Formulary Monographs [ANTIDIABETIC AGENTS, 6820]
ANTIDIABETIC AGENTS
6820
ANTIDIABETIC AGENTS
The oral hypoglycaemics are used in insulin independent diabetes mellitus e.g. maturity onset diabetes. Oral sulfonylureas should only be used in combination with insulin under special investigational environments. The routine practice of combining insulin with oral sulfonylureas is not generally encouraged thoughthere may be some clinical circumstances to merit such. They are used to augment caloric and sugar restriction and not to replace it. Metformin is the oral hypoglycaemic of choice in obese, mature onset diabetics, but it is not as well tolerated as the sulphonylureas.

Drug Interactions

Alcohol: Anti-diabetic agents interact with alcohol to produce excess hypoglycemia and a disulfiram reaction (flushing, sweating, palpitations). Reaction is most pronounced with 1st generation sulphonylureas. Reaction with metformin results in lactic acidosis.

Beta Blockers: Hypo/hyperglycemia or hypertension. Propranolol accounts for most interactions and should be avoided.

Acarbose: Increased risk of hypoglycemia. Caution patients to carry glucose products rather than sucrose to counteract hypoglycemia. Reaction may be life threatening.

MAOI’s: Excessive hypoglycemia, CNS depression, seizures. Monitor blood glucose levels and decrease dose of hypoglycemic agent if necessary