INDICES> Hypoglaemics for Elderly (Cont)

[David Woods <david.woods@stonebow.otago.ac.nz>]

Dear Abdul,

The major problem with sulphonylureas is hypoglycaemia. Glibenclamide has a
long duration of action (16-24 hours) and is about 50% excreted unchanged
in the urine. It also has active metabolites that are renally excreted (1,2).
The elderly seem predisposed to hypoglycaemia caused by glibenclamide (3)
and this perhaps due to accumlation caused by declining renal function.
The major problem with Tolbutamide is its short duration of action which
requires multiple daily dosing with the possibility of reduced compliance.
Glicalzide is preferred in the elderly as it is 80% metabolised in the
liver (1) and is less likely to accumulate even though it has a duration of
action of 24 hours and can be given once daily.
The general principle for dosing oral hypoglycaemics in the elderly is
start low and go slow.

References
1. Drug Data Handbook, 3rd edition, ADIS International.
2. Avery's Drug Treatment, ADIS International.
3. Henry RR et al. Geriatrics 1992;47(4):24-30

Regards,
David Woods
Drug Information Pharmacist, Dunedin Hospital
Lecturer, School of Pharmacy
University of Otago
PO Box 913
Dunedin
NEW ZEALAND
Ph 0064 3 474 7658
Fx 0064 3 474 7638
david.woods@stonebow.otago.ac.nz





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