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Sulfonylurea Pregnancy: C — not recommended; insulin preferred

Gliclazide

Brand names: Diamicron, Diamicron MR

Adult dose

Dose: 40–160mg twice daily (IR) or 30–120mg once daily (MR)

Route: Oral

Frequency: Twice daily (IR) or once daily (MR) with breakfast

MR: start 30mg OD. Standard: start 40mg OD. Titrate every 4 weeks. Max 320mg/day (IR) or 120mg/day (MR).

Clinical pearls

Preferred sulfonylurea over glibenclamide — lower hypoglycaemia risk (particularly in elderly)
Take with or just before meals — advise patients never to skip meals
Modified-release once daily improves adherence
Safer in mild-moderate renal impairment compared to other sulfonylureas
Second-line after metformin if HbA1c not controlled

Contraindications

Type 1 diabetes
DKA
Severe renal impairment (eGFR <30)
Sulfonamide allergy

Side effects

Hypoglycaemia (risk lower than glibenclamide)
Weight gain
GI upset
Hyponatraemia

Interactions

NSAIDs, fluconazole, clarithromycin — enhance hypoglycaemic effect
Rifampicin, corticosteroids — reduce efficacy

Monitoring

HbA1c (3–6 monthly)
eGFR annually
Capillary glucose (if symptoms of hypoglycaemia)

Reference: NICE NG28; Scottish Medicines Consortium. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Pathways