Sulfonylureas are well-established as part of the treat...

Sulfonylureas are well-established as part of the treatment of type 2 diabetes.

Sulfonylureas are well-established as part of the treatment of type 2 diabetes. They are pills that lower blood sugar.

The sulfonylurea ("SU") pills have been available for many years. They are useful as "monotherapy" (as the only diabetes medication) or in various combinations with other types of diabetes pills, Byetta (exenatide) and/or with insulin ("combination therapy"). There are also new pills that are a combination of two ingredients, one of which is a SU and the other another type of pill, such as metformin or a thiazolidinedione.
The action of all the SU's is the same, to cause insulin release from the beta cells; they may have other effects that help lower the blood sugar. There is no data to suggest that using more than one SU at the same time is of any greater benefit than using one.

The sulfonylureas can cause the blood sugar level to go below normal (hypoglycemia), and therefore are sometimes called "hypoglycemic" drugs. (Other classes of diabetes drugs, such as the thiazolidinediones pioglitazone and rosiglitazone, and the alpha-glucosidase inhibitors such as acarbose, do not lower the blood sugar below the normal range, except when used in combination with pills like the SU's or with insulin therapy.) Side effects other than hypoglycemia are rare. Occasionally, chlorpropamide, and more rarely other sulfonylureas, can interact with alcohol to cause vomiting and flushing.

There are many sulfonylurea pills available. Four, known as "first-generation" drugs, have been in use for many years. Three, called "second-generation" drugs, have been developed more recently. They are sometimes stronger than first-generation drugs, but mainly have fewer side effects. Each type of pill is sold under two names: one is the generic name as listed by the US Food and Drug Administration; the other is the brand name given by the manufacturer. Some pills are available as lower-priced generics, others are only available as the branded version. They are:

First-Generation Agents:

Generic Name: acetohexamide
Brand Name: Dymelor

Generic Name: chlorpropamide
Brand Name: Diabinese

Generic Name: tolazamide
Brand Name: Tolinase

Generic Name: tolbutamide
Brand Name: Orinase



Second-Generation Agents:
Generic Name: glimepiride
Brand Name: Amaryl

Generic Name: glipizide
Brand Names: Glucotrol, Glucotrol XL

Generic Name: glyburide
Brand Names: DiaBeta, Micronase, Glynase


Combination Agents:
Combination of glyburide plus metformin
Brand Name: GlucoVance

Combination of glipizide plus metformin
Brand name: Metaglip

Combination of rosiglitazone plus metformin
Brand name: Avandamet

Combination of rosiglitazone plus Amaryl
Brand name: Avandaryl