Dibenol 5

Indications

Dibenol finds application in managing non-insulin-dependent diabetes mellitus (NIDDM). It’s important to note its ineffectiveness in completely pancreatectomized patients and juvenile-onset diabetes cases where the pancreas lacks significant insulin secretion capacity. For such patients, insulin remains essential as attempts to manage them solely with oral therapy are both perilous and futile.

Pharmacology

Glibenclamide stands out as an orally administered hypoglycemic agent, effectively lowering blood sugar levels by stimulating the secretion of endogenous insulin from pancreatic β-cells. Its unique potency allows for the mobilization of endogenous insulin at lower dosages, with minimal incidence of side effects compared to other anti-diabetic medications. Short-term therapy with Glibenclamide appears to reduce basal hepatic glucose production and enhance peripheral insulin action at key target sites.

Dosage & Administration

For stabilization, an initial dosage of half a tablet (2.5 mg) of Glibenclamide is recommended, to be taken during or immediately after breakfast. After 3-5 days, blood sugar and urine sugar levels should be monitored. Maintenance therapy may continue with a daily dose of ½ tablet (2.5 mg) if good control is achieved. In cases where results are suboptimal, dosage increments of ½ tablet (2.5 mg) at intervals of 3-5 days, up to a maximum of 3 tablets daily, may be necessary. Daily doses exceeding 10 mg can be divided into two administrations. Transition from other oral anti-diabetics with similar action to Glibenclamide should be initiated with ½ to 1 tablet under a physician’s guidance.

Transitioning from insulin to Glibenclamide should be carefully managed. Patients with mild diabetes requiring fewer than 20 units of insulin daily can start Glibenclamide with immediate insulin discontinuation. For those with moderate to high insulin requirements, a gradual transition is advised, with simultaneous administration of insulin and Glibenclamide while slowly reducing insulin dosage.

During periods of increased insulin requirements, such as during fever, surgical interventions, or trauma, Glibenclamide alone may be inadequate, necessitating temporary insulin supplementation. This transition from insulin to Glibenclamide is primarily suitable for NIDDM cases of recent onset, preferably under hospital or daily medical supervision.

Interaction

Alcohol, cyclophosphamide, dicoumarol, monoamine oxidase inhibitors, phenylbutazone, propranolol, other beta-adrenergic blocking agents, and certain long-acting sulphonamides may potentiate the hypoglycemic effects of Dibenol.

Contraindications

Dibenol is contraindicated in cases of severe metabolic decompensation with acidosis, pre-comatose states, diabetic coma, severe renal or hepatic dysfunction, serious impairment of thyroid or adrenal function, pregnancy, and diabetes mellitus complicated by fever, trauma, or gangrene.

Side Effects

Dibenol is generally well-tolerated, with occasional side effects including nausea, vomiting, epigastric pain, dizziness, weakness, paraesthesia, headache, allergic skin reactions, and haematopoietic reactions (leukopenia, thrombocytopenia, etc.).

Pregnancy & Lactation

While human pregnancy data is lacking, Glibenclamide has been widely used for many years without apparent adverse effects. Animal studies have not shown any hazards, though transfer of Glibenclamide to human milk remains uncertain. Caution is advised, as other sulphonylureas have been detected in milk.

Precautions & Warnings

Weight reduction is pivotal in diabetes treatment. Both patients and physicians should actively pursue weight reduction alongside medication, regardless of the chosen drug.

Overdose Effects

Symptoms of overdose primarily manifest as hypoglycemia, which can be managed with oral glucose and adjustment of drug dosage and/or meal patterns.

Therapeutic Class

Glibenclamide belongs to the sulfonylureas therapeutic class.

Storage Conditions

Dibenol should be stored in a dry place below 30°C.