E-DRUG: RFI: Switching oral hypoglycaemic drugs?
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Dear E-druggers,
To what extent are glibenclamide and chlorpropamide
clinically interchangeable using equi-effective doses?
Sometimes, only one of these medicines is available
and a patient earlier stabilized on one may present
himself or herself at a time when it is temporarily
out of stock for logistic reasons.
A few physicians, out of justifiable cconcern about
quality in some community retail drug outlets, would
prefer that their patiants purchase and use the
available one in the hospital pharmacy.
What pertinent practical professional/clinical issues
need to be considered in switching from one to the
other?
From my pharmacological knowledge of both medicines, I
feel more comfortable with a switching from
chlorpropamide to glibenclamide but I have a concern
about possible loss of glycaemic control due to
non-adherence if maximum daily dosage has to be used
which may need be split into two. My concern about the
reverse switch is the prolonged duration of action of
chlorpropamide arising from its rather long biological
half-life with consequent hazard of hypoglycaemia and
the possibility of inducing the unpleasant flush
reaction with alcoholic beverages where the necessary
counselling is not given (which is professionally
indefensible but may sometimes happen due to excessive
workload) or the patient is just negligent.
Olutayo A.Moronkeji,
Pharmacist,
OAUTH Wesley Guild Hospital,
Ilesa,
NIGERIA
oamoronkeji@yahoo.com