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What is chlorpropamide?
Chlorpropamide is in a class of drugs called sulfonylureas. It is used to help control blood sugar levels. Chlorpropamide is used to treat type 2 diabetes along with diet, exercise, and insulin therapy, if necessary. Chlorpropamide may also be used for purposes other than those listed in this medication guide.

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What are the possible side effects of chlorpropamide?

Stop taking chlorpropamide and seek emergency medical attention if you experience an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives).

Other, less serious side effects from chlorpropamide result mostly from blood sugar levels that are either too high or too low. You should be familiar with the symptoms of both high and low blood sugar levels and know how to treat both conditions. Also, be sure your family and close friends know how to help you in an emergency situation.

Low blood sugar may occur when too much chlorpropamide is taken; when meals are missed or delayed; if you exercise more than usual; during illness, especially with vomiting or diarrhea; if you take other medications; after drinking alcohol; and in other situations.

Hypoglycemia or Low blood sugar has the following symptoms:

• shaking;

• headache;

• cold sweats;

• pale, cool skin;

• anxiety; and

• difficulty concentrating.

Keep hard, sugary candy; chocolate; fruit juice; or glucose tablets on hand to treat episodes of low blood sugar.

Increased blood sugar may occur when not enough chlorpropamide is taken; if you eat significantly more food than usual; if you exercise less than usual; if you take other medications; during fever or other illness; and in other situations.

Hyperglycemia or High blood sugar has the following symptoms:

• increased thirst,

• increased hunger, and

• increased urination.

There may be an increased risk of death due to cardiovascular (heart and blood vessels) complications with the use of chlorpropamide when compared to the treatment of diabetes with diet or diet plus insulin. The long-term use of chlorpropamide should be discussed with your doctor.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

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How should I take chlorpropamide?
Take chlorpropamide exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you. Take each dose with a full glass of water. Chlorpropamide is usually taken before breakfast or the first main meal if it is taken once a day, or before meals if it is taken multiple times each day. Follow your doctor's instructions. Do not change your dose of chlorpropamide without first talking to your doctor. It is important to take chlorpropamide regularly to get the most benefit.

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What is the most important information I should know about chlorpropamide?
Treatment with chlorpropamide may increase the risk of death from cardiovascular disease compared to treatment of diabetes with diet alone or diet plus insulin. Discuss with your doctor the risks and benefits of treatment with chlorpropamide. Know the signs and symptoms of low blood sugar (hypoglycemia), which include headache, drowsiness, weakness, dizziness, fast heartbeat, sweating, tremor, and nausea. Carry a piece of hard candy or glucose tablets with you to treat episodes of low blood sugar.

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What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of this medication.

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What other drugs will affect chlorpropamide?
Many other medicines may increase or decrease the effects of chlorpropamide or affect your condition. Before taking chlorpropamide, tell your doctor if you are taking any of the following medicines: aspirin or another salicylate such as magnesium/choline salicylate (Trilisate), salsalate (Disalcid, others), choline salicylate (Arthropan), magnesium salicylate (Magan), or bismuth subsalicylate (Pepto-Bismol); a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Motrin, Advil, Nuprin, others), ketoprofen (Orudis, Orudis KT, Oruvail), diclofenac (Voltaren, Cataflam), etodolac (Lodine), indomethacin (Indocin), nabumetone (Relafen), oxaprozin (Daypro), naproxen (Anaprox, Naprosyn, Aleve), and others;

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Can I take this if I am pregnant or trying to get pregnant or if I am breastfeeding?

Chlorpropamide has been assigned to pregnancy category C by the FDA. Animal studies have not been reported. However, other sulfonylureas have been associated with an increased teratogenic risk in animal studies. There are no controlled data in human pregnancy. Congenital anomalies have been reported in association with chlorpropamide use during gestation although causality is unknown. In addition, the use of oral sulfonylureas during pregnancy has been reported to result in neonatal hypoglycemia. Insulin remains the mainstay of therapy for gestational diabetes due to the close glucose control it affords. Chlorpropamide is generally considered contraindicated during pregnancy and is only recommended for use during pregnancy when there are no alternatives and benefit outweighs risk. If chlorpropamide must be used, it should be discontinued at least one month before expected delivery to prevent neonatal side effects.

Diabetes mellitus is a known risk factor for abnormal pregnancy outcome. One review cites a four- to six-fold increase in congenital anomalies among infants born to women with insulin-dependent diabetes mellitus compared to control populations. Such an association makes evaluation of teratogenic risk of chlorpropamide or other pharmacologic therapy difficult. Jackson and Campbell (1963) retrospectively analyzed hospital records and found 25 pregnancies in which chlorpropamide was used to treat diabetes mellitus. Of these 25 pregnancies, there were 16 perinatal deaths. All of the deaths were associated with maternal chlorpropamide doses of 500 mg daily. The authors did not find any association between gestational chlorpropamide use and congenital anomalies although autopsy data were only available for a few cases. In a study evaluating 701 infants born to diabetic women over a 25-year period, congenital anomalies occurred in 5 infants whose mothers received oral sulfonylureas during pregnancy (N=60). Of 46 pregnancies in which oral sulfonylureas were used in the first trimester, four infants had congenital anomalies. The incidence of congenital defects in pregnancies treated with oral sulfonylureas (8.3%) was similar to the overall incidence for the study (8.1%), indicating that these agents are not associated with an increased teratogenic risk. Profound, prolonged neonatal hypoglycemia has been reported in infants delivered of women treated with chlorpropamide up to the time of delivery. Infant chlorpropamide serum concentrations were near the usual range for adult patients. Hyperinsulinemia was documented in several cases.

Chlorpropamide is excreted into human milk in small amounts. Adverse effects in the nursing infant are unknown. The manufacturer recommends that due to the potential adverse reactions in nursing infants, a decision should be made to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

The manufacturer reports an average chlorpropamide concentration in breast milk of 5 mcg/mL five hours after oral administration of chlorpropamide 500 mg in one patient. Normal chlorpropamide peak plasma concentrations average 30 mcg/mL following a single 250 mg oral dose.

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What does my medication look like?
Chlorpropamide is available with a prescription under the brand name Diabinese. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you. Diabinese 100 mg--blue, D-shaped, scored tablets Diabinese 250 mg--blue, D-shaped, scored tablets

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What happens if I overdose?
Seek emergency medical attention. Symptoms of a chlorpropamide overdose include hunger, nausea, anxiety, cold sweats, weakness, drowsiness, unconsciousness, and coma.

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What should I discuss with my healthcare provider before taking chlorpropamide?
Before taking chlorpropamide, tell your doctor if you have kidney disease; have liver disease; have thyroid disease; have type 1 diabetes; have a serious infection, illness, or injury; or need surgery. You may not be able to take chlorpropamide, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above. Patients 65 years of age and older may have a stronger reaction to chlorpropamide and may require a reduced dose. Chlorpropamide is in the FDA pregnancy category C. This means that it is not known whether chlorpropamide will be harmful to an unborn baby. Insulin is usually the drug of choice for controlling diabetes during pregnancy. Do not take chlorpropamide without first talking to your doctor if you are pregnant or could become pregnant during treatment.

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Can I stop taking the medication if I feel better?
As a general rule, you should always take your medications exactly as prescribed and do not change the dosage or stop taking the medication without first discussing it with your healthcare provider.

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I am on so many medications; do I have to take them all?
This is called polypharmacy—many different medications being used at the same time by one person. Sometimes, being on multiple medications is acceptable and appropriate but at other times it may be problematic. If you are receiving your medications from multiple physicians you need to ensure that they all know what medications you are taking. The best way to do this is to make a list of all the medications you are currently using, including all nutritional supplements, homeopathic remedies, vitamins and over-the-counter drugs (if possible, also include all the diseases you have been diagnosed with). Give a copy to every doctor who takes care of you so they have it on file, this way they can avoid duplicating medications and perhaps even try to consolidate some. After every doctor's visit remember to update the list accordingly. Also, as much as you possibly can, try to use the same pharmacy to fill all your prescriptions, this way any potential drug interactions can be caught and averted.

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