Precautions With Oralagents

Hypoglycaemia is the most common adverse effect with sulphonylureas, but is less common than with insulin therapy. It can be severe, and prolonged (for days), and may be fatal in 10% of cases, especially in the elderly and in patients with heart failure. Erroneous alternate diagnoses such as stroke may be made.

Renal and hepatic disease. A biguanide should not be used in patients with either condition as the risk of lactic acidosis is too great. Sulphonylureas are potentiated in these diseases and a drug with a short (i.e. not glibenclamide) should be used in low dose.

Age adds to the hazard of oral agents.

Other adverse effects are rare but include skin rashes, gastrointestinal upset, minor derangement of haematological and hepatic indices.

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