$Unique_ID{BRK02162}
$Pretitle{}
$Title{TOLBUTAMIDE}
$Subject{Oramide (Major)
Orinase (Upjohn)
tolbutamide (various manufacturers)}
$Volume{}
$Log{}

Copyright (C) 1991 Publications International, Ltd.


TOLBUTAMIDE
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BRAND NAMES (Manufacturers):
     Oramide (Major)
     Orinase (Upjohn)
     tolbutamide (various manufacturers)
TYPE OF DRUG:
     Oral antidiabetic
INGREDIENT:
     tolbutamide
DOSAGE FORM:
     Tablets (250 mg and 500 mg)
STORAGE:
     This medication should be stored at room temperature in a tightly closed
       container.  Discard any outdated medication.

USES

     Tolbutamide is used for the treatment of diabetes mellitus (sugar
diabetes) that appears in adulthood and cannot be managed by control of diet
alone.  This type of diabetes is known as non-insulin-dependent diabetes (also
called maturity-onset or Type II diabetes).  Tolbutamide lowers blood sugar by
increasing the release of insulin from the pancreas.

TREATMENT

     In order for this medication to work correctly, it must be taken as
directed by your doctor.  It is best to take this medicine at the same time(s)
each day, in order to maintain a constant blood sugar level.  It is,
therefore, important to try not to miss any doses of tolbutamide.  If you do
miss a dose, take it as soon as possible, unless it is almost time for the
next dose.  In that case, do not take the missed dose at all; just return to
your regular dosing schedule.  Do not double the next dose.  Tell your doctor
if you feel any side effects from missing a dose of this drug.

SIDE EFFECTS

     Minor.

     Diarrhea, headache, heartburn, loss of appetite, nausea, stomach
discomfort, stomach pain, or vomiting.  These side effects usually disappear
during treatment, as your body adjusts to the medication.
     Tolbutamide may increase your sensitivity to sunlight.  You should,
therefore, avoid prolonged exposure to sunlight and sunlamps.  Wear protective
clothing and sunglasses, and use an effective sunscreen.

     Major.

     Tell your doctor about any side effects that are persistent or
particularly bothersome.  IT IS ESPECIALLY IMPORTANT TO TELL YOUR DOCTOR about
dark urine, fatigue, itching of the skin, light-colored stools, sore throat
and fever, unusual bleeding or bruising, or yellowing of the eyes or skin.

INTERACTIONS

     Tolbutamide interacts with a number of other types of drugs:
     1. The combination of tolbutamide and chloramphenicol, guanethidine,
insulin, fenfluramine, sulfinpyrazone, monoamine oxidase (MAO) inhibitors,
oxyphenbutazone, oxytetracycline, phenylbutazone, probenecid, aspirin or other
salicylates, or sulfonamide antibiotics can lower blood sugar
levels--sometimes to dangerously low levels.  At least 14 days should separate
the use of this drug and the use of an MAO inhibitor.
     2. Thyroid hormones, dextrothyroxine, epinephrine, phenytoin, thiazide
diuretics (water pills), and cortisone-like medications (such as
dexamethasone, hydrocortisone, and prednisone), combined with tolbutamide, can
actually increase blood sugar levels--just what you are trying to avoid.
     3. Rifampin can decrease the blood concentrations of tolbutamide, which
can lead to a decrease in its effectiveness.
     4. Oral antidiabetic medications can increase the effects of blood
thinners, such as warfarin, which can lead to bleeding complications.
     5. The combination of tolbutamide and beta-blocking medications
(acebutolol, atenolol, betaxolol, carteolol, esmolol, labetalol, metoprolol,
nadolol, penbutolol, pindolol, propranolol, timolol) can result in either high
or low blood sugar levels.  Beta blockers can also mask the symptoms of low
blood sugar, which can be dangerous.
     BE SURE TO TELL YOUR DOCTOR about any medications you are currently
taking, especially any of those listed above.

WARNINGS

     * It is important to tell your doctor if you have ever had unusual or
allergic reactions to tolbutamide or to any other sulfa medication
(sulfonamide antibiotics, diuretics {water pills}, other oral antidiabetics).
     * It is also important to tell your doctor if you now have or if you have
ever had kidney disease, liver disease, severe infection, or thyroid disease.
     * Avoid drinking alcoholic beverages while taking this medication (unless
otherwise directed by your doctor).  Some patients who take this medicine
suffer nausea, vomiting, dizziness, stomach pain, pounding headache, sweating,
and redness of the face and skin when they drink alcohol.  Also, large amounts
of alcohol can lower your blood sugar concentration to a dangerously low
level.
     * Follow the special diet that your doctor gave you.  This is an
important part of controlling your blood sugar levels and is necessary in
order for this medicine to work properly.
     * Before having surgery or any other medical or dental treatment,
be sure to tell your doctor or dentist about this drug.
     * Test for sugar in your urine as directed by your doctor.  It is a
convenient way to determine whether your diabetes is being controlled by this
medicine.
     * Eat or drink something containing sugar right away if you experience
any symptoms of hypoglycemia (low blood sugar), such as anxiety, chills, cold
sweats, cool or pale skin, drowsiness, excessive hunger, headache, nausea,
nervousness, rapid heartbeat, shakiness, or unusual tiredness or weakness).
It is important that your family and friends know the symptoms of low blood
sugar and what to do if they observe any of these symptoms in you.
     * Even if the hypoglycemic symptoms seem to disappear after you eat or
drink a sugar-containing product, it is important to contact your doctor as
soon as possible.  The blood-sugar-lowering effects of tolbutamide can last
for hours, and your symptoms may return during this period.  Good sources of
sugar are orange juice, corn syrup, honey, sugar cubes, and table sugar.  You
are at greatest risk of developing low blood sugar if you skip or delay meals,
exercise more than usual, are unable to eat because of nausea or vomiting, or
drink large amounts of alcohol.
     * You may need to be switched to insulin if you have a severe infection,
are scheduled for major surgery, suffer diabetic coma or become pregnant.
     * Be sure to tell your doctor if you are pregnant.  Your dosing
requirements for tolbutamide may change during pregnancy, or you may be
switched to insulin.  Although extensive studies in humans have not been
conducted, adverse effects have been observed in the fetuses of animals that
received the drug tolbutamide during pregnancy.  Also, tell your doctor if you
are breast-feeding an infant.  Since small amounts of tolbutamide may pass
into breast milk, cautious use is warranted.

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The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
