Home Drug Guide Tolbutamide

Drug Guide

Generic Name

Tolbutamide

Brand Names Orinase

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 inhibiting ATP-sensitive potassium channels, leading to increased insulin secretion.

Dosage and Administration

Adult: Typically 500 mg once daily initially, titrated up based on response, with usual doses between 500-2000 mg per day in divided doses.

Pediatric: Not commonly used in pediatric patients; consult specific pediatric guidelines.

Geriatric: Start at low doses due to potential increased sensitivity and comorbidities.

Renal Impairment: Use with caution; dosage adjustments may be necessary.

Hepatic Impairment: Use with caution; monitor liver function.

Pharmacokinetics

Absorption: Well absorbed from gastrointestinal tract.

Distribution: Widely distributed; crosses into placenta and breast milk.

Metabolism: Metabolized in the liver.

Excretion: Excreted mainly in urine as metabolites.

Half Life: Approximately 4-6 hours.

Contraindications

  • Known hypersensitivity to sulfonylureas or sulfonamides.
  • Type 1 diabetes mellitus.
  • Diabetic ketoacidosis.

Precautions

  • Use with caution in renal or hepatic impairment.
  • Risk of hypoglycemia; monitor blood glucose regularly.
  • Pregnancy category C; consider risks and benefits in pregnancy and lactation.

Adverse Reactions - Common

  • Hypoglycemia (Common)
  • Gastrointestinal discomfort (nausea, epigastric pain, heartburn) (Uncommon)

Adverse Reactions - Serious

  • Severe hypoglycemia (Rare)
  • Hematologic reactions (leukopenia, aplastic anemia) (Very rare)
  • Dermatologic reactions (rash, erythema, Stevens-Johnson syndrome) (Rare)

Drug-Drug Interactions

  • Other antidiabetic agents (risk of hypoglycemia), beta-blockers (mask hypoglycemia symptoms), NSAIDs (alter glucose levels).

Drug-Food Interactions

  • Alcohol (may increase hypoglycemia risk).

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood glucose levels regularly, assess renal and hepatic function.

Diagnoses:

  • Risk for hypoglycemia
  • Ineffective therapeutic regimen management.

Implementation: Administer with food to minimize gastrointestinal upset. Educate patient about signs of hypoglycemia.

Evaluation: Assess blood glucose control and adjust dosage accordingly.

Patient/Family Teaching

  • Take medication as prescribed. Monitor blood sugar levels regularly.
  • Recognize symptoms of hypoglycemia (sweating, trembling, weakness) and how to treat it.
  • Maintain a balanced diet and adhere to exercise recommendations.
  • Inform healthcare provider of all medications and supplements.

Special Considerations

Black Box Warnings:

  • Risk of severe and prolonged hypoglycemia in certain populations.

Genetic Factors: Limited data.

Lab Test Interference: May affect certain blood glucose and HbA1c measurements.

Overdose Management

Signs/Symptoms: Severe hypoglycemia, including dizziness, confusion, seizures, loss of consciousness.

Treatment: Immediate administration of oral glucose or IV dextrose; patient may require hospitalization for monitoring and supportive care.

Storage and Handling

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

Stability: Stable under recommended storage conditions for the shelf life indicated on the packaging.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.