Home Drug Guide Tolbutamide Sodium

Drug Guide

Generic Name

Tolbutamide Sodium

Brand Names Orinase Diagnostic

Classification

Therapeutic: Antidiabetic agent

Pharmacological: Sulfonylurea

FDA Approved Indications

Management of type 2 diabetes mellitus

Mechanism of Action

Stimulates insulin release from pancreatic beta cells by blocking ATP-sensitive potassium channels, leading to increased insulin secretion and decreased blood glucose levels.

Dosage and Administration

Adult: Initially 250 mg once daily with meals; adjust based on response, usually up to 500-1000 mg per day in divided doses.

Pediatric: Not approved for pediatric use.

Geriatric: Start at lower doses due to increased sensitivity and risk of hypoglycemia.

Renal Impairment: Use with caution, dose adjustments recommended.

Hepatic Impairment: No specific data, caution advised.

Pharmacokinetics

Absorption: Absorbed rapidly from GI tract.

Distribution: Widely distributed; crosses blood-brain barrier.

Metabolism: Metabolized in the liver.

Excretion: Excreted primarily in urine.

Half Life: Approximately 4-6 hours.

Contraindications

Hypoglycemia
Allergy to sulfonylureas

Precautions

Use with caution in renal or hepatic impairment, pregnancy, lactation, and elderly patients. Monitor blood glucose regularly.

Adverse Reactions - Common

Hypoglycemia (Common)
Gastrointestinal upset (nausea, vomiting) (Uncommon)

Adverse Reactions - Serious

Allergic skin reactions (Rare)
Possibility of cardiovascular events (rare) (Rare)

Drug-Drug Interactions

Other antidiabetic agents, especially insulin or other sulfonylureas; beta-blockers; NSAIDs; corticosteroids.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood glucose levels regularly; assess for signs of hypoglycemia and hyperglycemia.

Diagnoses:

Risk for unstable blood glucose levels.
Risk for hypoglycemia.

Implementation: Administer with meals to reduce gastrointestinal discomfort; educate patient about hypoglycemia symptoms and management.

Evaluation: Adjust dosage based on blood glucose readings and patient response.

Patient/Family Teaching

Take medication with meals to minimize stomach upset.
Recognize hypoglycemia symptoms (shaking, sweating, confusion).
Do not skip meals while on medication.
Follow recommended diet and exercise plan.

Special Considerations

Black Box Warnings:

Risk of severe hypoglycemia.

Genetic Factors: Not specifically related to genetics.

Lab Test Interference: May interfere with urine testing for glucose.

Overdose Management

Signs/Symptoms: Severe hypoglycemia: sweating, tremors, confusion, seizures.

Treatment: Administer oral glucose if conscious; IV glucose or glucagon in severe cases; monitor blood glucose levels closely.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable for 2-3 years when stored properly.