Chlorpropamide Dosage

Applies to the following strengths: 100 mg; 250 mg

Usual Adult Dose for Diabetes Type 2

Initial dose: 100 mg to 250 mg orally once a day

Adjust dose in increments of 50 to 125 mg no more often than every 3 to 5 days

Maintenance dose: 100 mg to 500 mg per day
Maximum dose: 750 mg per day

Comments:

Therapy for the management of type 2 diabetes mellitus should be individualized; lower initial doses should be considered for patients at greater risk of hypoglycemia.
Patients who do not respond completely to 500 mg/day will usually not respond to higher doses.
Total daily dose may be taken as a single dose each morning with breakfast; gastrointestinal intolerance may be relieved by dividing the daily dose.
Transferring patients from other antidiabetic regimens should be done conservatively: see dose adjustments.

Use: As an adjunct to diet and exercise improve glycemic control in patients with type 2 diabetes.

Usual Geriatric Dose for Diabetes Type 2

Initial dose: 100 mg to 125 mg orally once a day

Renal Dose Adjustments

Use with caution; initial and maintenance dosing should be conservative to avoid hypoglycemic reactions.

Liver Dose Adjustments

Use with caution; initial and maintenance dosing should be conservative to avoid hypoglycemic reactions.

Dose Adjustments

Elderly, debilitated, or malnourished patient: Initial and maintenance dosing should be conservative to avoid hypoglycemic reactions.

Transferring Patients from other Oral Antidiabetic Therapy:

No transition period is necessary; consideration should be given to its greater potency.

Transferring Patients from Insulin Therapy:

For patients on 40 units per day or less of insulin: Discontinue insulin on initiation of therapy.
For patients on greater than 40 units of insulin per day: Reduce insulin dose by 50% on initiation of therapy; follow with subsequent insulin reductions based on response.
Patients should self-monitor glucose at least 3 times a day during the insulin withdrawal period.
Hypoglycemic reactions within 24 hours after withdrawal of intermediate or long-acting insulin may be due to insulin carry over and not primarily due to the effect of this drug.

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration Advice:
Take orally once a day in the morning

If gastrointestinal intolerance develops, may take in divided doses

General:

Hypoglycemia may occur, especially in the elderly, debilitated, or malnourished patient, in patients receiving combination therapy, and/or those with renal, hepatic or adrenal insufficiency; due to the long half-life of this drug, frequent feedings for at least 3 to 5 days and careful supervision of dose are necessary for patients who become hypoglycemic during therapy.
This drug should not be used in patients with type 1 diabetes mellitus or diabetic ketoacidosis.
Hemolytic anemia may occur in glucose 6-phosphate dehydrogenase (G6PD) deficient patients; consider a non-sulfonylurea alternative.
When a patient stabilized on any diabetic regimen is exposed to stress such as fever, trauma infection, or surgery, it may be necessary to stop this drug and administer insulin.

Monitoring:

Patients experiencing hypoglycemia should be monitored for a minimum of 24 to 48 hours due to the long half-life of this drug.
Regular clinical and laboratory evaluations are necessary to determine minimum effective dose and detect primary or secondary failure.
Clinical status should be checked within the first 4 to 8 weeks and regularly, thereafter.
Laboratory monitoring including periodic fasting blood glucose, self-monitoring of blood glucose, and urine testing (i.e., glucose and ketones) should be done more frequently during drug initiation and with changing doses; glycosylated hemoglobin levels (HbA1c) should be done as clinically warranted.

Patient advice:

Patients should understand the importance of exercise and dietary control in the management of their disease.
Patients should understand that alcohol ingestion, intense or prolonged exercise, skipping meals, illness, or lifestyle changes may increase their risks for hypoglycemia; they should know how to recognize the symptoms of hypoglycemia and be prepared to treat it.
Patients should be careful about driving and use of machinery, especially when at risk for hypoglycemia.
Patients should speak with their health care provider during periods of stress such as fever, trauma, or illness, as their diabetes management may need to be changed.
Advise patient to speak to physician or health care professional if pregnant, intend to become pregnant, or are breastfeeding.