CHLORPROPAMIDE
(klor-proe'pa-mide)
Apo-Chlorpropamide  , Chloronase, Diabinese, Glucamide, Novopropamide
Classifications: hormone and synthetic substitute; antidiabetic sulfonylurea
Prototype: Glyburide
Pregnancy Category: C
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100 mg, 250 mg tablets
Longest-acting first-generation sulfonylurea compound, structurally and pharmacologically related to tolbutamide. Although
a sulfonamide derivative, it has no antiinfective activity. Lowers blood glucose by stimulating beta cells in pancreas to
synthesize and release endogenous insulin. May potentiate available antidiuretic hormone (ADH) secretion, a property not shared
by other sulfonylureas.
Antidiabetic effect is due to the ability of the drug to stimulate the beta cells of the pancreas to manufacture and release
insulin. Therapeutic effectiveness is indicated by HbA1c levels >7%.
Mild to moderately severe, stable non-insulin-dependent diabetes mellitus (type 2) in patients who cannot be controlled by
diet alone and who do not have complications of diabetes.
Neurogenic diabetes insipidus.
Known hypersensitivity to sulfonylureas and to sulfonamides; diabetes complicated by severe infection; acidosis; severe renal,
hepatic, or thyroid insufficiency. Safe use during pregnancy (category C), in nursing mothers, and in children not established.
Older adult patients, Addison's disease, CHF, and hepatic porphyria.
Antidiabetic
Adult: PO Initial: 100–250 mg/d with breakfast, adjust by 50–125 mg/d q3–5d until glycemic control is achieved, up to
750 mg/d
Antidiuretic
Adult: PO 100–250 mg/d, may adjust q2–3d up to 500 mg/d
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Oral
- Give as a single morning dose with breakfast. To reduce GI adverse effects, drug may be prescribed as 2 or 3 doses and taken
with meals.
- Store below 40° C (104° F), preferably at 15°–30° C (59°–86° F) in a tightly closed
container, unless otherwise directed.
Body as a Whole: Flushing, photosensitivity, alcohol intolerance. GI: GI distress, anorexia, nausea, diarrhea, constipation, cholestatic jaundice. Hematologic: Leukopenia, thrombocytopenia, agranulocytosis. Metabolic:
Hypoglycemia, antidiuretic effect (SIADH), dilutional hyponatremia, water intoxication. CNS: Drowsiness, muscle cramps, weakness, paresthesias. Skin: Rash, pruritus.
Drug: Adverse effects of oral anticoagulants, phenytoin,
salicylates, nsaids may be increased along with those of chlorpropamide; thiazide diuretics may increase blood sugar; alcohol produces disulfiram reaction; probenecid,
mao inhibitors may increase hypoglycemic effects. Herbal:
Garlic,
ginseng may increase hypoglycemic effects.
Absorption: Readily absorbed from GI tract. Onset: 1 h. Peak: 3–6 h. Distribution: Highly protein bound; distributed into breast milk. Metabolism: Metabolized in liver. Elimination: 80–90% excreted in urine in 96 h. Half-Life: 36 h.
Assessment & Drug Effects
- Monitor therapeutic effectiveness: Indicated by HbA1c levels >7%.
- Monitor blood and urine glucose to determine effectiveness of glycemic control.
- Lab tests: Periodic fasting and postprandial blood glucose; HbA1c every 3 mo; baseline and periodic hematologic and hepatic studies are advisable, particularly in patients receiving high
doses. A CBC should be performed if symptoms of anemia appear.
- Report dizziness, shortness of breath, malaise, fatigue.
- Monitor for S&S of hypoglycemia (see Appendix F).
- Monitor I&O ratio and pattern: Infrequently, chlorpropamide produces an antidiuretic effect, with resulting severe hyponatremia,
edema, and water intoxication. If fluid intake far exceeds output and edema develops (weight gain), report to the physician.
Patient & Family Education
- Report hypoglycemic episodes to physician. Because chlorpropamide has a long half-life, hypoglycemia can be severe, although
onset is not as fast or as dramatic as with use of insulin.
- Report any of the following immediately to physician: skin eruptions, malaise, fever, or photosensitivity. Immediately report
these symptoms to physician. A change to another hypoglycemic agent may be indicated.
- Do not self-dose with OTC drugs unless approved or prescribed by the physician.
- Do not breast feed while using this drug.
1%)
Prototype drug