Tolbutamide
ORINASE
Pronunciation: toel-BYOO-ta-mide
What it isFirst-generation sulfonylurea; type 2 diabetes.
Why this oneShort-acting and hepatically cleared, so it was once favored in renal impairment.
What limits itThe UGDP trial suggested excess cardiovascular mortality, which shaped sulfonylurea labeling for decades. Obsolete.
Tolbutamide prescription history
Animated chart of estimated U.S. prescriptions per year, Diabetes meds (1923–2026). Tolbutamide enters in 1957 (estimated).
FDA-approved for
- type 2 diabetes (~1957)
⚠ BOXED WARNING
- Increased cardiovascular mortality
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityProlonged severe hypoglycemia
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Self-check
- Why was tolbutamide once favored in renal impairment?
Short action and hepatic clearance. - Which trial suggested excess cardiovascular mortality with tolbutamide?
UGDP.