Sulfonylurea Drug Names
The sulfonylureas currently used in clinical practice are glibenclamide (glyburide), gliclazide, glipizide, and glimepiride, which are second-generation agents that have largely replaced first-generation sulfonylureas due to their superior potency, tolerability, and lower risk of adverse effects. 1, 2
Second-Generation Sulfonylureas (Current Clinical Use)
The following are the primary sulfonylureas in current clinical practice for type 2 diabetes:
- Glipizide - Preferred agent in patients with renal impairment due to lack of active metabolites; does not require dose adjustment in kidney disease 3
- Glimepiride - Associated with reduced likelihood of hypoglycemia compared to glyburide and preserves cardioprotective responses to ischemia 1, 4
- Glyburide (Glibenclamide) - Has higher frequency of hypoglycemia than other agents and should be avoided in elderly patients 3, 2
- Gliclazide - Second-generation agent with lower hypoglycemia risk 3, 2
First-Generation Sulfonylureas (Generally Avoided)
First-generation sulfonylureas should generally be avoided in clinical practice, particularly in patients with chronic kidney disease, due to their prolonged half-lives and substantially greater risk of hypoglycemia compared to second-generation agents. 3
Clinical Selection Guidance
Among the available sulfonylureas, glipizide and glimepiride are preferred over glyburide due to their lower hypoglycemia risk, with glipizide being the agent of choice in renal impairment and elderly patients. 3
- Glipizide is recommended as the preferred sulfonylurea in patients with chronic kidney disease because it does not have active metabolites and does not significantly increase hypoglycemia risk 3
- Glyburide is explicitly contraindicated in elderly patients by the American Geriatrics Society due to prolonged hypoglycemia risk 3
- Glimepiride demonstrates more rapid lowering of fasting plasma glucose and improved first-phase insulin secretion compared to glipizide 1
Important Safety Considerations
All sulfonylureas lower glucose by stimulating insulin secretion from pancreatic β-cells and carry risk of hypoglycemia and weight gain, though the magnitude varies by agent. 5, 6 Professional societies recommend against routine use of sulfonylureas in hospital settings due to potential for sustained hypoglycemia. 5