Diabetes Medication and Treatment

                                                                                         

Tolazamide (Tolinase) is an oral agent that is absorbed more slowly (its onset is 4 to 6 hours). If you have a tendency to absorb food slowly, then this oral agent might be recommended for you. It comes in 100-mg, 250-mg, and 500-mg tablets from the Upjohn Company. Half of the usefulness of this medication in your body occurs within approximately 7 hours. The maximum recommended dosage is 1 gm (ten 100mg tablets, four 250-mg tablets, or two 50b-mg tablets) per day. This product is also available as a generic through the Barr, Danbury, Lederle, and Zenith drug companies.

Glyburide is a product available through the Upjohn Company (Micronase and Glynase) and the Hoechst-Roussel Company (OiaBeta). The tablet sizes are 1.25 mg, 2.5 mg, and 5 mg. The maximum dose recommended is 20 mg/day. Glynase is a more bioactive drug (Le., it works slightly better). It is available in 3 mg and 6 mg tablets; top dose is 12 mg. These tablets are easily broken into two pieces. As with any other intermediate acting oral agent, the dosages are usually divided (some before breakfast and some before supper) when 10 mg or more of medication is needed. The onset is 1.5 hours, and the total duration is around 24 hours. Half of the medication's usefulness may occur anywhere from 3.2 hours, for part of its chemical action, up to 10 hours for the rest of its half-life. Half of this medication is excreted in the urine and the other half through the bile in the liver, but caution is still encouraged for use in the elderly.

Glimepiride is the newest sulfonylurea oral hypoglycemic agent. This drug has the advantage of being insulin sparing. Glimepiride works by making the available insulin more effective by it effects on muscle and fat cells and on the liver. The drug is taken once a day in 1-, 2-, and 4- mg tablet sizes.

Starting dose is 1 mg/day. The dose can be increased every two to four weeks if the full therapeutic effect is not achieved. Maximum dose is 8 mg per day.

Glipizide (Glucotrol) is a 5-mg or 10-mg tablet product developed by Pfizer but marketed by Roerig Company. Its action begins an hour after it is swallowed. The half-life is 3.5 to 6 hours, and it may remain in the body for anywhere from 12 to 16 hours. It is recommended that a total of no more than 40 mg be taken in a day and that the medication should be taken on an empty stomach (that is, about 30 minutes before a meal). If more than 15 mg are needed, the dose should be divided. Glucotrol XL has more recently been made available. The XL stands for extended life or longer-lasting medication. The top dose of Glucotrol XL is 20 mg. Although this medication is changed in the liver to an inactive form, caution for use in the elderly is recommended.

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