Tolinase

Hives, itching, and rash may appear initially and then disappear as you continue to take the drug. If a skin reaction persists, you should stop taking Tolinase.

Why should Tolinase not be prescribed?

Do not take Tolinase if you are sensitive to it or have ever had an allergic reaction to it; if you are suffering from diabetic ketoacidosis (a chemical imbalance leading to nausea, vomiting, confusion, and coma); or if you have type 1 (insulin-dependent) diabetes and are not taking insulin.

Special warnings about Tolinase

It's possible that drugs such as Tolinase may lead to more heart problems than diet treatment alone, or diet plus insulin. If you have a heart condition, you may want to discuss this with your doctor.

Like other oral antidiabetic drugs, Tolinase may produce severe low blood sugar (hypoglycemia) if the dosing is wrong. While taking Tolinase, you are particularly susceptible to episodes of low blood sugar if:

• You suffer from a kidney or liver problem;
• You have a lack of adrenal or pituitary hormones; or
• You are older, run-down, or malnourished.

You are at increased risk for a low blood sugar episode if you are hungry, exercising heavily, drinking alcohol, or using more than one glucose-lowering drug.

Note that an episode of low blood sugar may be difficult to recognize if you are an older person or if you are taking a beta-blocker drug (Inderal, Lopressor, Tenormin, and others).

If switching to Tolinase from chlorpropamide (Diabinese), you should take special care to avoid an episode of low blood sugar.

Stress such as fever, trauma, infection, or surgery may increase blood sugar to the point that you require insulin injections.

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Possible food and drug interactions when taking Tolinase

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If Tolinase is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Tolinase with the following:

• Airway-opening drugs such as Sudafed and Ventolin
• Alcohol
• Aspirin or related drugs
• Beta-blocking blood pressure medications such as Inderal and Lopressor
• Blood-thinning drugs such as Coumadin
• Calcium channel blockers such as Calan and Isoptin
• Chloramphenicol (Chloromycetin)
• Corticosteroids such as Cortef, Decadron, and Medrol
• Diuretics such as Esidrix and Diuril
• Estrogens such as Premarin and Estraderm
• Isoniazid (Nydrazid)
• MAO inhibitors (antidepressants such as Nardil and Parnate)
• Miconazole (Monistat)
• Nicotinic acid
• Nonsteroidal anti-inflammatory drugs such as Motrin and Naprosyn
• Oral contraceptives
• Phenothiazines (antipsychotic drugs such as Mellaril)
• Phenytoin (Dilantin)
• Probenecid
• Rifampin (Rifadin)
• Sulfa drugs such as Bactrim and Gantrisin
• Thyroid drugs such as Synthroid

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Special information if you are pregnant or breastfeeding

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If you are pregnant or plan to become pregnant, inform your doctor immediately. Tolinase is not recommended for use during pregnancy, and should not be prescribed if you might become pregnant while taking it.

Control of diabetes during pregnancy is very important, but in most cases it should be accomplished with insulin injections rather than oral antidiabetic drugs.

Tolinase should not be used during breastfeeding because of possible harmful effects on the baby. If you are a new mother, you may need to choose between taking Tolinase and breastfeeding your baby.

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Recommended dosage for Tolinase

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Your doctor will determine the dosage level based on your needs.

ADULTS

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The usual starting dose of Tolinase tablets for the mild to moderately severe type 2 diabetic is 100 to 150 milligrams daily taken with breakfast or the first main meal.

OLDER ADULTS

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If you are malnourished, underweight, an older person, or not eating properly, the initial dose is usually 100 milligrams once a day. Failure to follow an appropriate dosage regimen may precipitate hypoglycemia (low blood sugar). If you do not stick to your prescribed dietary regimen, you are more likely to have an unsatisfactory response to this medication.

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Overdosage

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An overdose of Tolinase can cause an episode of low blood sugar. Mild low blood sugar without loss of consciousness should be treated with oral glucose, an adjusted meal pattern, and possibly a reduction in the Tolinase dosage. Severe low blood sugar, which may cause coma or seizures, is a medical emergency and must be treated in a hospital. If you suspect an overdose of Tolinase, seek medical attention immediately.