Indications: Type 2 diabetes mellitus

Cautions: Sulfonylureas can encourage weight gain and should be prescribed only if poor control and symptoms persist despite adequate attempts at dieting; metformin is considered the drug of choice in obese patients. Caution is needed in the elderly and in patients with G6PD deficiency.

Contra-indications: Sulfonylureas should be avoided where possible in acute porphyria but glimepiride are thought to be safe. Sulfonylureas are contra-indicated in the presence of ketoacidosis.

Hepatic impairment: Sulfonylureas should be avoided or a reduced dose should be used in severe hepatic impairment, because there is an increased risk of hypoglycaemia. Jaundice may occur.

Renal impairment: Sulfonylureas should be used with care in those with mild to moderate renal impairment, because of the hazard of hypoglycaemia; they should be avoided where possible in severe renal impairment. care is required to use the lowest dose that adequately controls blood glucose.

Pregnancy: The use of sulfonylureas in pregnancy should generally be avoided because of the risk of neonatal hypoglycaemia.

Breast-feeding: The use of sulfonylureas.in breast- feeding: should be avoided because there is a theoretical possibility of hypoglycaemia in the infant.

Side Effects: sulfonylureas are generally mild and infrequent and include gastro-intestinal disturbances such as nausea, vomiting, diarrhoea, and constipation.

Hyponatraemia has been reported with glimepiride and glipizide.

Sulfonylureas can occasionally cause a disturbance in liver function, which may rarely lead to cholestatic jaundice, hepatitis, and hepatic failure. Hypersensitivity reactions can occur, usually in the first 6–8 weeks of therapy. They consist mainly of allergic skin reactions which progress rarely to erythema multiforme and exfoliative dermatitis, fever, and jaundice; photosensitivity has rarely been reported with glipizide. Blood disorders are also rare but may include leucopenia, thrombocytopenia, agranulocytosis, pancytopenia, haemolytic anaemia, and aplastic anaemia.

Dose: Initially 1 mg daily, adjusted according to response in 1-mg steps at 1–2 week intervals; usual max. 4 mg daily (exceptionally, up to 6 mg daily may be used); taken shortly before or with first main meal.