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.
A strategy to optimize glyburide efficacy and safety in pregnancy is suggested.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and the Department of Pharmacy and Obstetrics & Gynecology, University of Washington, Seattle, Washington, for the Obstetric-Fetal Pharmacology Research Unit Network.
Corresponding author: Steve N. Caritis, MD, 300 Halket Street, Room 2229, Pittsburgh, PA 15213; e-mail: firstname.lastname@example.org.
Supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD047905 and HD047892). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development or the National Institutes of Health.
Financial Disclosure The authors did not report any potential conflicts of interest.
The authors thank Shannon Clark, MD, David M. Haas, MD, MS, Gary Hankins, MD, Zhaoxia Ren, MD, PhD, Raman Venkataramanan, PhD, and Anne Zajicek, MD, PharmD, from the Obstetric-Fetal Pharmacology Research Unit Network for reviewing and making suggestions for improving the manuscript.