Glyburide


Brand Names: Diabeta, Glynase, Micronase, Pres Tab

Clinical Names: Glyburide

Summary

generic name: Glyburide

trade names: Diabeta®, Glynase®, Micronase®, Pres Tab®

related drugs: Acetohexamide®, Chlorpropamide®, Glibenclamide®, Gliclazide®, Glipizide®, Tolbutamide®

type of drug: Sulfonylurea, oral hypoglycemic agent.

used to treat: Hyperglycemia in non-insulin-dependent (NIDDM or Type 2) diabetes mellitus which is stable, mild, and nonketosis-prone and cannot be controlled solely by proper dietary management, exercise and weight reduction.

overview of interactions:
• herb affecting drug performance: Aloe vera (Aloe)

• herb/nutrient affecting drug performance: Cyamopsis tetragonolobus (Guar gum)

• herbal preparation affecting drug performance: D-400



Interactions

herb affecting drug performance: Aloe vera (Aloe)

• nutritional synergy/interaction: Several studies have found that Aloe vera can work as an effective agent in bringing down high blood glucose levels. If taken at the same time as glyburide, Aloe may reduce the dosage of the drug needed or, if unsupervised, could potentially cause blood glucose levels to drop excessively. In one study of diabetics who had been unresponsive to glibenclamide alone, significantly improved blood sugar and lipid levels resulted when one tablespoon of aloe juice twice daily was combined with the glibenclamide.
(Bunyapraphatsara, N, et al. Phytomed 1996;3:245-248.; Ghannam N, et al. Horm Res 1986;24(4):288-294.)

herb/nutrient affecting drug performance: Cyamopsis tetragonolobus (Guar gum)

• research: Huupponen found that the co-administration of 5 gm of guar gum to healthy patients significantly enhanced the insulinogenic and blood glucose lowering effect of glyburide. Several years later Uusitupa et al conducted a randomized double-blind placebo controlled crossover study and came to two conclusions: 1.) guar gum improved the metabolic control and decreased serum lipids of patients with NIDDM, 2.) guar gum ingested with glibenclamide did not interfere with the absorption of glibenclamide.
(Huupponen R. Res Commun Chem Pathol Pharmacol 1986 Oct;54(1):137-140; Neugebauer G, et al. Beitr Infusionther Klin Ernahr 1983;12:40-47; Uusitupa M, et al. Int J Clin Pharmacol Ther Toxicol 1990 Apr;28(4):153-157.)

• nutritional concern: If taken at the same time as glyburide, guar gum may reduce the dosage of the drug needed or, if unsupervised, could potentially cause blood glucose levels to drop excessively. Individuals taking glyburide or related drugs should avoid the consumption of guar gum at the same time as their medication.

herbal preparation affecting drug performance: D-400

• nutritional synergy: In a study done with rabbits, an Ayurvedic "herbomineral preparation," called D-400, with proven antidiabetic activity, was combined with glibenclamide in alloxan-induced diabetic rabbits. Administration of D-400 significantly elevated plasma glibenclamide concentrations with simultaneous reduction of blood glucose. More information on the D-400 product can be found in the References following the citations.
(Sundaram R, et al. J Ethnopharmacol 1996 Dec;55(1):55-61.)


Please read the disclaimer concerning the intent and limitations of the information provided here.
Do not rely solely on the information in this article.

The information presented in Interactions is for informational and educational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, case reports, and/or traditional usage with sources as cited in each topic. The results reported may not necessarily occur in all individuals and different individuals with the same medical conditions with the same symptoms will often require differing treatments. For many of the conditions discussed, treatment with conventional medical therapies, including prescription drugs or over-the-counter medications, is also available. Consult your physician, an appropriately trained healthcare practitioner, and/or pharmacist for any health concern or medical problem before using any herbal products or nutritional supplements or before making any changes in prescribed medications and/or before attempting to independently treat a medical condition using supplements, herbs, remedies, or other forms of self-care.



References

Bunyapraphatsara, N, Yongchaiyudha, S, Rungpitarangsi, V, Chokechaijaroenporn, O. Antidiabetic activity of Aloe vera L. juice. II. Clinical trial in diabetes mellitus patients in combination with glibenclamide. Phytomed 1996;3:245-248.

Ghannam N, Kingston M, Al-Meshaal IA, Tariq M, Parman NS, Woodhouse N. The antidiabetic activity of aloes: preliminary clinical and experimental observations. Horm Res 1986;24(4):288-294.
Abstract: The dried sap of the aloe plant (aloes) is one of several traditional remedies used for diabetes in the Arabian peninsula. Its ability to lower the blood glucose was studied in 5 patients with non-insulin-dependent diabetes and in Swiss albino mice made diabetic using alloxan. During the ingestion of aloes, half a teaspoonful daily for 4-14 weeks, the fasting serum glucose level fell in every patient from a mean of 273 +/- 25 (SE) to 151 +/- 23 mg/dl (p less than 0.05) with no change in body weight. In normal mice, both glibenclamide (10 mg/kg twice daily) and aloes (500 mg/kg twice daily) induced hypoglycaemia after 5 days, 71 +/- 6.2 and 91 +/- 7.6 mg/dl, respectively, versus 130 +/- 7 mg/dl in control animals (p less than 0.01); only glibenclamide was effective after 3 days. In the diabetic mice, fasting plasma glucose was significantly reduced by glibenclamide and aloes after 3 days. Thereafter only aloes was effective and by day 7 the plasma glucose was 394 +/- 22.0 versus 646 +/- 35.9 mg/dl, in the controls and 726 +/- 30.9 mg/dl in the glibenclamide treated group (p less than 0.01). We conclude that aloes contains a hypoglycaemic agent which lowers the blood glucose by as yet unknown mechanisms.

Huupponen R. The effect of guar gum on the acute metabolic response to glyburide. Res Commun Chem Pathol Pharmacol 1986 Oct;54(1):137-140.
Abstract: The effect of 5 g guar gum on the acute blood glucose, insulin and C-peptide response to 5 mg glyburide (HB 419) was investigated in 10 healthy volunteers after an overnight fast. The co-administration of guar gum significantly enhanced the insulinogenic and blood glucose lowering effect of glyburide.

Mitra SK, Gopumadhavan S, Muralidhar TS, Seshadri SJ. Effect of D-400, a herbomineral formulation on liver glycogen content and microscopic structure of pancreas and liver in streptozotocin induced diabetes in rats. Indian J Exp Biol 1996 Oct;34(10):964-967.
Abstract: Streptozotocin induces severe and irreversible hyperglycaemia in experimental animals. The effect of oral administration of D-400 (1 gm/kg/day), a herbomineral formulation on streptozotocin induced-diabetes was studied in rats. Liver glycogen content was assayed biochemically on 2,4 and 8 weeks after D-400 treatment. Superoxide dismutase(SOD) activity of pancreatic islet cells was assessed on 8th week of D-400 treatment. The microscopic structure of pancreas and liver were examined in both control and treated animals. D-400 treatment showed progressive and significant increase in liver glycogen at 2,4 and 8 weeks respectively. Streptozotocin induced a decrease in pancreatic islet cell superoxide dismutase which was reversed by D-400 treatment for a period of 8 weeks. The free radical scavenging activity of D-400 may be attributed to shilajeet, one of its important ingredient. Streptozotocin induced histopathological changes in pancreas and liver was also partially reversed by D-400. The findings indicate that D-400 helps in improving the glycogen stores in the liver and prevents the streptozotocin induced damage through free radicals by increasing the islet cell superoxide dismutase activity.

Neugebauer G, Akpan W, Abshagen U. [Interaction of guar with glibenclamide and bezafibrate]. Beitr Infusionther Klin Ernahr 1983;12:40-47. [Article in German]

Sundaram R, Venkataranganna MV, Gopumadhavan S, Mitra SK. Interaction of a herbomineral preparation D-400, with oral hypoglycaemic drugs. J Ethnopharmacol 1996 Dec;55(1):55-61.
Abstract: D-400, a herbomineral preparation has proven antidiabetic activity in experimental models as well as in clinical trials. The possibility of concomitant use of this drug with sulphonylureas was explored in animal models. D-400 has been investigated for its interaction with oral hypoglycaemic agents namely, tolbutamide and glibenclamide in alloxan-induced diabetic rabbits. Administration of D-400 at a dose of 1 g/kg for 15 days significantly elevated plasma tolbutamide and glibenclamide concentrations with simultaneous reduction of blood glucose. Plasma tolbutamide and glibenclamide concentrations were significantly lowered after withdrawal of D-400 treatment. Elevation of plasma concentration of tolbutamide was observed only for the first 4 h after which it declined towards normal levels and no significant difference between D-400 treated and control group was observed at the end of 8 h. Significant elevation of plasma glibenclamide levels was observed at 2, 4 and 8 h with D-400 treatment. Incubation of D-400 with tolbutamide in plasma resulted in a significant increase in free tolbutamide levels.

Uusitupa M, Sodervik H, Silvasti M, Karttunen P. Effects of a gel forming dietary fiber, guar gum, on the absorption of glibenclamide and metabolic control and serum lipids in patients with non-insulin-dependent (type 2) diabetes. Int J Clin Pharmacol Ther Toxicol 1990 Apr;28(4):153-157.
Abstract: Nine patients with non-insulin-dependent diabetes (NIDDM) treated with glibenclamide (3.5 mg b.i.d.) participated in this randomized double-blind placebo controlled crossover study to evaluate the effects of granulated guar gum (5 g t.i.d. with meals) on the absorption of glibenclamide and metabolic control and serum lipids. Each treatment period lasted for 4 weeks, and there was a wash-out period of one week between the treatments. The fasting blood glucose (10.5 +/- 3.4 mmol/l on guar gum vs 11.3 +/- 3.7 mmol/l on placebo, p less than 0.05) and serum total cholesterol (5.9 +/- 1.4 mmol/l on guar gum vs 6.6 +/- 1.6 mmol/l on placebo; p less than 0.05) levels were lower after the treatment with guar gum than placebo. No significant differences were observed in serum triglycerides or HDL cholesterol between guar gum and placebo treatments. The administration of guar gum together with glibenclamide did not change significantly the maximum concentration (223 +/- 196 ng/ml on guar gum vs 184 +/- 138 ng/ml on placebo; n = 7, NS) or area under the curve (AUC0-6) [729 +/- 813 (ng/ml) X h on guar gum vs 560 +/- 513 (ng/ml) X h on placebo; NS] of glibenclamide. The fasting serum glibenclamide concentrations were similar at the end of the 4-week treatment period with guar gum and placebo. In conclusion, guar gum improved the metabolic control and decreased serum lipids of patients with NIDDM. In addition, guar gum ingested with glibenclamide did not interfere with the absorption of glibenclamide.


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D-400, also known as Diabecon as per the manufacturer: www.thehimalayadrugco.com
Composition of each Diabecon tablet contains:
Exts.
Meshashringi (Gymnema sylvestre) 30 mg
Pitasara (Pterocarpus marsupium) 20 mg
Yashti-madhu (Glycyrrhiza glabra) 20 mg
Saptarangi (Casearia esculenta) 20 mg
Jambu (Eugenia jambolana) 20 mg
Shatavari (Asparagus racemosus) 20 mg
Punarnava (Boerhavia diffusa) 20 mg
Mundatika (Sphaeranthus indicus) 10 mg
Guduchi (Tinospora cordifolia) 10 mg
Kairata (Swertia chirata Syn. S.chirayita) 10 mg
Gokshura (Tribulus terrestris) 10 mg
Bhumyaamlaki (Phyllanthus amarus) 10 mg
Gumbhari (Gmelina arborea) 10 mg
Karpasi (Gossypium herbaceum) 10 mg
Daru haridra (Berberis aristata) 5 mg
Kumari (Aloe vera Syn. A.barbadensis) 5 mg
Triphala 3 mg

Pdrs.
Guggul (Commiphora wightii) (purified) 30 mg
Shilajeet (purified) 30 mg
Sushavi (Momordica charantia) 20 mg
Maricha (Piper nigrum) 10 mg
Vishnu priya (Ocimum sanctum Syn. O.tenuiflorum) 10 mg
Atibala (Abutilon indicum) 10 mg
Haridra (Curcuma longa) 10 mg
Jungli palak (Rumex maritimus) 5 mg
Vidangadi lauham 27 mg
Vang bhasma 5 mg
Abhrak bhasma 10 mg
Praval bhasma 10 mg
Akik pishti 5 mg
Shingraf 5 mg
Yashad bhasma 5 mg
Trikuta 5 mg