A pharmacologic approach to the use of glyburide in pregnancy

Abstract

Despite widespread use of glyburide to treat pregnancy-related hyperglycemia, the dosing regimen is based in large part on pharmacokinetic and pharmacodynamic studies in men and nonpregnant women. Like many medications used by pregnant women, adequate pharmacokinetic and pharmacodynamic data in pregnancy have been sorely lacking. This lack of information can lead to both overdosing with excessive side effects and underdosing with an inadequate therapeutic response. Both of these problems may apply to glyburide use in pregnancy. This commentary provides a pharmacologic basis for altering the glyburide administration regimen. Taking glyburide 1 hour before a meal may improve efficacy in patients with pregnancy-related hyperglycemia.

Conflict of interest statement

Financial Disclosure

The authors did not report any potential conflicts of interest.

Figures

Fig. 1

Plasma concentration of glyburide after a 2.5-mg oral dose in women with type 2 diabetes (n=8) or gestational diabetes (n=18). The data in this figure are taken from a subset of the data from the Obstetric-Fetal Pharmacology Research Unit collected, as described in Hebert MF, Ma X, Naraharisetti SB, Krudys KM, Umans JG, Hankins GD, et al, for the Obstetric-Fetal Pharmacology Research Unit Network. Are we optimizing gestational diabetes treatment with glyburide? The pharmacologic basis for better clinical practice. Clin Pharmacol Ther 2009;85:607–14. Caritis. Glyburide Use in Women With GDM. Obstet Gynecol 2013.

Fig. 2

Average plasma concentrations of glyburide (ng/dL), glucose (mg/dL), insulin (microunits/mL), and C-peptide (pmol/L×0.01) in 40 women with gestational diabetes after a mixed meal tolerance test. Glyburide concentrations are dose normalized to a 1.25-mg dose twice daily. Glyburide was administered at time 0 and the mixed meal load at 60 minutes. Concentrations of C-peptide and glyburide are scaled to enable better visualization of change over time course on a single graph. The data in this figure are taken from a subset of the data the Obstetric-Fetal Pharmacology Research Unit collected, as described in Hebert MF, Ma X, Naraharisetti SB, Krudys KM, Umans JG, Hankins GD, et al, for the Obstetric-Fetal Pharmacology Research Unit Network. Are we optimizing gestational diabetes treatment with glyburide? The pharmacologic basis for better clinical practice. Clin Pharmacol Ther 2009;85:607–14. Caritis. Glyburide Use in Women With GDM. Obstet Gynecol 2013.