Which diabetic medication, according to the Beers criteria, can cause prolonged hypoglycemia in older adults?

Chlorpropamide Causes Prolonged Hypoglycemia in Older Adults According to Beers Criteria

Chlorpropamide should not be used in older adults due to its prolonged half-life and increased risk of severe, prolonged hypoglycemia that worsens with age. 1

Primary Offending Medication

• Chlorpropamide is explicitly contraindicated in the Beers Criteria for older adults because it has a prolonged half-life, particularly in elderly patients, and carries an increased risk of hypoglycemia that escalates with advancing age 1
• Among all sulfonylureas, chlorpropamide achieved the highest consensus among geriatric clinical pharmacists as requiring dose adjustment or avoidance in older adults 1
• Historical data confirms that chlorpropamide, along with glyburide, accounts for a substantial proportion of drug-induced hypoglycemia cases, with sulfonylureas responsible for 63% of all reported cases 2

Other High-Risk Diabetic Medications in Older Adults

While the question specifically asks about Beers Criteria, it's important to understand the broader context:

Glyburide (Glibenclamide)

• Glyburide is also contraindicated in older adults according to the American Geriatrics Society due to its prolonged half-life and highest risk of drug-induced hypoglycemia among all sulfonylureas 1, 3
• Glyburide carries greater hypoglycemia risk than other sulfonylureas like gliclazide and glipizide 4

Sulfonylureas as a Class

• All sulfonylureas and short-acting insulin are among the highest-risk medications for causing episodic hypoglycemia leading to emergency department admissions in older adults 1
• The American Diabetes Association recommends using sulfonylureas with extreme caution in older adults 3

Why Prolonged Hypoglycemia Occurs

• Age-related pharmacokinetic changes slow the metabolism and excretion of these medications, particularly chlorpropamide, leading to drug accumulation 1, 5
• Reduced counter-regulatory hormone responses in older adults impair their ability to recover from hypoglycemic episodes 3
• Impaired hypoglycemia awareness is common in elderly patients, making recognition and treatment more difficult 3
• Renal insufficiency, which is common with aging, further prolongs drug half-life and increases hypoglycemia risk 1, 5

Clinical Risk Factors That Amplify the Problem

• Elderly, debilitated, or malnourished patients are particularly susceptible to prolonged hypoglycemic reactions 5
• Restricted food intake, hepatic disease, and renal disease—individually or in combination—set the stage for drug-induced hypoglycemia 2
• Polypharmacy with medications that potentiate hypoglycemia (NSAIDs, beta-blockers, salicylates, sulfonamides) increases risk 5
• Comorbidities including dementia, frailty, and cardiovascular disease compound the danger 3

Management Implications

• Deintensification of diabetes regimens is paramount when older patients experience episodic hypoglycemia 1
• If hypoglycemia occurs with chlorpropamide, it may be prolonged and require sustained intravenous glucose for one or more days until all drug effects have worn off 2
• Patients on chlorpropamide should be offered referral to a diabetes educator or endocrinologist for medication adjustment 1
• Safer alternatives include metformin (minimal hypoglycemia risk), DPP-4 inhibitors, and GLP-1 receptor agonists 3