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(klor-PRO-puh-mide)
Diabinese,  APO-Chlorpropamide
Class: Antidiabetic/sulfonylurea

 Action Decreases blood glucose by stimulating insulin release from pancreas.

 Indications Adjunct to diet to lower blood glucose in patients with non-insulin-dependent diabetes mellitus (type II) whose hyperglycemia cannot be controlled by diet alone. Unlabeled use(s): Control of neurogenic diabetes insipidus.

 Contraindications Hypersensitivity to sulfonylureas; diabetes complicated by ketoacidosis with or without coma; sole therapy for insulin-independent (type I) diabetes mellitus; diabetes when complicated by pregnancy.

 Route/Dosage

ADULTS: Initial dose: PO 250 mg/day in single dose. ELDERLY: Initial dose: PO 100–125 mg/day in single dose. MAINTENANCE: PO 100–250 mg/day in single dose. Severe Diabetic Adults: PO up to 500 mg/day; avoid doses > 750 mg/day.

 Interactions

Androgens, anticoagulants, chloramphenicol, clofibrate, fenfluramine, methyldopa, MAO inhibitors, phenylbutazone, probenecid, salicylates, sulfonamides, tricyclic antidepressants, urinary acidifiers: May increase hypoglycemic effect. Beta-blockers, corticosteroids, diazoxide, hydantoins, rifampin, thiazide diuretics, urinary alkalinizers: May decrease hypoglycemic effect.

 Lab Test Interferences Liver function tests: Drug causes elevated results. BUN and creatinine: Drug causes mild to moderate elevations.

 Adverse Reactions

CV: Increased risk of cardiovascular mortality when compared with patients treated with diet alone. CNS: Dizziness; vertigo. DERM: Allergic skin reactions; eczema; pruritus; erythema; urticaria; morbilliform or maculopapular eruptions; lichenoid reactions; photosensitivity. EENT: Tinnitus. GI: GI disturbances (eg, nausea, epigastric fullness, heartburn). HEMA: Leukopenia; thrombocytopenia; aplastic anemia; agranulocytosis; hemolytic anemia; pancytopenia; hepatic porphyria. HEPA: Cholestatic jaundice; elevated liver function tests. META: Hypoglycemia; syndrome of inappropriate secretion of antidiuretic hormone with water retention and dilutional hyponatremia, especially in patients with CHF or hepatic cirrhosis. OTHER: Disulfiram-like reaction; weakness; paresthesia; fatigue; malaise.

 Precautions

Pregnancy: Category C. Insulin is recommended to maintain blood glucose levels during pregnancy. Prolonged severe neonatal hypoglycemia can occur if sulfonylureas are administered at time of delivery. If administering to pregnant patient, discontinue 2 days-4 wk before expected date of delivery. Lactation: Excreted in breast milk. Children: Safety and efficacy not established. Disulfiram-like syndrome: A sulfonylurea-induced facial flushing reaction may occur when administered with alcohol. Elderly or debilitated patients: Particularly susceptible to hypoglycemic action. Hypoglycemia can be difficult to recognize in elderly patients. Hepatic and renal impairment: Use drug with caution and monitor liver and renal function frequently.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer once a day.
  • Give with food or 30 min before meal if drug causes GI upset.
  • When discontinuing chlorpropamide and switching to another oral hypoglycemic agent, exercise caution for 2 wk; prolonged action of chlorpropamide may provoke hypoglycemia.
  • Store in cool environment in tightly closed container.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies. Note presence of hepatic or renal impairment and nature of patient’s diabetic illness.
  • Check blood sugar levels frequently and observe for symptoms of hypoglycemia or hyperglycemia and report to physician.
  • Be aware that hypoglycemia may be difficult to recognize in elderly patients or patients taking beta-blockers.
  • When patients with impaired liver or renal function are receiving this drug, check liver and renal function test results frequently.
  • Observe for evidence of possible water retention (especially in patients with CHF) and report to physician.
  • If cholestatic jaundice occurs, discontinue drug and notify physician.
OVERDOSAGE: SIGNS & SYMPTOMS
  Hypoglycemia, tingling of lips and tongue, hunger, nausea, lethargy, confusion, agitation, nervousness, tachycardia, sweating, tremor, convulsions, stupor, coma

 Patient/Family Education

  • Explain that this medication will not cure disease.
  • Emphasize that drug must be taken on daily basis and should not be discontinued abruptly.
  • Tell patient that drug may cause GI upset and to take it with food if GI upset occurs.
  • Teach patient to self-monitor blood glucose.
  • Inform patient that physician should be contacted if symptoms of hypoglycemia occur (fatigue, excessive hunger, profuse sweating, numbness of extremities).
  • Instruct patient to notify physician if symptoms of hyperglycemia occur (excessive thirst or urination, urinary glucose or ketones).
  • Tell patient to report constipation, nausea, vomiting, drowsiness, dizziness, fever, sore throat, rash, or unusual bruising or bleeding to physician.
  • Inform patient that this drug is not a substitute for exercise and diet control; patient must follow prescribed regimens of diet, exercise and personal hygiene.
  • Instruct patient to inform all physicians involved in patient’s care that this drug is being taken.
  • Advise patient not to take any medication (including otc) or drink alcoholic beverages without consulting physician; flushing has been reported with chlorpropamide.
  • Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
  • Advise patient that drug can cause dizziness and to use caution while driving or performing other tasks requiring mental alertness.
  • Remind patient to wear Medi-Alert identification.

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