Chlorpropamide – Oral Route

Chlorpropamide is a prescription only drug that is used to treat patients with high blood sugar levels that are caused by type two diabetes.

Overview

Diabetes mellitus, or type 2 diabetes, affects the body’s natural ability to break down glucose. As a result, excess sugar builds up in the body, leading to unhealthily high levels in the blood stream. If left untreated over a long period of time, high blood sugar levels can lead to a range of serious health problems, including heart failure, glaucoma, and other heart and respiratory problems. People that suffer from type 2 diabetes often need to change their diets to consume less sugary foods in order to help the body retain healthy levels of sugar. In addition, a drug such as chlorapropamide may be prescribed.

Chlorpropamide is part of a group of drugs called the sulfonylureas. These drugs improve the release of insulin from the pancreas, which aids the body in storing sugar. This then lowers the blood sugar to a healthier level. This drug is often used when other treatments have proved to be inefficient in lowering blood sugar levels. Exercise and diet will usually be prescribed first, and then a glucose-lowering drug introduced after. Where other glucose-lowering drugs have not worked, chlorpropamide may be used. The drug usually has more side effects than similar drugs.

Chlorpropamide is also known and sold by its brand name Diabinese in the United States.

Conditions treated

  • high blood sugar levels in people with type 2 diabetes

Type of medication

  • tablet

Side effects

When taking a new medication, your body may react in certain ways as it adapts to the drug being in your system. Most of these side effects are relatively common and are not usually a cause for concern unless they persist or become particularly unpleasant.

The most common side effect of this drug is a condition called hypoglycaemia - often referred to as low blood sugar. If you experience any of the symptoms of this condition, you should notify a doctor straight away, as severe low blood pressure can lead to seizures and can be fatal in the most extreme of cases. Symptoms of low blood pressure include faintness, dizziness, extreme hunger, feelings of weakness in the limbs, irritability, headaches, excessive sweating, difficulty concentrating, tremors, fast heartbeat or irregular heartbeat.

Other common side effects of taking this drug that may not be linked to low blood pressure include the below:

  • headache
  • Nausea
  • Vomiting
  • Tiredness
  • Stomach aches
  • Dry mouth
  • Sore throat
  • Temperature
  • Dizziness or faintness

There are some less common side effects that you should also report to your doctor, as these could be a sign of serious reactions or health conditions. These are:

* unusual fatigue - difficulty in waking up in the mornings or urge to fall asleep during the day
* Thickening of the skin
* Darkening of the skin (not linked to sun exposure)
* Changes in heart rate - faster or irregular
* easy bruising
* Unusual bleeding at various areas of the body
* Changes in your mood or mental state
* Rapid or sudden weight gain
* swelling of the hands or feet
* weakness in the muscles
* Spasms of muscles
* Pain in passing bowel movements or urine
* Black or very dark stools
* Blood in the stools
* Jaundice - yellow skin or eyes
* Nausea or vomiting that persists for more than two consecutive days
* Pain in the stomach
* Infections
* Fever of over 100 degrees, or persistent temperature
* Sore throat that lasts more than two to three days
* Seizures or fits
* Dark colored or cloudy urine
* Passing urine more frequently, or passing more urine than normal
* Muscle or joint pain

Major drug interactions

Before you start taking this medication, you should have a conversation with your doctor about your full medical history and any other medications you may be taking. There are some drugs that are not suitable to take together, so you should always be upfront with your doctor when he or she is deciding on the most suitable prescription for you. If you are taking any medicine that contains tequin, you should tell your doctor, as this drug causes a major interaction with chlorpropamide. This combination should be avoided.

A drug interaction is when two or more drugs react with each other when mixed together. If this reaction happens inside the human body, it can lead to increased and more severe side effects. In some severe cases, the consequences of taking two interactive drugs at the same time could be dangerous and even life-threatening.

There are different levels of interactions, and not all are life-threatening. Major interactions should be avoided at all costs, moderate interactions should usually be avoided as the risk will generally outweigh the benefits, while minor interactions may still be able to be taken together but at a reduced or adapted dose. You should generally avoid taking chlorpropamide with the following drugs:

* Acarbose
* Aspirin
* Balofloxacin
* Besifloxacin
* Ciprofloxacin
* Disopyramide
* Dulaglutide
* Enoxacin
* Fleroxacin
* Flumequine
* Gatifloxacin
* Gemifloxacin
* Lanreotide
* Levofloxacin
* Lixisenatide
* Lomefloxacin
* Metreleptin
* Moxifloxacin
* Nadifloxacin
* Norfloxacin
* Octreotide
* Ofloxacin
* Pasireotide
* Pazufloxacin
* Pefloxacin
* Prulifloxacin
* Rufloxacin
* Sparfloxacin
* Thioctic Acid
* Tosufloxacin

If you are using any of the following medications, they may contribute to more severe side effects, or may put you at increased risk of developing side effects. However, you may decide with your doctor that the drug combinations are the best treatment option for you:

* Acebutolol
* Atenolol
* Betaxolol
* Bisoprolol
* Bitter Melon
* Carteolol
* Carvedilol
* Celiprolol
* Chloramphenicol
* Clofibrate
* Esmolol
* Fenugreek
* Furazolidone
* Garlic
* Glucomannan
* Guar Gum
* Iproniazid
* Isocarboxazid
* Labetalol
* Levobunolol
* Linezolid
* Methylene Blue
* Metipranolol
* Metoprolol
* Moclobemide
* Nadolol
* Nebivolol
* Nialamide
* Oxprenolol
* Penbutolol
* Phenelzine
* Pindolol
* Practolol
* Procarbazine
* Propranolol
* Psyllium
* Rasagiline
* Rifampin
* Rifapentine
* Safinamide
* Selegiline
* Sotalol
* Timolol
* Tranylcypromine

Dosage

The dosage that is prescribed to patients may vary depending on their individual medical history and current lifestyle choices.

The initial dosage for the most typical patient suffering from type 2 diabetes and high blood sugar levels is 250 mg. This dosage is usually adequate for those that are middle-aged, and with stable mild to moderately severe type 2 diabetes.

Dosage adjustment for older patients is usually set at 100-125 mg/day PO initially. This may then be increased or decreased by 50-125 mg/day at three to five-day intervals.

The maintenance dosage is usually set somewhere between 100 mg - 250 mg per day. However, this can be increased to a higher dose of 500 mg per day for those patients suffering from severe diabetes. It can even be increased to up to 750 mg per day in the most extreme cases if a doctor decides this is necessary. Dosage given should not exceed more than 750 mg per day or the patient may experience severe side effects or signs of overdose.

Tablets should be taken around 30 minutes before eating a meal to enable absorption by the body.

Warnings

Increased risk of cardiovascular diseases and mortality

Taking hypoglycemic drugs such as this one has been found to increase the risk of cardiovascular mortality, when compared to treatments of diet improvement and exercise alone, or insulin-based treatment. This warning comes after a study was carried out by the University Group Diabetes Program (UGDP). This study was a long-term medical trial at Ked at evaluating the impact of glucose reducing drugs. The study took place on the data of more than 800 patients with type 2 diabetes that were then randomly assigned to one of four treatment groups.

It was found that, over a treatment course of five to eight years, patients treated with a glucose-lowering drug were 2.5 times more likely to suffer from cardiovascular mortality than those that were treated with diet improvements alone. Patients that take this drug should, therefore, be closely monitored for any signs of developing cardiovascular problems. If any signs are detected, the treatment should be stopped and an alternative medication should be prescribed.

Allergies

You should always inform your doctor if you have suffered from an allergic reaction to this medication or any other drugs. Your doctor will also want to know about any other allergies you may have experienced in the past, including allergies to dogs and cats, foods, preservatives, dust, pollen - or anything else.

Children

As type 2 diabetes is usually suffered from by older patients, it is very rare that this drug would be prescribed for children. Therefore, there is little data available to suggest its impact on younger patients. If prescribing this medication to a child, he or she should be closely monitored for adverse reactions, and any side effects should be reported immediately.

Elderly

This drug is commonly used by older patients that have been diagnosed with type 2 diabetes and there are very few reports of adverse reactions or severe side effects. The drug is thought to have the same level of effectiveness in geriatric patients as it does in younger adults. However, older patients are at a slightly higher risk of developing health complications such as kidney or liver problems. When prescribing this drug to elderly patients, the doctor may decide to offer a lower dose or may monitor the patient closely and reduce the dosage if side effects are reported.

Pregnancy and breastfeeding

Chlorpropamide has been classed as a category C drug with relation to risk during pregnancy. This means that there is a slight risk presented to the unborn baby. Studies on animals have found that there is an adverse reaction due to taking the drug in pregnancy throughout all three trimesters.

There has been no identified risk to breastfeeding mothers and babies. However, doctors should proceed with caution when prescribing this drug to mothers that are nursing babies. The mother and baby should be monitored closely for any signs of adverse reactions. Before taking this drug, you should weigh up the health benefits versus the risks.

Food and alcohol interactions

The nature of type 2 diabetes means that patients will be advised to adapt their eating and drinking habits. This will involve cutting down on sugar, processed foods and alcohol. It is therefore not advisable to drink alcohol or eat unhealthy foods when taking chlorpropamide. The medication works best when it is complemented with a healthy and wholesome diet; failure to follow this advice could impact the effectiveness of the drug and may lead to higher blood sugar levels.

Storage

In the United States alone, there are at least 60,000 cases of children being admitted to emergency rooms because of taking medication that wasn’t intended for their consumption. You should therefore always keep your prescription away from the sight and reach of children, ideally in a locked cabinet.

Always keep your prescription of chlorpropamide in the packaging with which it was supplied. Keep it clearly labelled so that it does not get mixed up with any other medications.

You should always keep your tablets at room temperature; this is when they are most effective. Generally, this means temperatures of between 15 to 25 degrees centigrade. Do not refrigerate or freeze your tablets as this could render them ineffective. It is also imperative that you keep the tablets away from direct sunlight and away from heat sources such as radiators. Do not store your tablets in areas that could be damp, such as bathrooms; instead keep them in a dry, clean environment.

Disposal

You should never consume tablets that have reached their expiry date. If you discover that your chlorpropamide prescription has become out of date, then you should dispose of it. Medication should be disposed of in certain ways, not just thrown in the garbage or flushed down a drain. The FDA has published a useful guide to disposing of medicines on its website, designed to help people minimize the risk of their drugs getting into the wrong hands.

As a general rule, when disposing of tablets, you should take them out of their box and mix them with a sort of undesirable substance - like used ground coffee, cat litter or even soil or dirt from the garden. After you’ve thoroughly mixed the substances, put the mixture in a plastic sandwich bag and seal it tightly shut. Then you can throw it in the trash can for regular collection.

You can also search the FDA’s website for a local take-back scheme that operates in your area. Take back schemes are pick up services for unwanted and out of date drugs. They aim to reduce the risk of disposed or old medications being consumed by pets, children or causing harm to the environment. There are take back schemes available to book at the click of a button in many locations throughout the country. However, if your location is not included in the scheme, you should follow the advice given above, or ask your doctor of how to dispose of your prescription if you are not sure.

Summary

Chlorpropamide is a widely used drug that has proven to be effective in most cases of reducing blood sugar levels to a more manageable level. However, as will be the case with most type 2 diabetes medications, taking the drug alone is not usually sufficient at improving the condition. Improvement in blood sugar levels and therefore quality of life for those living with diabetes depends equally on the patient’s willingness to make positive lifestyle changes. This includes cutting out harmful foods such as those high in sugar, as well as highly processed foods. Patients should also cut down on alcohol, smoking and other harmful substances such as fizzy drinks, sugary unnatural drinks and foods that are high in preservatives.

While taking chlorpropamide, patients should also take part in regular exercise to improve their condition. Improvement in the quality of life of those suffering from type 2 diabetes relies heavily on the effort and commitment of the patient - they should not rely on chlorpropamide alone.

There are many studies into the effectiveness of the drug, finding it to be successful at improving quality of life for patients of a variety of age groups. There is, however, limited data about the risk of the drug when administered to children, breastfeeding mothers, or those that are pregnant. In addition, recent studies have also found that the drug leads to more side effects than other drugs in its category. Therefore, a doctor may not choose to offer this medication as a first choice treatment. Other drugs with fewer side effects may be tried first and, if the patient does not respond to them, then chlorpropamide may be prescribed. Patients should be closely monitored for side effects, particularly signs of low blood pressure and should also help to decrease the risk of side effects by telling their doctors about any other medications they may be taking or health conditions that they may be suffering from.