glyburide

(glye' byoor ide)

Albert Glyburide (CAN), DiaBeta, Euglucon (CAN), Gen-Glybe (CAN),
Glibenclamide, Glynase PresTab, Micronase

Pregnancy Category B

Drug class
Antidiabetic
Sulfonylurea

Therapeutic actions
Stimulates insulin release from functioning beta cells in the pancreas; may improve
binding between insulin and insulin receptors or increase the number of insulin receptors;
more potent in effect than first-generation sulfonylureas.

Indications
• Adjunct to diet to lower blood glucose with type 2 (non–insulin-dependent)
diabetes mellitus
• Adjunct to metformin when adequate results are not achieved with either drug
alone
• Adjunct to insulin therapy in the stabilization of certain cases of type 2 diabetes,
reducing the insulin requirement, and decreasing the chance of hypoglycemic
reactions

Contraindications and cautions

• Contraindicated with allergy to sulfonylureas; diabetes with ketoacidosis, sole
therapy of type 1 (insulin-dependent) diabetes or diabetes complicated by
pregnancy, serious hepatic or renal impairment, uremia; diabetes complicated by
fever, severe infections, severe trauma, major surgery, ketosis, acidosis, coma
(insulin is contraindicated); thyroid or endocrine impairment, glycosuria,
hyperglycemia associated with primary renal disease; labor and delivery (if
glyburide is used during pregnancy, discontinue drug at least 1 mo before
delivery).
• Use cautiously with pregnancy, lactation.

Available forms
Tablets—1.25, 1.5, 2.5, 3, 4.5, 5, 6 mg

Dosages
ADULTS
• Initial therapy: 2.5–5 mg PO with breakfast (DiaBeta, Micronase); 1.5–3 mg/day
PO (Glynase).
• Maintenance therapy: 1.25–20 mg/day PO given as a single dose or in divided
doses. Increase in increments of no more than 2.5 mg at weekly intervals based on
 patient's blood glucose response (DiaBeta, Micronase); 0.75–12 mg/day PO
(Glynase).
PEDIATRIC PATIENTS
Safety and efficacy not established.
GERIATRIC PATIENTS
Geriatric patients tend to be more sensitive to the drug; start with initial dose of
1.25 mg/day PO (DiaBeta, Micronase) 0.75 mg/day PO (Glynase). Monitor for 24 hr, and
gradually increase dose after at least 1 wk as needed.

Pharmacokinetics
Route Onset Duration
Oral, 1 hr 12–24 hr
micronized
Oral, 2–4 hr 12–24 hr
nonmicronized

Metabolism: Hepatic; T1/2: 4 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Bile and urine

Adverse effects
• CNS: Drowsiness, tinnitus, fatigue, asthenia, nervousness, tremor, insomnia
• CV: Increased risk of CV mortality
• Endocrine: Hypoglycemia
• GI: Anorexia, nausea, vomiting, epigastric discomfort, heartburn, diarrhea
• Hematologic: Leukopenia, thrombocytopenia, anemia
• Hypersensitivity: Allergic skin reactions, eczema, pruritus, erythema, urticaria,
photosensitivity, fever, eosinophilia, jaundice

Interactions
Drug-drug
• Increased risk of hypoglycemia with sulfonamides, chloramphenicol,
oxyphenbutazone, phenylbutazone, salicylates, clofibrate
• Decreased effectiveness of glyburide and diazoxide if taken concurrently
• Increased risk of hyperglycemia with rifampin, thiazides
• Risk of hypoglycemia and hyperglycemia with ethanol; "disulfiram reaction" has
been reported
Drug-alternative therapy
• Increased risk of hypoglycemia if taken with juniper berries, ginseng, garlic,
fenugreek, coriander, dandelion root, celery

Nursing considerations
CLINICAL ALERT!
Name confusion has occurred between DiaBeta (glyburide) and Zebeta
(bisoprolol); use caution.

Assessment
 • History: Allergy to sulfonylureas; diabetes with complications; type 1 diabetes,
serious hepatic or renal impairment, uremia, thyroid or endocrine impairment,
glycosuria, hyperglycemia associated with primary renal disease, pregnancy
• Physical: Skin color, lesions; T; orientation, reflexes, peripheral sensation; R,
adventitious sounds; liver evaluation, bowel sounds; urinalysis, BUN, serum
creatinine, liver function tests, blood glucose, CBC

Interventions
• Give drug before breakfast. If severe GI upset occurs, dose may be divided and
given before meals.
• Monitor urine or serum glucose levels frequently to determine drug effectiveness
and dosage.
• Monitor dosage carefully if switching to or from Glynase.
• Transfer to insulin therapy during periods of high stress (eg, infections, surgery,
trauma).
• Use IV glucose if severe hypoglycemia occurs as a result of overdose.

Teaching points
• Do not discontinue this medication without consulting your health care provider.
• Monitor urine or blood for glucose and ketones.
• Do not use this drug during pregnancy; consult health care provider.
• Avoid alcohol while using this drug.
• Report fever, sore throat, unusual bleeding or bruising, rash, dark urine, light-
colored stools, hypoglycemic or hyperglycemic reactions.

Adverse effects in Italic are most common; those in Bold are life-threatening.