A patient with type 2 diabetes on metformin is started on a sulfonylurea. He presents 3 hours after a meal with sweating, tremors and a blood glucose of 42 mg/dL. Which sulfonylurea is MOST likely to cause this prolonged hypoglycaemia?

• A Glipizide
• B Glibenclamide (Glyburide) ✓
• C Tolbutamide
• D Gliclazide

Explanation

Glibenclamide (glyburide) is a second-generation sulfonylurea with the longest half-life (~10 hours) among commonly used agents, and its active metabolites further prolong hypoglycaemia. It strongly closes pancreatic beta-cell KATP channels independent of glucose concentration. Tolbutamide has the shortest half-life (~4-6 hours) and is the safest in elderly patients. Glipizide and gliclazide have intermediate durations and are safer in renal impairment.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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