Individual Drugs

Absorption from the alimentary tract is good for all the oral agents. It is advisable to take drugs -30 min before a meal. These three groups of drugs are effective only in the presence of insulin. If a patient fails to respond to one drug, response to another as single treatment is unlikely. Proceeding to a combination of drugs from different classes may then be effective.

Sulphonylureas (see also Table 35.1)

Several sulphonylureas are available. Choice is determined by the duration of action as well as the patient's age and renal function, and unwanted effects. The long-acting sulphonylureas, e.g. gliben-clamide, are associated with a greater risk of hypoglycaemia; for this reason they should be avoided in the elderly for whom the shorter-acting alternatives, such as gliclazide or tolbutamide, should be used. As chlorpropamide is both long-acting and has more unwanted effects than the other sulphonylureas (see below) it is no longer recommended. In patients with impaired renal function, gliclazide, glipizide or tolbutamide are preferred since they are not excreted by the kidney. Generally, it is prudent to start at the lowest recommended dose in order to minimise risk of hypoglycaemia.

TABLE 35. t Principal oral antidiabetes drugs

Drug

Total

Dosing

Duration

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