyburide has been confirmed in other reports. In a review of 33,243 patients using a sulfonylurea in the United Kingdom, the risk of clinically reported hypoglycemia, after adjustment for covariates, was 40% lower with glipizide and 26% lower with gliclazide than with glyburide (13). A population-based study in a part of Germany where the only sulfonylureas used were glyburide and glimepiride found that severe hypoglycemia leading to care in an emergency room was much less frequent with glimepiride (0.86 vs. 5.6 events per 1000 patient-years) (14). Therefore, glyburide has well-documented differences from other sulfonylureas in causing hypoglycemia and interfering with ischemic preconditioning, and now also good epidemiological evidence for an association with greater mortality in vulnerable populations. Even so, it is still often prescribed.
More evidence distinguishing glyburide from other sulfonylureas is not the only important finding in the report of Zeller et al. (3). The further observation that early mortality after myocardial infarction was 50% lower when the patient was taking a sulfonylurea is at odds with widespread beliefs. It must be acknowledged that bias in treatment assignment to metformin, insulin, a sulfonylurea, or other antihyperglycemic agents is more likely to elude efforts to adjust for it in statistical models than is bias in assignment to one or another sulfonylurea. Even so, the highly significant association of lower risk of death after myocardial infarction during sulfonylurea therapy in this study is quite different from what has been reported in earlier studies that compared sulfonylureas with other therapies, especially metformin (15–17). In those studies, which have suggested that sulfonylurea therapy leads to increased cardiovascular risk compared with metformin, glyburide was the most frequently used or only sulfonylurea, yet the results have been assumed to apply to all sulfonylureas. The present study, in which glyburide was used less by less than one third of those taking a sulfonylurea, suggests that this assumption may not be valid. The balance of benefits vs. risks and costs with sulfonylureas relative to other classes of agents is not a trivial concern. Treatment for type 2 diabetes is complex, costly, often unsuccessful, and a topic of current debate. Considerable resources are devoted to promoting newer but less well-tested therapies, such as thiazolidinediones, GLP-1 (glucagon-like peptide-1) agonists, and DPP-4 (dipeptidyl peptidase-4) inhibitors, which are still under patent protection and therefore potentially very profitable. Sulfonylureas are inexpensive, easy to use, and have proven medical benefits. They deserve adequate consideration as well. Well-designed randomized studies are needed.
One large, long-term randomized study including a sulfonylurea was recently completed (18). This study, called ADOPT, examined the effects of glyburide rather than a newer sulfonylurea. The aim of ADOPT was to assess the persistence of glycemic control with rosiglitazone in comparison with metformin and glyburide, using the time until fasting glucose rose above 180 mg/dl as the primary endpoint. Thus defined, monotherapy failure occurred earliest with glyburide and latest with rosiglitazone. With hemoglobin A1c, a more revealing endpoint, the differences between the treatments were less obvious, and glyburide produced more improvement in the first year. In the UKPDS, similarly, more rapid loss of glycemic control was observed among participants randomized to glyburide relative to metformin, but the greatest persistence of glycemic control was observed not with metformin but with another sulfonylurea, chlorpropamide, which contributed as many participant-years to the study as did glyburide (19). Although ADOPT was not intended to identify medical outcomes, safety findings were reported. Glyburide caused the most hypoglycemia and 1.6-kg weight gain (vs. a 4.8-kg gain with rosiglitazone and weight loss with metformin), but serious cardiovascular events were, if different at all, less frequent with glyburide (26 events) than with metformin (46 events) or rosiglitazone (49 events). We must wonder what ADOPT might have shown had glimepiride or extended-release formulations of gliclazide or glipizide been studied instead of glyburide. We should reconsider the balance of benefits vs. risks accompanying use of these sulfonylureas. Suppose a new drug were proposed for clinical use with properties including very low cost, once-daily oral administration, glucose-lowering power equal to metformin, few side effects other than hypoglycemia and moderate weight gain, and similar (possibly less) cardiovascular risk than other available drugs? Would we not take it seriously? At present these appear to be the properties of modern sulfonylureas.
In conclusion, the report by Zeller et al. (3) draws attention to important questions about the role of sulfonylureas in medical practice. These include whether glyburide should continue to be used despite safety concerns and how other sulfonylureas should be placed in treatment algorithms. To the first question I propose that, just as we said farewell to phenformin (20) and allowed metformin to demonstrate its superior qualities, we say goodbye to glyburide. To answer the second question, we need comparative effectiveness studies that directly compare modern sulfonylureas (gliclazide, glimepiride, or glipizide), not glyburide, with metformin and with newer agents. Why let one bad apple spoil the whole barrel?
This work was supported in part by the Rose Hastings and Russell Standley Memorial Trusts.
Disclosure Summary: The author has received research grant support from Amylin, Eli Lilly, GlaxoSmithKline, and Sanofi-Aventis and has received honoraria for consulting or lectures from Amylin, Eli Lilly, Hoffmann-La Roche, Pfizer, and Sanofi-Aventis.
For article see page 4993
1 Holman RR , Paul SK , Bethel MA , Matthews DR , Neil HAW 2008 10-Year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 359:1577–1589 2 Alexander GC , Sehgal NL , Moloney RM , Stafford RS 2008 National trends in treatment of type 2 diabetes mellitus, 1994–2007. Arch Intern Med 168:2088–2094 3 Zeller M , Danchin N , Simon D , Vahanian A , Lorgis L , Cottin Y , Berland J , Gueret P , Wyart P , Deturck R , Tabone X , Machecourt J , Leclercq F , Drouet E , Mulak G , Bataille V , Cambou JP , Ferrieres J , Simon T 2010 Impact of type of preadmission sulfonylureas on mortality and cardiovascular outcomes in diabetic patients with acute myocardial infarction. J Clin Endocrinol Metab 95:4993–5002 4 Meinert CL , Natterud GL , Prout TE , Klimt CR 1970 A study of the effects of hypoglycemic agents on vascular complications in patients with adult-onset diabetes. II. Mortality results. Diabetes 19(Suppl):789–830 5 Mocanu MM , Maddock HL , Baxter GF , Lawrence CL , Standen NB , Yellon DM 2001 Glimepiride, a novel sulfonylurea, does not abolish myocardial protection afforded by either ischemic preconditioning or diazoxide. Circulation 103:3111–3116 6 Lee TM , Chou TF 2003 Impairment of myocardial protection in type 2 diabetic patients. J Clin Endocrinol Metab 88:531–537 7 Maddock HL , Siedlecka SM , Yellon DM 2004 Myocardial protection from either ischaemic preconditioning or nicorandil is not blocked by gliclazide. Cardiovasc Drugs Ther 18:113–119 8 Flynn DM , Smith AH , Treadway JL , Levy CB , Soeller WC , Boettner WA , Wisniecki P , Plowchalk DR , Gernhardt SS , Tracey WR , Knight DR 2005 The sulfonylurea glipizide does not inhibit ischemic preconditioning in anesthetized rabbits. Cardiovasc Drugs Ther 19:337–346 9 Monami M , Luzzi C , Lamanna C , Chiasserini V , Addante F , Desideri CM , Masotti G , Marchionni N , Mannucci E 2006 Three-year mortality in diabetic patients treated with different combinations of insulin secretatogues and metformin. Diabetes Metab Res Rev 22:477–482 10 Riddle MC 2003 Sulfonylureas differ in effects on ischemic preconditioning—is it time to retire glyburide? J Clin Endocrinol Metab 88:528–530 11 Schwartz TB , Meinert CL 2004 The UGDP controversy: thirty-four years of contentious ambiguity laid to rest. Perspect Biol Med 47:564–574 12 United Kingdom Prospective Diabetes Study Group 1995 The United Kingdom Prospective Diabetes Study (UKPDS) 13. Relative efficacy of randomly allocated diet, sulphonylurea, insulin, or metformin in patients with newly diagnosed non-insulin dependent diabetes followed for three years. BMJ 310:83–88 13 van Staa T , Abenhaim L , Monette J 1997 Rates of hypoglycemia in users of sulfonylureas. J Clin Epidemiol 50:735–741 14 Holstein A , Plaschke A , Egberts EH 2001 Lower incidence of severe hypoglycemia in patients with type 2 diabetes treated with glimepiride versus glibenclamide. Diabetes Metab Res Rev 17:467–473 15 Garratt KN , Brady PA , Hassinger NL , Grill DE , Terzic A , Holmes Jr DR 1999 Sulfonylurea drugs increase early mortality in patients with diabetes mellitus after direct angioplasty for acute myocardial infarction. J Am Coll Cardiol 33:119–124 16 Evans JM , Ogston SA , Emslie-Smith A , Morris AD 2006 Risk of mortality and adverse cardiovascular outcomes in type 2 diabetes: a comparison of patients treated with sulfonylureas and metformin. Diabetologia 49:930–936 17 Simpson SH , Majumdar SR , Tsuyuki RT , Eurich DT , Johnson JA 2006 Dose-response relation between sulfonylurea drugs and mortality in type 2 diabetes mellitus: a population-based cohort study. CMAJ 174:169–174 18 Kahn SE , Haffner SM , Heise MA , Herman WH , Holman RR , Jones NP , Kravitz BG , Lachin JM , O’Neill MC , Zinman B , Viberti G 2006 Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. N Engl J Med 355:2427–2443 19 U.K. Prospective Diabetes Study Group 1998 Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 352:854–865 20 Williams RH , Palmer JP 1975 Farewell to phenformin for treating diabetes mellitus. Ann Intern Med 83:567–568 Copyright © 2010 by The Endocrine Society
|Type of medicine||A sulfonylurea antidiabetic medicine|
|Used for||Type 2 diabetes mellitus|
|Also called||Diaβeta®, Glynase® PresTab®|
Insulin is a hormone which is made naturally in your body, in the pancreas. It helps to control the levels of sugar (glucose) in your blood. If your body does not make enough insulin, or if it does not use the insulin it makes effectively, this results in the condition called sugar diabetes (diabetes mellitus).
People with diabetes need treatment to control the amount of sugar in their blood. This is because good control of blood sugar levels reduces the risk of complications later on. Some people can control the sugar in their blood by making changes to the food they eat but, for other people, medicines like glyburide are given alongside the changes in diet.
Glyburide (also know as glibenclamide) works by increasing the amount of insulin that your pancreas produces. This helps to reduce the amount of sugar in your blood.
Before taking glyburide
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking glyburide it is important that your physician knows:
- If you are pregnant, trying for a baby or breastfeeding.
- If you have any problems with the way your liver works, or with the way your kidneys work.
- If you have been told you have porphyria or glucose 6-phosphate dehydrogenase (G6PD) deficiency. These are rare inherited disorders.
- If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
- If you have ever had an allergic reaction to a medicine.
How to take glyburide tablets
- Before you start the treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about glyburide tablets and will provide you with a full list of the side-effects which you may experience from taking them.
- Take glyburide exactly as your physician tells you to. The usual starting dose is 5 mg daily. It is prescribed as a single dose to be taken with, or immediately after, breakfast.
- Depending on your blood sugar (glucose) levels, your daily dose may need to be increased. Your physician will do this slowly, usually increasing by one 2.5 mg tablet each week. Your blood sugar levels will need to be tested regularly.
- If you need higher doses your physician may ask you to take glyburide twice each day. If this happens take each dose with a meal or snack and try to space your doses evenly.
- Different manufacturers’ products may contain different amounts of glyburide and have different recommended doses. Each time you get a prescription make sure you receive the same strength of tablet as before. Ask the pharmacist for advice if you are unsure.
- If you forget to take a dose at the usual time, take it with your next meal. If you do not remember until the following day, skip the missed dose. Do not take two doses on the same day to make up for a forgotten dose.
Getting the most from your treatment
- It is important that you keep your regular physician’s and laboratory appointments. This is so that your progress can be monitored. You will need regular check-ups with an eye clinic and a foot clinic as well as with your physician and diabetes clinic.
- Your physician may recommend that you test for sugar (glucose) in your blood regularly to check that your diabetes is being controlled. Your physician will show you how to do this.
- If you have been given advice by your physician about changes to your diet, stopping smoking or taking regular exercise, it is important for you to follow the advice you have been given.
- Make sure you know what it feels like if your blood sugar drops too low. This is known as hypoglycemia, or a ‘hypo’. The first signs of hypoglycemia are feeling shaky or anxious, sweating, looking pale, feeling hungry, having a feeling that your heart is pounding (palpitations), and feeling dizzy. If this happens, eat something containing sugar, such as dextrose tablets, sugary candy or a sugary soda (non-diet). Then follow this up with a snack such as a sandwich or a banana.
- Low blood sugar can occur if you miss a meal, if you exercise more than usual, if you are ill, or if you drink alcohol.
- Do not drink alcohol, as it can affect the control of your blood sugar. Ask your physician if you need further advice about this.
- If you are a driver you should take special care, as your ability to concentrate may be affected if your diabetes is not well controlled. You may be advised to check your blood sugar levels before you travel and to have a snack with you on long journeys.
- All US states have special licensing laws for drivers with medical conditions. You may be required to report your diabetes to local agencies. Ask your physician for advice about the laws in your state.
- If you get unusually thirsty, pass urine more frequently than normal, or feel very tired, you should let your physician know. These are signs that there is too much sugar in your blood and your treatment may need adjusting.
- Check with your physician before taking up any new physical exercise, as this will have an effect on your blood sugar levels and you may need to check your blood levels more regularly.
- If you are due to have an operation or dental treatment, you should tell the person carrying out the treatment that you have diabetes and give them a list of the medicines you are taking.
- If you buy any medicines, always check with a pharmacist that they are suitable for you to take.
- Treatment for diabetes is usually lifelong. Continue to take the tablets unless you are advised otherwise by your physician.
Can glyburide cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with glyburide. You will find a full list in the manufacturer’s information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your physician or pharmacist if any of the following continue or become troublesome.
|Common glyburide side-effects||What can I do if I experience this?|
|Feeling sick (nauseous) or being sick (vomiting)||Stick to simple foods – avoid rich or spicy meals|
|Hard stools that are difficult to pass (constipation)||Eat a well-balanced diet and drink plenty of water|
|Loose, watery stools (diarrhea)||Drink plenty of water to replace any lost fluids|
|Signs of low blood sugar (hypoglycemia): feeling shaky or anxious, sweating, looking pale, feeling hungry, feeling that your heart is pounding (palpitations), feeling dizzy||Eat something containing sugar such as a sweet cookie or a sugary drink (not diet) and follow this up with a snack such as a sandwich. Tell your physician if you notice these symptoms|
|Increase in weight||If this becomes a problem, let your physician know at your next check-up|
If you experience any other symptoms which you think may be due to this medicine, speak with your physician or pharmacist.
How to store glyburide
- Keep all medicines out of the reach and sight of children.
- Store in a cool, dry place, away from direct heat and light.
Important information about all medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the emergency room of your local hospital. Take the container with you, even if it is empty.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
Do not keep out-of-date or unwanted medicines. Ask your pharmacist about ways to dispose of medicines safely in your local area.
If you have any questions about this medicine ask your pharmacist.
Generic Name: glyburide (GLYE bue ride)
Brand Name: DiaBeta, Glynase PresTab
Medically reviewed by Drugs.com on Feb 16, 2018 – Written by Cerner Multum
- Side Effects
What is DiaBeta?
DiaBeta is an oral diabetes medicine that helps control blood sugar levels.
DiaBeta is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes mellitus. This medicine is not for treating type 1 diabetes.
DiaBeta may also be used for purposes not listed in this medication guide.
You should not use DiaBeta if you are being treated with bosentan (Tracleer), or if you have diabetic ketoacidosis (call your doctor for treatment). DiaBeta is not for treating type 1 diabetes.
Before taking this medicine
You should not use DiaBeta if you are allergic to it, or if:
you are being treated with bosentan (Tracleer);
you have type 1 diabetes; or
you have diabetic ketoacidosis (call your doctor for treatment).
Tell your doctor if you have ever had:
hemolytic anemia (a lack of red blood cells);
an enzyme deficiency called glucose-6-phosphate dehydrogenase deficiency (G6PD);
a nerve disorder affecting bodily functions;
liver or kidney disease; or
an allergy to sulfa drugs.
Before taking DiaBeta, tell your doctor if you have taken another oral diabetes medicine or used insulin during the past 2 weeks.
DiaBeta may increase your risk of serious heart problems, but not treating your diabetes can also damage your heart and other organs. Talk to your doctor about the risks and benefits of this medicine.
Follow your doctor’s instructions about using this medicine if you are pregnant or breast-feeding a baby. Blood sugar control is very important during pregnancy, and your dose needs may be different during each trimester of pregnancy.
You should not breast-feed while using this medicine.
How should I take DiaBeta?
DiaBeta is usually taken with breakfast or the first main meal of the day.
Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.
Your blood sugar will need to be checked often, and you may need other blood tests at your doctor’s office.
Low blood sugar (hypoglycemia) can happen to everyone who has diabetes. Symptoms include headache, hunger, sweating, irritability, dizziness, nausea, fast heart rate, and feeling anxious or shaky. To quickly treat low blood sugar, always keep a fast-acting source of sugar with you such as fruit juice, hard candy, crackers, raisins, or non-diet soda.
Your doctor can prescribe a glucagon emergency injection kit to use in case you have severe hypoglycemia and cannot eat or drink. Be sure your family and close friends know how to give you this injection in an emergency.
Also watch for signs of high blood sugar (hyperglycemia) such as increased thirst or urination, blurred vision, headache, and tiredness.
Blood sugar levels can be affected by stress, illness, surgery, exercise, alcohol use, or skipping meals. Ask your doctor before changing your dose or medication schedule.
If your doctor changes your brand, strength, or type of glyburide, your dosage needs may change. Ask your pharmacist if you have any questions about the new kind of glyburide you receive at the pharmacy.
Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. A DiaBeta overdose can cause life-threatening hypoglycemia.
Symptoms of severe hypoglycemia include extreme weakness, nausea, tremors, sweating, confusion, trouble speaking, fast heartbeats, or seizure.
What should I avoid while taking glyburide?
If you also take colesevelam, avoid taking it within 4 hours after you take DiaBeta.
Avoid drinking alcohol. It lowers blood sugar and may interfere with your diabetes treatment.
DiaBeta could make you sunburn more easily. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.
DiaBeta side effects
Get emergency medical help if you have signs of an allergic reaction (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).
Call your doctor at once if you have:
dark urine, jaundice (yellowing of the skin or eyes);
severe skin rash, redness, or itching;
pale skin, easy bruising or bleeding;
fever, chills, sore throat, mouth sores; or
low levels of sodium in the body–headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady.
Older adults may be more likely to have low blood sugar while taking DiaBeta.
Common side effects may include:
low blood sugar;
nausea, heartburn, feeling full;
muscle or joint pain;
blurred vision; or
mild rash or skin redness.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What other drugs will affect DiaBeta?
DiaBeta may not work as well when you use other medicines at the same time. Many other drugs can also affect blood sugar control. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Copyright 1996-2018 Cerner Multum, Inc. Version: 11.02.
More about DiaBeta (glyburide)
- Side Effects
- During Pregnancy or Breastfeeding
- Dosage Information
- Drug Images
- Drug Interactions
- En Español
- Generic Availability
- Drug class: sulfonylureas
- Diabeta (Advanced Reading)
Other brands: Micronase, Glynase, Glycron, Glynase PresTab
- DiaBeta (FDA)
- … +1 more
Related treatment guides
- Diabetes, Type 2
First, let’s talk about what makes Glynase and Diabeta similar. Both of these medications are used in type 2 diabetes to improve glycemic control and lower blood sugar levels, both are 2nd generation drugs in the sulfonylurea class and work by telling the pancreas to release more insulin, and both have a form of glyburide as the active ingredient.
So, how does Glynase differ from Diabeta?
Glynase is micronized glyburide which has a different duration of action, absorption, and dosage than its nonmicronized counterpart, Diabeta or Micronase (regular glyburide). Micronized glyburide contains smaller particles that allow the medication to be absorbed better by the body—therefore, lower doses can be used.
What are the available strengths and MAX dose of Glynase?
Glynase (micronized glyburide) comes in 1.5 mg, 3 mg, and 6 mg tablets. The max dose is 12 mg per day.
What are the available strengths and MAX dose of Diabeta and glyburide?
Diabeta and generic glyburide come in 1.25 mg, 2.5 mg, and 5 mg tablets. The max dose 20 mg per day.
How are these medications taken?
Both Glynase and Diabeta are usually taken once or twice daily before meals.
What if you have a SULFA allergy?
A reaction is possible with any of the sulfonylureas, however, remember, glyburide is a 2nd generation sulfonylurea. Reactions occur more frequently with the 1st generation sulfonylurea, chlorpropamide (Diabinese).
Can these medications be substituted for one another?
NO. Although glyburide is the active ingredient in both Diabeta and Glynase, the formulations DO differ.
You can find prices and more information about Glynase here, and you can find prices and more information about Diabeta here. Micronase (glyburide) is also available.
Glyburide Side Effects
Visit your doctor or health care professional for regular checks on your progress.
A test called the HbA1C (A1C) will be monitored. This is a simple blood test. It measures your blood sugar control over the last 2 to 3 months. You will receive this test every 3 to 6 months.
Learn how to check your blood sugar. Learn the symptoms of low and high blood sugar and how to manage them.
Always carry a quick-source of sugar with you in case you have symptoms of low blood sugar. Examples include hard sugar candy or glucose tablets. Make sure others know that you can choke if you eat or drink when you develop serious symptoms of low blood sugar, such as seizures or unconsciousness. They must get medical help at once.
Tell your doctor or health care professional if you have high blood sugar. You might need to change the dose of your medicine. If you are sick or exercising more than usual, you might need to change the dose of your medicine.
Do not skip meals. Ask your doctor or health care professional if you should avoid alcohol. Many nonprescription cough and cold products contain sugar or alcohol. These can affect blood sugar.
This medicine can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds/booths.
Wear a medical ID bracelet or chain, and carry a card that describes your disease and details of your medicine and dosage times.
This medicine may cause a decrease in Co-Enyzme Q-10. You should make sure that you get enough Co-Enzyme Q-10 while you are taking this medicine. Discuss the foods you eat and the vitamins you take with your health care professional.