Glibenclamide, Gliclazide, Glimepiride, Glipizide, Tolbutamide[Wockhardt, the only UK manufacturer of glibenclamide, have discontinued production. At the current time, this preparation remains in the British National Formulary and has been included in this monograph as unlicensed imports are available for patients in whom a switch to an alternative is inappropriate] |
Issues for Surgery |
Increased risk of post-operative infection and delayed wound healing due to poor glycaemic control if omitted. |
Advice in the Perioperative period |
Morning Surgery Twice daily dosing – omit the morning dose on day of surgery1 Afternoon Surgery Twice daily dosing – omit both doses on day of surgery1 Patients undergoing Bariatric Surgery Patients with type 2 diabetes mellitus not following a LRD: Follow the advice above for Elective Surgery. Emergency Surgery Perioperative Considerations Ensure emergency treatment of hypoglycaemia is prescribed i.e. Glucogel® and 20% dextrose. Rapid acting insulin should also be prescribed1, 3. Post-operative Advice 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. Patients undergoing Bariatric Surgery |
Interaction(s) with Common Anaesthetic Agents |
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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. Antibiotics Clarithromycin slightly increases, and sulfamethoxazole (found in co-trimoxazole) increases, sulfonylurea exposure which may cause hypoglycaemia2, 3, 4, 5, 6, 7. Case reports of hypoglycaemia have been noted with concomitant use of glibenclamide and ciprofloxacin7. Increase CBG monitoring with concomitant use and adjust dose of sulfonylurea if necessary7. |
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 (although VRIII may be necessary if emergency surgery or in people with poorly controlled diabetes (HbA1c >69mmol/mol))1. Patients expected to miss more than one meal should have VRIII if they develop hyperglycaemia (CBG >12mmol/L)1. Liver Reduction Diet (LRD) |
References |
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