Generic Name

Tolazamide

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Classification

FDA Approved Indications

• Management of non-insulin-dependent (type 2) diabetes mellitus

Mechanism of Action

Stimulates insulin release from pancreatic beta cells, thereby lowering blood glucose levels.

Dosage and Administration

Adult: Initial dose usually 100-250 mg once daily, adjusted based on response. Maintenance doses typically 100-300 mg daily in divided doses

Pediatric: Not recommended for pediatric use

Geriatric: Use with caution; start at lower doses due to increased prevalence of renal, hepatic, or cardiac impairment

Renal Impairment: Adjust doses based on renal function; monitor renal status

Hepatic Impairment: Use with caution; hepatic function should be evaluated before initiation and periodically thereafter.

Pharmacokinetics

Absorption: Well absorbed from gastrointestinal tract

Distribution: Distributed widely in body tissues and fluids

Metabolism: Partially metabolized in the liver

Excretion: Primarily excreted via urine

Half Life: Approximately 4-8 hours

Contraindications

• Hypersensitivity to tolazamide or other sulfonylureas
• Diabetic ketoacidosis

Precautions

• Use with caution in patients with hepatic or renal impairment, adrenal or pituitary insufficiency, or sulfonamide allergy; risk of hypoglycemia, especially in elderly.

Adverse Reactions - Common

• Hypoglycemia (Common)
• Gastrointestinal upset (Less common)

Adverse Reactions - Serious

• Hypersensitivity reactions (Rare)
• Blood dyscrasias (Rare)
• Jaundice or hepatic dysfunction (Rare)

Drug-Drug Interactions

• Other antidiabetic agents, especially insulin or other sulfonylureas; beta-blockers (may mask hypoglycemia symptoms); NSAIDs (may enhance hypoglycemic effect).

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Take medication regularly and as prescribed.
• Recognize symptoms of hypoglycemia and how to treat it.
• Maintain a balanced diet and consistent carbohydrate intake.
• Avoid alcohol and inform healthcare provider of any side effects.

Special Considerations

Black Box Warnings:

• Serious hypoglycemia can occur, especially in the elderly or with concomitant medication use.

Genetic Factors: Patients with G6PD deficiency may have an increased risk of hemolytic anemia.

Lab Test Interference: None significant.

Overdose Management

Signs/Symptoms: Severe hypoglycemia—confusion, weakness, sweating, seizures, or coma.

Treatment: Administer oral glucose if conscious; for severe cases, may require IV glucose or glucagon; monitor closely and provide supportive care.

Storage and Handling

Storage: Store at room temperature in a tightly closed container, away from heat and moisture.

Stability: Stable under recommended storage conditions.