Makindo Medical Notes

🍬 Gliclazide is a short-acting sulphonylurea used in the management of Type 2 Diabetes Mellitus (T2DM). ⚠️ Key risk: hypoglycaemia – especially if meals are delayed, missed, or in elderly patients. 👉 Always check the BNF for up-to-date dosing and cautions.

⚙️ Mode of Action

• Stimulates pancreatic β-cell receptors → increased insulin release.
• Inhibits hepatic gluconeogenesis, reducing glucose output from the liver.
• Overall: lowers blood glucose by increasing insulin activity & reducing endogenous glucose production.

📌 Indications

• Type 2 Diabetes Mellitus (T2DM) – when diet and metformin alone are insufficient.

💊 Dose

• 40–80 mg pre-meals (max 320 mg/day, usually in divided doses).
• Modified-release (MR) form also available for once-daily dosing.

🔗 Interactions

• ❗ Increased risk of hypoglycaemia with:
  • Chloramphenicol
  • Sulphonamides, Co-trimoxazole
  • Warfarin
  • Fibrates
• Alcohol 🍷 can also exacerbate hypoglycaemia.

⚠️ Cautions

• Renal/hepatic impairment – risk of prolonged hypoglycaemia.
• Obesity – consider metformin first-line (weight-neutral).
• Switch to variable rate IV insulin infusion (VRIII) in acute illness or perioperatively.
• Care in elderly due to higher hypo risk and impaired counter-regulation.

⛔ Contraindications

• Type 1 Diabetes Mellitus.
• Ketoacidosis.
• See full BNF for other contraindications.

💥 Side Effects

• 🍬 Hypoglycaemia – sweating, tremor, confusion, seizures (exam classic).
• ⚖️ Weight gain.
• 😣 GI upset (nausea, diarrhoea).
• 🌸 Rash, hypersensitivity reactions.
• 🩸 Rare: blood disorders (e.g., agranulocytosis, haemolytic anaemia).
• Hepatic toxicity (rare but important).

🧠 Clinical Pearls

• Preferred sulphonylurea in the UK due to its shorter half-life compared with glibenclamide → lower risk of severe hypos.
• Good choice for patients with irregular meal patterns (safer than long-acting agents).
• Patients should always be counselled on “hypo rules” (carry glucose, don’t skip meals, recognise warning signs).
• Monitor HbA1c every 3–6 months and review if frequent hypoglycaemia occurs.

📚 References

• BNF – Gliclazide
• NHS – Gliclazide