Sulfonylureas


 

Glibenclamide, Gliclazide, Glimepiride, Glipizide, Tolbutamide


  Issues for Surgery


Increased risk of post-operative infection and delayed wound healing due to poor glycaemic control if omitted.

Hypoglycaemia if continued during nil by mouth period.


  Advice in the Perioperative period


Elective Surgery

Sulfonylureas should be taken as normal the day prior to surgery1.

Morning Surgery
Once daily dosing (in the morning) – omit the dose on day of surgery1

Twice daily dosing – omit the morning dose on day of surgery1

Afternoon Surgery
Once daily dosing (in the morning) – omit the dose of day of surgery1

Twice daily dosing – omit both doses on day of surgery1

Emergency Surgery

In the event of emergency surgery and the patient has already taken their sulfonylurea dose(s) monitor blood glucose levels closely and treat any hypoglycaemia accordingly.

Perioperative Considerations

Commence variable rate intravenous insulin infusion (VRIII) perioperatively where indicated (see Further Information) and omit sulfonylurea during VRIII treatment1.

Ensure emergency treatment of hypoglycaemia is prescribed i.e. Glucogel® and 20% dextrose. Rapid acting insulin should also be prescribed1, 2.

Post-operative Advice

Restart once eating and drinking normally and VRIII (where applicable) has been stopped1, 2. The dose of sulfonylurea may need to be withheld or reduced if food intake is likely to be reduced1.

NB: Patients undergoing afternoon surgery and taking twice daily sulfonylurea will restart their medication the day after surgery, once they are eating and drinking normally and VRIII (where applicable) has been stopped.


  Interaction(s) with Common Anaesthetic Agents


None2, 3, 4, 5, 6, 7, 8, 9.


  Interaction(s) with other Common Medicines used in the Perioperative Period


Non-Steroidal Anti-inflammatory Drugs (NSAIDs)

Caution with concomitant use of NSAIDs as they may cause hypoglycaemia3, 4, 5, 6, 7, 8, 9.


  Further Information

 

VRIII

Patients with a planned short starvation period (no more than one missed meal in total) should be managed by modification of their usual diabetes medication, avoiding VRIII wherever possible. Patients expected to miss more than one meal should have VRIII1.


  References


  1. Joint British Diabetes Societies for Inpatient Care. Management of adults with diabetes undergoing surgery and elective procedures: improving standards (Revised March 2016). Available at: www.diabetes.org.uk [Accessed 3rd April 2019]
  2. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 3rd April 2019]
  3. Summary of Product Characteristics – Glibenclamide 2.5mg Tablets. Wockhardt UK Ltd. Accessed via www.medicines.org.uk 07/04/2019 [date of revision of the text December 2015]
  4. Summary of Product Characteristics – Diamicron® (gliclazide) 80mg Tablets. Servier Laboratories Limited. Accessed via www.medicines.org.uk 07/04/2019 [date of revision of the text January 2017]
  5. Summary of Product Characteristics – Biloxona® (gliclazide) 30mg Modified-release Tablets. Accord-UK Ltd. Accessed via www.medicines.org.uk 07/04/2019 [date of revision of the text June 2017]
  6. Summary of Product Characteristics – Glimepiride 1mg Tablets. Accord Healthcare Ltd. Accessed via www.medicines.org.uk 07/04/2019 [date of revision of the text September 2014)
  7. Summary of Product Characteristics – Glipizide 5mg Tablets. Generics UK T/A Mylan. Accessed via www.medicines.org.uk 07/04/2019 [date of revision of the text October 2017)
  8. Summary of Product Characteristics – Tolbutamide 500mg Tablets. Kent Pharmaceuticals Ltd. Accessed via www.medicines.org.uk 07/04/2019 [date of revision of the text February 2017)
  9. Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 7th April 2019]