Tolbutamide

The recommended adult dose of tolbutamide ranges from 500 mg to 3,000 mg per day, either as a single dose or in divided doses, depending on the need according to blood glucose tests and as prescribed by your doctor. The tablets should be taken with or before food.

It is very important to monitor blood sugar levels closely, especially when increasing and decreasing doses of medication or when exercise levels or weight changes occur. Your doctor or diabetes educator will instruct you on the best use of a glucose monitor.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take Tolbutamide exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Low blood sugar (Hypoglycemia) is an important concern if too much of Tolbutamide is taken for your circumstances. Ask your doctor or diabetes educator what you should do when you are not going to be eating for a long period of time or when you are going to be exercising more than usual.

Store Tolbutamide at room temperature, protect it from moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Each round, white, biconvex, scored tablet marked "APO" over "TOL" on one side contains 500 mg of tolbutamide. Nonmedicinal ingredients: information not available.

Tolbutamide should not be taken by anyone who:

• is allergic to tolbutamide or to any of the ingredients of the medication
• is breast-feeding
• is in a state of ketoacidosis (high ketones in urine)
• is pregnant
• is undergoing surgery or has suffered from recent severe trauma
• has a serious infection
• has severely reduced kidney and liver function
• has thyrotoxicosis (severe overactive Thyroid brought on by stress or infection)
• has Type 1 Diabetes (they should always be using insulin)

There may be an interaction between tolbutamide and any of the following:

• Acetazolamide
• alcohol
• anabolic steroids
• androgens (e.g., testosterone)
• angiotensin converting enzyme (ACE) inhibitors (e.g., Enalapril, Ramipril)
• Aprepitant
• "azole" antifungals (e.g., fluconazole, ketoconazole)
• beta-blockers (e.g., Nadolol, propanolol)
• birth control pills
• calcium channel blockers (e.g., Diltiazem, Verapamil)
• chloramphenicol
• Cimetidine
• clarithromycin
• corticosteroids (e.g., Prednisone)
• Cyclophosphamide
• Cyclosporine
• diazoxide
• Disopyramide
• diuretics (e.g., Hydrochlorothiazide, Chlorthalidone, Indapamide)
• estrogens
• fibrates (e.g., clofibrate, Fenofibrate)
• Fluoxetine
• guanethidine
• Ifosfamide

• Leflunomide
• luteinizing hormone-releasing hormone analogs (e.g., Buserelin, Goserelin, Leuprolide)
• monoamine oxidase (MAO) inhibitors (e.g., Phenelzine, tranylpromine)
• nicotinic acid (Niacin)
• nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., Ibuprofen, Naproxen)
• other antidiabetes medications
• Pegvisomant
• phenothiazines (e.g., Chlorpromazine, thioridazine, Prochlorperazine)
• phenylbutazone
• Phenytoin
• probenecid
• quinolones (e.g., ciprofloxacin, Ofloxacin)
• Ranitidine
• rifampin
• salicylates (e.g., Asa)
• Somatropin
• suflinpyrazone
• sulfonamides (e.g., Sulfasalazine, sulfamethoxazole)
• sympathomimetic amines (e.g., Epinephrine)
• Tetracycline
• thyroid hormone
• Warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Tolbutamide. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Tolbutamide.

Blood sugar control: Over a period of time, people may become progressively less responsive to a particular treatment for diabetes because of a worsening of their diabetes. If tolbutamide fails to lower blood glucose to target levels, the medication should be stopped and replaced, or another medication added to it. Loss of blood sugar control may occur during illness or stressful situations such as trauma or surgery. Under these conditions, your doctor may consider stopping the medication and prescribing insulin until the situation improves.

Diabetes complications: Although Tolbutamide may delay the development of complications, tolbutamide has not been shown to prevent the development of complications of diabetes. Tolbutamide must be used in addition to a proper dietary regimen and not as a substitute for diet.

Drowsiness/reduced alertness: Until your blood sugar is under control, or when changing doses of medication or when the tablets have not been taken regularly, use caution when driving or operating dangerous machinery, as alertness and reaction time may be reduced.

Low blood sugar: As with other sulfonylurea medications like tolbutamide, symptoms of hypoglycemia (low blood sugar) including dizziness, lack of energy, drowsiness, headache, and sweating have been observed with use of Tolbutamide. Weakness, nervousness, shakiness, and numbness or tingling have also been reported. Severe hypoglycemia can result from taking any of the sulfonylurea medications. Seniors, those with reduced kidney or liver function, and those who are fragile or malnourished are more likely to experience low blood sugar with these medications.

Low blood sugar is more likely to occur when food intake is inadequate or after strenuous or prolonged physical exercise. Blood glucose should be monitored regularly and emergency glucose (and Glucagon kit) should be kept available in case the need arises to increase blood sugar levels.

Reaction with alcohol: Unpleasant reactions to alcohol (flushing, sensation of warmth, giddiness, nausea, and occasionally racing heart rate) may occur for people taking tolbutamide. This reaction can be prevented by avoiding the use of alcohol.

Pregnancy: Tolbutamide should not be taken by pregnant women (insulin should be used to control blood sugar). If you become pregnant while taking Tolbutamide, contact your doctor immediately.

Breast-feeding: Tolbutamide passes into breast milk and should not be taken by breast-feeding women. If you are a breast-feeding mother and are taking tolbutamide, it may affect your baby.