drug adverse effects of sulfonylureas
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Adverse effects
- gastrointestinal
- common: (> 10%)
- constipation, diarrhea, heartburn, anorexia, epigastric fullness
- uncommon (< 1%): cholestatic jaundice
- common: (> 10%)
- dizziness (common)
- hypoglycemia, especially with renal insufficiency[5]
- among nursing home residents, new use of glimepiride & standard sulfonylurea dosing results in higher rates of severe hypoglycemia[8]
- inhibition of gluconeogenesis by inappropriate stimulation of insulin secretion in the absence of hyperglycemia[11]
- more important than masking symptoms of hypoglycemia by beta-blocker[11]
- renal gluconeogenesis normally accounts for 20% of gluconeogenesis[11]
- photosensitivity
- increased appetite, weight gain[6]
- bone marrow suppression (uncommon < 1%)
- increased risk of cardiovascular & all-cause mortality[2]
- 1st & 2nd generation sulfonylureas are associated with higher mortality than metformin
- 2nd generation sulfonylureas are more likely to cause heart failure
- increased cardiovascular risk relative to metformin[3]
- compared with DPP-4 inhibitors & thiazolidinediones, sulfonylureas are not associated with increased risk for adverse cardiovascular events[9]
- increased risk of dementia (12%) vs metformin[7] or DPP4 inhibitor (RR=1.1)[10]
- toxicity:
- hypoglycemia:
- confusion, seizure, anxiety, diaphoresis
- dextrose + octreotide, glucagon temporizing
- monitor for 48 hours
- hypoglycemia:
More general terms
References
- ↑ Simpson SH, Majumdar SR, Tsuyuki RT, Eurich DT, Johnson JA. Dose-response relation between sulfonylurea drugs and mortality in type 2 diabetes mellitus: a population-based cohort study. CMAJ. 2006 Jan 17;174(2):169-74. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16415461
Bell DS. Do sulfonylurea drugs increase the risk of cardiac events? CMAJ. 2006 Jan 17;174(2):185-6. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16415463
Prescriber's Letter 13(3): 2006 Sulfonylureas and the Risk of Mortality Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220307&pb=PRL (subscription needed) http://www.prescribersletter.com - ↑ 2.0 2.1 Tzoulaki I et al Risk of cardiovascular disease and all cause mortality among patients with type 2 diabetes prescribed oral antidiabetes drugs: retrospective cohort study using UK general practice research database BMJ 2009;339:b4731 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19959591 <Internet> http://www.bmj.com/cgi/content/full/339/dec03_1/b4731
- ↑ 3.0 3.1 Roumie CL et al Comparative Effectiveness of Sulfonylurea and Metformin Monotherapy on Cardiovascular Events in Type 2 Diabetes Mellitus: A Cohort Study Ann Intern Med. 6 November 2012;157(9):601-610 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/ 23128859 <Internet> http://annals.org/article.aspx?articleid=1389845
Nissen SE Cardiovascular Effects of Diabetes Drugs: Emerging From the Dark Ages Ann Intern Med. 6 November 2012;157(9):671-672 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23128866 <Internet> http://annals.org/article.aspx?articleid=1389852 - ↑ Jenkins-Jones S Association between first-line monotherapy with sulfonylurea versus metformin and risk of all-cause mortality. Abstract #201 http://www.easdvirtualmeeting.org/resources/3059
- ↑ 5.0 5.1 van Dalem J et al Risk of hypoglycaemia in users of sulphonylureas compared with metformin in relation to renal function and sulphonylurea metabolite group: population based cohort study. BMJ 2016;354:i3625 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27413017 Free full text <Internet> http://www.bmj.com/content/354/bmj.i3625
- ↑ 6.0 6.1 Medical Knowledge Self Assessment Program (MKSAP) 19 American College of Physicians, Philadelphia 2022
- ↑ 7.0 7.1 Tucker ME One Type of Older Diabetes Drug Cuts Dementia Risk, Another Ups It. Medscape. Oct 11, 2022 https://www.medscape.com/viewarticle/982256
Tang X et al Use of oral diabetes medications and the risk of incident dementia in US veterans aged >= 60 years with type 2 diabetes. BMJ Open Diabetes Research & Care. 2022 10(5): PMID: https://www.ncbi.nlm.nih.gov/pubmed/36220195 PMCID: PMC9472121 Free PMC article https://drc.bmj.com/content/10/5/e002894 - ↑ 8.0 8.1 Zullo AR Comparative safety of sulfonylureas among U.S. nursing home residents. J Am Geriatr Soc. 2023 Apr;71(4):1047-1057. Epub 2022 Dec 10. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36495141 https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.18160
- ↑ 9.0 9.1 Wang H et al. Cardiovascular safety in type 2 diabetes with sulfonylureas as second-line drugs: A nationwide population-based comparative safety study. Diabetes Care 2023 Mar 21; 46:967. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36944118 PMCID: PMC10154665 Free PMC article https://diabetesjournals.org/care/article/46/5/967/148656/Cardiovascular-Safety-in-Type-2-Diabetes-With
- ↑ 10.0 10.1 Wu CW, Iskander C, Wang C et al Association of sulfonylureas with the risk of dementia: A population-based cohort study. J Am Geriatr Soc. 2023. Oct;71(10):3059-3070 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37218376 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18397
- ↑ 11.0 11.1 11.2 11.3 NEJM Knowledge+