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Geriatric patients should receive an initial dose of 1 mg once a day. Upjohn under the same NDA; Greenstone's generic product is distributed by Geneva and Greenstone. Sylvalahti E, Pihlajamki K, Iisalo E. Effect of tuberculostatic agents on the response of serum growth hormone and immunoreactive insulin to intravenous tolbutamide, and on the half-life of tolbutamide. Int J Clin Pharmacol 1976; 13: 83-9. nifedipine

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Stotter G, Seidler I, Dorfmuller T, et al. Report on experiences in one and a half years of oral treatment of diabetes with tolbutamide. Ann NY Acad Sci 1957; 711: 280-91. Long-term studies in rats and mice showed no evidence of carcinogenicity. If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip themissed dose and resume your usual dosing schedule. Tolbutamide Mobenol, Horner. In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association; 1994. p. 796.

Important information

This dose should also be used in patients with medical problems that make them more sensitive to the effects of glyburide. Self TH, Morris T. Interaction of rifampin and chlorpropamide. Doucet J, Fresel J, Moore N, et al. In vitro serum binding of gliclazide in patients with Type I diabetes mellitus. Drug Invest 1994; 84: 219-24. Glyburide Euglucon, Boehringer Mannheim. In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 33rd ed. Ottawa: Canadian Pharmacists Association; 1998. p. 599-600. The United States pharmacopeia. The national formulary. USP 23rd revision January 1, 1995. NF 18th ed January 1, 1995. Rockville, MD: The United States Pharmacopeial Convention, Inc; 1995 First supplement, 1995. p. 2465-6. benadryl

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Halter JB, Morrow LA. Use of sulfonylurea drugs in the elderly patients. Diabetes Care 1990 Feb; 13 Suppl 2: 86-92. Leslie RDG, Pyke DA. Chlorpropamide-alcohol flushing: a dominantly inherited trait associated with diabetes. BMJ 1978; 2: 1519. Use this medicine only as directed even if you feel well and do not notice any signs of high blood sugar. Davidson MB. Rational use of sulfonylureas. Postgrad Med 1992 Aug; 922: 69-81. primperan buy sell hold



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Klimt CF, Knatterud G, Meinert CL, et al. A study of the effects of hypoglycemic agents on vascular complications in patients with adult-onset diabetes. I. Design, methods, and baseline results, II. Mortality results. Diabetes 1970; 19 Suppl 2: 747-810. High blood sugar hyperglycemia is another problem related to uncontrolled diabetes. Rett K, Wicklmayr M, Dietz GJ. Hypoglycemia in hypertensive diabetic patients treated with sulfonylurea, biguanides, and captopril. N Engl J Med 1988; 319: 1609. Boyle PJ, Justice K, Krentz AJ, et al. Octreotide reverses hyperinsulinemia and prevents hypoglycemia induced by sulfonylurea overdoses. J Clin Endocrinol Metab 1993; 763: 752-6. Davies RR, Miller M, Turner SJ, et al. Effects of somatostatin analogue SMS 201-995 in normal man. Clin Endocrinol 1986; 24: 665-74. Tolbutamide Orinase, Hoechst Marion Roussel. In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 33rd ed. Ottawa: Canadian Pharmacists Association; 1998. p. 1232. Committee of Drugs, American Academy of Pediatrics. Transfer of drugs and other chemicals into human milk. Pediatrics 1989; 845: 924-36. When patients are transferred to tolazamide from another sulfonylurea antidiabetic medication with the exception of chlorpropamide no transition period is required. When transferring patients from chlorpropamide, caution should be exercised during the first 1 to 2 weeks because of the prolonged retention of chlorpropamide in the body. Periodic adjustments in insulin dosage may be necessary as guided by glucose and glycosylated hemoglobin concentrations. Combination insulin-glimepiride therapy may increase the potential for development of hypoglycemia.



Food delays absorption of chlorpropamide

Ferrari C, Frezzati S, Romussi M, et al. Effect of short-term clofibrate administration on glucose tolerance and insulin secretion in patients with chemical diabetes or hypertriglyceridaemia. Metabolism 1977; 262: 129-39. Reduces serum uric acid concentration. SIADH electrolyte imbalance hyponatremia. Symptoms of severe high blood sugar called ketoacidosis or diabetic coma that need immediate hospitalization include: flushed dry skin, fruit-like breath odor, ketones in urine, passing out, troubled breathing rapid and deep. Tolbutamide interferes with thyroidal uptake of I 123 and I 131. The effect on the nursing infants is not known. The American Academy of Pediatrics considers tolbutamide to be compatible with breast-feeding. Renal Physiol Biochem 1994; 173-4: 118-20. Metformin Glucophage, Nordic. In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association; 1994. p. 525. TEQUIN gatifloxacin and serious hypoglycemia and hyperglycemia. Bristol-Myers Squibb Canada May 12, 2006. Takla PG. Glibenclamide. In: Florey K, editor. Analytical profiles of drug substances. New York: Academic Press, 1981; 10: 338-55. Genetic syndromes, including inborn errors of metabolism, such as glycogen-storage disease type I, or insulin-resistant syndromes, such as muscular dystrophies, late onset proximal myopathy, or Huntington's chorea. telmisartan



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Chlorpropamide or tolbutamide causes some patients to retain keep more body water than usual. Kristensen M, Hansen JM. Potentiation of the tolbutamide effect by dicoumarol. Diabetes 1967; 16: 211-4. Mack RB. He is happy whom the muses love: Micronase sulfonylurea overdose. NC Med J 1989 Jun; 506: 312-4. Groop LC. Sulfonylureas in NIDDM. Diabetes Care 1992; 156: 737-54. Jackson RA. Mechanisms of age-related glucose intolerance. Diabetes Care 1990 Feb; 13 Suppl 2: 9-19. purchase cheapest furosemide shop uk furosemide



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Clinical chemistry, toxicology, serology. In: Wyngaarden JB, Smith LH. Cecil textbook of medicine. 18th ed. Philadelphia: Saunders; 1988. p. 2397. Chlorpropamide crosses the placenta; glyburide does not significantly cross the placenta, and it is not known whether other sulfonylureas cross the placenta. Use of insulin rather than sulfonylurea antidiabetic agents during pregnancy allows for the maintenance of blood glucose concentrations that are as close to normal as possible. Abnormal blood glucose concentrations in the mother have been associated with a higher incidence of congenital abnormalities during early pregnancy, and with increased perinatal morbidity and mortality later in pregnancy. Adequate and well-controlled studies in humans have not been done to determine whether sulfonylureas are teratogenic. It remains possible that sulfonylureas cause congenital malformations if they cross the placenta, but current data leave unresolved the issue of whether the abnormalities are due to poor glucose control or to sulfonylurea treatment. Generally, sulfonylureas are not recommended during pregnancy. In the rare case that sulfonylureas are used during pregnancy, they should be discontinued to allow an interval before delivery appropriate for the particular sulfonylurea being used because of the risk that they will cause insulin release and hypoglycemia in the neonate at delivery. Petitpierre B, Perrin L, Rudhardt M, et al. Behaviour of chlorpropamide in renal insufficiency and under the effects of associated drug therapy. Int J Clin Pharmacol 1972; 6: 120. Glyburide Apo-Glyburide, Apotex. In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 33rd ed. Ottawa: Canadian Pharmacists Association; 1998. p. 105. Palmer KJ, Brogden RN. Gliclazide: an update of its pharmacological properties and therapeutic efficacy in non-insulin-dependent diabetes mellitus. Drugs 1993; 461: 92-125. The United States pharmacopeia. The national formulary. USP 23rd revision January 1, 1995. NF 18th ed January 1, 1995. Rockville, MD: The United States Pharmacopeial Convention, Inc; 1995. p. 357, 1565. Weight gain is greater with combination use of insulin and sulfonylureas than with sulfonylurea therapy alone. Gliclazide alone, or metformin in combination with sulfonylureas, usually results in less weight gain than other sulfonylureas and has exhibited a weight loss effect. Acetohexamide and its more potent major metabolite, hydroxyhexamide, have uricosuric properties. Gliclazide, at therapeutic doses, reduces platelet adhesiveness and aggregation by inhibiting arachidonic acid release and thromboxane synthesis, and increasing production of prostacyclin PGI 2 and release of plasminogen activator, which increases fibrinolysis. It is also thought that gliclazide and glyburide have protective activity against cardiac arrhythmias because they can stabilize potassium and calcium concentrations by inhibition of the sodium-potassium-ATPase pump transport system. Tolbutamide and chlorpropamide decrease free water clearance while glyburide, glipizide, and tolazamide produce a mild diuresis effect by enhancement of renal free water clearance. In contrast to glyburide, tolazamide and tolbutamide increase hexose uptake in adipocytes and myocytes. Sulfonylureas directly increase the secretion of pancreatic and gastric somatostatin and do not seem to have a direct effect on glucagon. Being hospitalized if ketoacidosis or diabetic coma occurs with a possible change of treatment. Brown KS, Armstrong IC, Wang A, Walker JR, Noveck RJ, Swearingen D, Allison M, Kissling JC, Kisicki J, Salazar DE. Effect of the bile acid sequestrant colesevelam on the pharmacokinetics of pioglitazone, repaglinide, estrogen estradiol, norethindrone, levothyroxine, and glyburide. Connor H, Marks V. Alcohol and diabetes. A position paper prepared by the Nutrition Subcommittee of the British Diabetic Association's Medical Advisory Committe and approved by the Executive Council of the British Diabetic Association. Human Appl Nutr 1985; 39A, 393-9. Protective activity for some cardiac arrhythmias; also, has mild diuretic activity. Lancet 1991 Nov 9; 3388776: 1222. During conversion from insulin therapy to gliclazide therapy, no gradual dosage adjustment usually is required for patients using less than 20 USP Units of insulin daily. For patients using 20 or more USP Units daily, a 25 to 30% reduction in insulin every day or every second day with gradual dosage adjustment is advisable. Hospitalization for some patients on a higher insulin dosage may be required for uneventful conversion. dokter online flonase



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Pharmaceuticals, Inc. July, 2016. Managing with potassium supplements. Danazol Sanofi Winthrop. In: PDR Physicians' desk reference. 48th ed. 1994. Montvale, NJ: Medical Economics Data Production Company; 1994. p. 2092-3. Br J Clin Pharmacol 1986; 22: 43-8. Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day. Studies in animals have not been done. Vigneri R, Trischitta V, Italia S, et al. Treatment of NIDDM patients with secondary failure to glyburide: comparison of the addition of either metformin or bedtime NPH insulin to glyburide. Diabete Metab 1991 May; 17 1 Pt 20: 232-4. Alkalinization of urine with sodium bicarbonate to pH of 8 can eliminate 80% of chlorpropamide over 24 hours, but is not useful with other sulfonylureas. Caution with concurrent use with diazoxide treatment because of possible significant sodium retention. order cheapest reductil usa reductil



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Endoscopic or combines upper endoscopy and examination to obtain images and information about various parts of the digestive tract. Why Do I Need an Endoscopy? Large-dose studies using up to 75 times the maximum human dose in rats and in mice for 20 and 18 months, respectively, showed no evidence of drug-related carcinogenicity. Gastric removal by administration of repeated doses of oral activated charcoal with appropriate cathartic, although the usefulness of this has not been established. The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. The majority of a single dose of tolazamide is eliminated in urine within 24 hours and elimination is complete after 5 days. Less active metabolites include carboxytolazamide, hydroxytolazamide, and p-toulene sulfonamide. Lower initial doses may be required in patients with medical problems that make them more sensitive to the effects of tolazamide. Immediately treating with 50 mL of 50% dextrose injection given intravenously to stabilize the patient. Chlorpropamide crosses the placenta. Sulfonylureas should not be used during pregnancy, especially when insulin is available. In the rare cases that a sulfonylurea is used, chlorpropamide and glipizide should be discontinued at least 1 month before delivery date and other sulfonylureas stopped at least 2 weeks before delivery date. Geriatric patients may be more likely to develop a reversible syndrome of inappropriate antidiuretic hormone SIADH from the use of chlorpropamide. The incidence of SIADH is rare and occurs with greater incidence when thiazides are taken concurrently with chlorpropamide than when chlorpropamide is taken alone 10% versus 3%, respectively. In one study, women over 70 years of age were affected 10 times more often than women under 60 years of age when thiazides were used concurrently with chlorpropamide. It is not thought to be a gender-oriented effect. SIADH has been rarely reported with tolbutamide.



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Chlorpropamide is not effective in the treatment of nephrogenic diabetes insipidus. In addition, your doctor may use an endoscope to take a removal of tissue to look for the presence of disease. Judis J. Binding of sulfonylureas to serum proteins. J Pharm Sci 1972; 611: 89-93. Fatal hypoglycemia occurs more often with glyburide than with chlorpropamide; potential for serious adverse effect because of prolonged action of glyburide, especially with predisposed individuals. Also indicated in the treatment of central diabetes insipidus. Sulfonylurea-induced blood dyscrasias and dermatologic conditions generally occur within the initial six weeks of therapy and are thought to be hypersensitivity reactions. Brazy JE, Pupkin MJ. Effects of maternal isoxsuprine administration on preterm infants. J Pediatr 1979 Mar; 444-8. Batch J, Ma A, Bird D, et al. The effects of ingestion time of gliclazide in relationship to meals on plasma glucose, insulin and C-peptide levels. Eur J Clin Pharmacol 1990; 385: 465-7. During conversion from insulin therapy to glyburide therapy, no gradual dosage adjustment usually is required for patients using less than 40 USP Units of insulin daily. Patients requiring more than 40 USP Units should receive a 50% reduction of insulin the first day with initiation of 3 mg of micronized glyburide or 5 mg of nonmicronized glyburide as a single dose and gradual dosage adjustments of glyburide as needed. Hospitalization for some patients on a higher insulin dosage may be required for uneventful conversion. There is little evidence that one sulfonylurea is more effective in lowering blood glucose than another, especially between first and second generation sulfonylureas. Some pharmacokinetic differences between sulfonylureas may result in small qualitative and temporal differences that may make one medication more suitable in a certain situation. For instance, glyburide possibly due to its longer duration of action and effect on hepatic glucose suppression and gliclazide exert a better effect on fasting blood glucose than does glipizide, which results in lowered nocturnal and morning blood glucose; glipizide has greater postprandial insulin release and lower postprandial blood glucose concentrations. Overall, the resulting reduction in blood glucose concentration is similar between sulfonylureas. Initial: Oral, 250 mg once a day, the dosage being changed by 50 to 125 mg every three to five days if needed. Has mild diuretic activity. Food delays absorption of gliclazide up to 187 minutes; may be best taken 30 minutes before or with a meal. Safety and efficacy have not been established. If a snack is not scheduled for an hour or more you should also eat a light snack, such as crackers or a half sandwich, or drink an 8-ounce glass of milk. When patients are transferred to chlorpropamide from another sulfonylurea, no transition period is required. When transferring patients from chlorpropamide, caution should be exercised during the first 1 to 2 weeks because of the prolonged retention of chlorpropamide in the body. llil.info zocor



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Feeley J, Peden N. Enhancement of sulphonylurea-induced hypoglycaemia with cimetidine. Br J Clin Pharmacol 183; 15: 607. May be preferred for those patients with moderate renal function impairment but should be discontinued with renal failure. Lebovitz HE. Glipizide: a second-generation sulfonylurea hypoglycemic agent. Pharmacotherapy 1985; 5: 63-7. Self TH, Tsiu SJ, Fowler JW Jr. Interaction of rifampin and glyburide. At first, 1000 to 2000 milligrams mg a day. Some elderly people may need lower doses to start. The dose is usually divided into two doses. These doses are taken before the morning and evening meals. Your doctor may change your dose a little at a time if needed. The dose is usually not more than 3000 mg a day. In general, no overall difference in safety or efficacy was apparent in persons over 65 years of age when compared to persons younger than 65 years of age taking sulfonylureas for type 2 diabetes. Lower doses are used initially because of possible increased sensitivity to these agents due to age-related metabolism and excretion changes; the steady state concentration of extended-release glipizide has been delayed for 1 or 2 days in elderly patients. The risk of adverse reactions is relatively low when other factors for toxicity, including liver and kidney disease and known drug interactions, are considered. Special counseling with emphasis on hydration, diet, and exercise may be necessary because of the greater risk of hypoglycemia in this age group. Special instruction to recognize hypoglycemia may be needed because early warning adrenergic symptoms of hypoglycemia such as sweating, weakness, tachycardia, and nervousness are absent in many patients. Hypoglycemia manifests as neurological symptoms such as headache, irritability, mental confusion, unusual tiredness, and drowsiness and may be more prolonged and severe in the elderly. Combining antidiabetic agents sulfonylureas with metformin or insulin or using long-acting sulfonylureas, such as chlorpropamide and glyburide, is most often associated with hypoglycemia in elderly patients and is not generally recommended; shorter-acting sulfonylureas cause fewer problems. Also, instructions may be needed to help the patient monitor urine or blood glucose if visual problems are present. Check the labels on all your medicines such as -and-cold products because they may contain ingredients that could affect your sugar. Ask your pharmacist about using those products safely. Piacquadio K, Hollingsworth DR, Murphy H. Effects of in-utero exposure to oral hypoglycaemic drugs. Lancet 1991 Oct; 338: 866-9. When these two medicines are taken together, rifamycins may cause your body to process your diabetes medicine more quickly. It is unknown if this medication passes into milk. However, similar drugs pass into milk. Consult your doctor before breast-feeding. Jain AK, Ryan JR, McMahon FG. Potentiation of hypoglycemic effect of sulphonylureas by clofibrate. N Engl J Med 1976; 29411: 613. Glucose administration is the basis for treatment of hypoglycemia; however, an exposure to sudden or excessive hyperglycemia caused by an injection of hypertonic glucose solution may further stimulate the sulfonylurea-primed pancreas to release more insulin, worsening the hypoglycemia. No evidence of teratogenicity was found in rats following oral administration of glimepiride at doses approximately 4000 times the maximum recommended human dose based on body surface area, or in rabbits following administration of glimepiride at doses approximately 60 times the maximum recommended human dose based on body surface area. Campbell DB, Lavielle R, Nathan C. The mode of action and clinical pharmacology of gliclazide: a review. Diabetes Res Clin Pract 1991; S21-S36. Carry a recent prescription and your medical history. Be prepared for an emergency as you would normally. Make allowances for changing time zones, and keep your meal times as close as possible to your usual meal times. euro generic duloxetine



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Sulfonylureas lower blood glucose in patients with type 2 diabetes by directly stimulating the acute release of insulin from functioning beta cells of pancreatic islet tissue by an unknown process that involves a sulfonylurea receptor on the beta cell. Sulfonylureas inhibit the ATP-potassium channels on the beta cell membrane and potassium efflux, which results in depolarization and calcium influx, calcium-calmodulin binding, kinase activation, and release of insulin-containing granules by exocytosis, an effect similar to that of glucose. Insulin is a hormone that lowers blood glucose and controls the storage and metabolism of carbohydrates, proteins, and fats. Sulfonylureas are effective only in patients whose pancreata are capable of producing insulin. cheap bonviva last

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Renal impairment prolongs acetohexamide half-life to 30 hours. The results are questionable because negative results were also shown in rats and Chinese hamsters. Some elderly patients may be more sensitive than younger adults to the effects of sulfonylureas, especially when more than one antidiabetic medicine is being taken or if other medicines that affect blood sugar are also being taken. This may increase your chance of developing low blood sugar during treatment. Furthermore, the first signs of low or high blood sugar are not easily seen or do not occur at all in older patients. This may increase the chance of low blood sugar developing during treatment. price of anafranil with insurance

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Palatnick W, Meatherall RC, Tenenbein M. Clinical spectrum of sulfonylurea overdose and experience with diazoxide therapy. Arch Intern Med 1991 Sep; 151: 1859-62. Adequate and well-controlled studies in humans have not been done. Food delays absorption of immediate-release glipizide by 40 minutes; therefore, it is recommended that glipizide be taken 30 minutes before a meal. While food had no effect on the lag time of absorption 3 to 4 hours for extended-release glipizide, administration of glipizide to normal males before a meal high in fat showed a 40% increase in the time to peak serum concentrations; AUC was not affected.

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Niemi M, Kivisto KT, Backman JT, Neuvonen PJ. Effect of rifampicin on the pharmacokinetics and pharmacodynamics of glimepiride. Groop L, Totterman KJ, Harno K, et al. Influence of beta-blocking drugs on glucose metabolism in patients with non-insulin dependent diabetes. Acta Med Scand 1982; 211: 7-12. Reaven GM, Johnston P, Hollenbeck CB, et al. Combined metformin-sulfonylurea treatment of patients with noninsulin-dependent diabetes in fair to poor glycemic control. J Clin Endocrinol Metab 1992; 745: 1020-6. Chlorpropamide crosses the placenta. Adequate and well-controlled studies have not been done in humans. Low doses 250 mg a day or less of chlorpropamide have been used in pregnant women without adverse effects. The manufacturer recommends discontinuing chlorpropamide at least 1 month before the expected delivery date. order cheapest ursofalk shop

Ferner RE, Chaplin S. The relationship between the pharmacokinetics and the pharmacodynamic effects of oral hypoglycaemic drugs. Clin Pharmacokinet 1987 12: 379-401. Jacobs DS, DeMott WR, Strobel SL, et al. Chemistry. In: Jacobs DS, Kasten BL, DeMott WR, editors. Laboratory test handbook. The effectiveness of sulfonylureas in controlling blood glucose can decrease over time. If maximum doses of a sulfonylurea fail to control blood glucose, switching to another sulfonylurea or adding metformin to a sulfonylurea treatment regimen may be beneficial in increasing glycemic control and lipoprotein metabolism and may help avoid initiation of insulin therapy. This is especially successful in patients with type 2 diabetes whose blood sugar levels are poorly controlled by insulin alone, in short-term diabetics, or in patients who are 120 to 160% over ideal baseline body weight but who are not excessively insulin-resistant. Glimepiride and metformin may be used concomitantly when diet, exercise and glimepiride or metformin alone do not adequately control blood glucose levels. Combined use of glimepiride and metformin may increase the potential for hypoglycemia. Alternatively, low-dose insulin in conjunction with sulfonylureas can help to avoid using large doses of insulin, especially for patients with type 2 diabetes who are obese. However, complications, such as weight gain, the effects of hyperinsulinemia, and an increased risk of hypoglycemia need to be considered. Some patients with type 2 diabetes who are nonobese and who are experiencing secondary sulfonylurea failure may be best treated with insulin. A sulfonylurea should be discontinued any time it fails to contribute to the lowering of plasma glucose in a patient for whom compliance with proper diet and sulfonylurea dosing has been determined to be adequate. sulfasalazine

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