Sulfonylureas · Endocrine
Glyburide (glibenclamide)
glibenclamide · Diabeta® · Micronase®(brand names vary by market)
The long sulfonylurea that older kidneys cannot clear.
Mechanism
Sulfonylurea receptor agonist closing the beta-cell KATP channel, with active metabolites that are cleared renally and keep working long after the parent drug is gone.
Indications
- Type 2 diabetes
Formulations
Dosing concepts
Why it is being deprescribed
Its active renally-cleared metabolites and long duration make it the highest-hypoglycemia-risk sulfonylurea, and most explicit lists of medications to avoid in older adults name it by name.
Concepts, not prescribing instructions. Practice numbers live in current references and local protocols.
Pharmacokinetics
- Bioavailability
- High
- Half-life
- ~10 h, but the metabolites act much longer
- Elimination
- mixed: Active metabolites renally cleared: the mechanism of accumulation in CKD
- Protein binding
- >99%
Adverse effects
- Hypoglycemia, prolonged and severecommon & serious
- Weight gaincommon
- Hyponatremiaserious
Contraindications & precautions
Contraindications
- Type 1 diabetes
- Significant renal impairment
- Severe hepatic impairment
Precautions
- Older adults, where it is best avoided altogether
- Any declining renal function
- Irregular meals
Interactions
Monitoring
Hypoglycemia, actively asked about rather than waited for
Older patients often describe it as falls, confusion or 'turns'
Renal function
The variable that turns a stable dose dangerous
HbA1c
A low HbA1c in an older patient on a sulfonylurea is a warning, not a success
Counselling points
- Always eat with this tablet.
- Carry glucose. Lows from this medicine can last many hours.
- Tell us about dizziness, sweating, confusion or falls.
Clinical pearls
- An HbA1c below target in an older adult on glyburide is a deprescribing signal. Over-treatment in this population causes more harm than a slightly higher number.
- If a sulfonylurea is genuinely needed, gliclazide does the same job with a far better safety profile. There is rarely a reason to start glyburide today.
References & review
- Glyburide product monograph (consult the current version for your market) (monograph)
- Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)
Last reviewed 2026-08-16 · jurisdiction: global · drug information changes; verify against current references before practice use.