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[e-drug] Antidiabetic drugs

E-drug: Antidiabetic drugs

Dear e-druggers,
I'd like to comment on the 3 hypoglycaemic drugs on the current WHO
EDL in the hope that the WHO Essential Medicines Committee could take a
fresh look at them.

Glibenclamide (glyburide for the Americans).
This is the cheapest sulphonylurea. However, its use in western
countries has been largely superseded by other sulphs, particularly
glipizide and gliclazide. These are not "me too" as they have the
clinical advantage of being shorter acting and therefore causing less
hypoglycaemia, a real problem with glibenclamide with which several
fatal cases have occurred. Gliclazide has also another major advantage
as, being metabolized by the liver, is the only sulphonylurea which can
be used (with care) in renal failure. This may be important in the
setting of developing countries where type 2 diabetes presents late,
with a full house of complications. Gliclazide is off patent but, in the
UK, costs almost 5 times as much as glibenclamide in pharmacologically
equivalent doses (fortunately our government does not mind footing the
  In the UK,  gliclazide comes only in 80 mg, scored, tablets which
are very practical as doses vary from 40 to 160 mg twice daily.
Trying to push down the price of gliclazide in order to put it in the
EDL instead of glibenclamide would be very useful.

Insulin U40/U100.
The concomitant presence of two such different strength formulations
is not only confusing but can lead to clinical disasters. Could the U40
preparation be forever banned, as it has rightly happened in most
western countries ?

Only the 500 mg preparation appears in the EDL. In western clinical
practice the 850 mg strength is also frequently used but it might be
wiser to stick to a single strength preparation in developing countries
and the current EDL thus seems appropriate.


Dr. Valeria Frighi
Diabetes Trials Unit
Radcliffe Infirmary
Woodstock Road
Oxford OX2 6HE

tel. -44-1865-228422
fax -44-1865-224584
e-mail valeria.frighi@dtu.ox.ac.uk
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