From the Guidelines
Gliclazide can be used in patients with Impaired Renal Function (IRF), but with caution and careful monitoring of blood glucose levels.
Key Considerations
- Gliclazide is a second-generation sulfonylurea that does not have active metabolites, making it a preferred agent in patients with IRF compared to first-generation sulfonylureas 1.
- However, patients with IRF are at increased risk of hypoglycemia due to decreased clearance of insulin and oral agents, as well as impaired renal gluconeogenesis 1.
- The risk of hypoglycemia is particularly high in patients with advanced CKD (stages 4 and 5) 1.
- Dose reduction may be necessary in patients with IRF, particularly those with GFR < 30 ml/min/1.73 m2 1.
Monitoring and Precautions
- Patients with IRF should be closely monitored for signs of hypoglycemia and have their glucose levels regularly checked 1.
- Patient education is crucial to mitigate the risk of hypoglycemia, especially in older patients and those with CKD 1.
- Gliclazide should be used with caution in patients with liver dysfunction, as it is metabolized in the liver 1.
Comparison with Other Sulfonylureas
- Gliclazide has a lower risk of hypoglycemia compared to other sulfonylureas, such as glyburide 1.
- Glipizide is also a preferred agent in patients with IRF, as it does not have active metabolites and has a lower risk of hypoglycemia 1.
From the Research
Considerations for Using Gliclazide in Patients with Impaired Renal Function (IRF)
- Gliclazide, a sulfonylurea, may be used in patients with type 2 diabetes mellitus, but its use in patients with impaired renal function (IRF) requires caution 2, 3.
- The risk of hypoglycaemia is increased in patients with IRF, particularly those with an estimated glomerular filtration rate (eGFR) of less than 30 mL/min/1.73 m² 2.
- Gliclazide's effect is prolonged in patients with IRF, and spontaneous hypoglycaemic episodes can occur up to 21 days after discontinuation of the drug 3.
- The use of sulfonylureas, including gliclazide, in patients with IRF requires careful consideration of the risk of hypoglycaemia and the need for dose reduction and slower titration 4.
- Compared to other sulfonylureas, gliclazide may have a lower risk of renal complications in certain populations, such as those with preserved renal function and good glycaemic control 5.
Pharmacokinetics and Pharmacodynamics
- Gliclazide's pharmacokinetics and pharmacodynamics are affected by renal function, and its use in patients with IRF requires careful consideration of these factors 3, 4.
- The drug's effect lasts 10-24 hours in patients with adequate renal function, but its effect is prolonged in patients with IRF 3.
Clinical Implications
- Patients with IRF require careful monitoring of renal function and dose adjustment of gliclazide to minimize the risk of hypoglycaemia and renal complications 2, 4.
- The use of gliclazide in patients with IRF should be individualized, taking into account the patient's renal function, glycaemic control, and other comorbidities 5, 4.