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Before using this medicationtell your doctor or pharmacist your medical historyespecially ofkidney diseaseliver diseaseconditions that may cause a low level of oxygen in the blood or poor circulationsuch as severe congestive heart failurerecent heart attackrecent strokeserious infectionsevere loss of body fluidsdehydrationalcohol usesevere breathing problemssuch as obstructive lung diseasesevere asthmablood problemssuch as anemiavitamin B12 deficiencyelectrolyte imbalancehyponatremiafertility problemssuch as ovulation problemscertain hormonal conditionsadrenal/pituitary insufficiencythyroid diseasesyndrome of inappropriate antidiuretic hormone-SIADHa certain nervous system problemautonomic neuropathy

During pregnancythis medication should be used only when clearly neededPregnancy may cause or worsen diabetesDiscuss a plan with your doctor for managing your blood sugar while pregnantYour doctor may substitute insulin for this product during pregnancyIf you are using glyburide during your pregnancyyour doctor may switch you to insulin at least 2 weeks before the expected delivery date because of glyburide’s risk of causing low blood sugar in your newbornDiscuss the risks and benefits with your doctor.

Certain individualsthose with inadequate vitamin B 12 or calcium intake or absorptionappear to be predisposed to developing subnormal vitamin B 12 levelsIn these patientsroutine serum vitamin B 12 measurements at 2to 3-year intervals may be useful.

For each of the known and possible risk factors for metformin-associated lactic acidosisrecommendations to reduce the risk of and manage metformin-associated lactic acidosis are provided below:

Sulfonylurea drugs are extensively bound to serum proteinsDisplacement from protein binding sites by other drugs may lead to enhanced hypoglycemic actionIn vitrothe protein binding exhibited by glyburide is predominantly non-ionicwhereas that of other sulfonylureaschlorpropamidetolbutamidetolazamideis predominantly ionicAcidic drugssuch as phenylbutazonewarfarinand salicylatesdisplace the ionic-binding sulfonylureas from serum proteins to a far greater extent than the non-ionic binding glyburideIt has not been shown that this difference in protein binding results in fewer drug-drug interactions with glyburide tablets in clinical use.

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