Friday March 9, 2007
Sulfonylurea overdose

Anti-diabetic pills overdose remained one of the leading cause of drug overdose worldwide. Among anti-diabetic pills sulfonylureas are the most dangerous and hard to correct. Overdose of metformin rarely causes clinically evident hypoglycemia (It has its own danger of cardiovascular collapse and renal failure, due to severe lactic acidosis).

Unfortunately very few clinicians use the real antidote for sulfonylurea which is Octreotide (Sandostatin) in resistant hypoglycemia. Infusion of glucose to achieve euglycemia in the early phase is an appropriate treatment but there is some literature available which argues that prolong infusion of dextrose in sulfonylurea overdose may make hypoglycemia longer and worse by stimulating insulin release. The dose for Octreotide is 50 mcg SC every 8 hours with adjustment of dose according to blood glucose level. Octreotide is a somatostatin analogue, which activates G-protein K channel and hyperpolarization of the beta cell results in inhibition of Ca influx and insulin release.

Another antidote for sulfonylurea overdose beside octreotide is Diazoxide. Exact mechanism is unknow but probably it increases blood glucose by inhibiting pancreatic insulin release. It is found to be effective within 60 minutes of administration. The usual dose is 5 mg/kg/day intravenously and should be divided every 8 hours. Dose can be increased if needed but still its experience in comparison to octreotide is limited.


References: click to get abstracts/articles

1. Octreotide for sulfonylurea-induced hypoglycemia following overdose - The Annals of Pharmacotherapy: Vol. 36, No. 11, pp. 1727-1732

2. Clinical spectrum of sulfonylurea overdose and experience with diazoxide therapy - Archives of Internal Medicine Vol. 151 No. 9, September 1, 1991