Management overview for sulfonylurea poisoning

Glibenclamide, gliclazide, glimepiride and glipizide are sulfonylurea drugs used to treat type 2 diabetes. Glibenclamide is available on its own or as a coformulation with metformin. Gliclazide is available as both immediate-release and modified-release preparations.

Sulfonylurea poisoning causes hypoglycaemia that can be delayed and prolonged. Hypoglycaemia can occur at therapeutic doses, particularly in the elderly and those with kidney impairment.

For all patients with hypoglycaemia due to sulfonylurea poisoning, initial management includes glucose replacement and administration of the antidote, octreotide. In addition to glucose administration, encourage the patient to eat complex carbohydrates because this will reduce their overall glucose requirement.

For the management of poisoning due to coformulations of glibenclamide plus metformin, see also advice for Metformin poisoning.