Sulfonylureas: Medicines involved

Last updated: February 17, 2020

Gliclazide molecule
There are five sulfonylureas licensed in the UK. Doses should be given with a meal. Often this meal is breakfast, if the medicine is given once daily, so patients must always eat breakfast when taking these medicines to reduce the risk of hypoglycaemia. They should also eat meals at regular times and not skip meals.

If a sulfonylurea is used, the preferred choices in the elderly are the shorter-acting medicines:
Gliclazide – modified-release 30mg dose is approximately equivalent to standard formulation 80mg.
Glipizide – manufacturer advises dosing shortly before breakfast or lunch.
Glimepiride – less likely to cause gastrointestinal side effects.
The following two sulfonylureas are not favoured in the elderly:
Tolbutamide – although short-acting, there is a suspicion that it may be associated with adverse cardiovascular outcomes.
Glibenclamide – a longer acting drug and so more likely to cause hypoglycaemia; known as glyburide in US literature.

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