Implementation

• High Alert: Accidental administration of oral hypoglycemic agents to non-diabetic adults and children has resulted in serious harm or death. Before administering, confirm that patient has diabetes. Do not confuse acetohexamide with acetazolamide

• Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma, infection, or surgery may require administration of insulin

» To convert from other oral hypoglycemic agents, the initial dose of acetohexamide should be about half the dose of tolbutamide and double the dose of chlorpropamide. A transition period is necessary with chlorpropamide because of the long half-life. Subsequent dose adjustments should be made based on the patient's response. For patients on an insulin dosage of <20 units/day, insulin can be discontinued immediately after starting acetohexamide. Patients taking >20 units/day should convert gradually by receiving an initial dose of acetohexamide of 250 mg and a 25–30% reduction in insulin dose the first day, with gradual insulin dosage reduction as tolerated. Hospitalization should be considered during the transition from insulin to acetohexamide

• PO: May be administered once in the morning or divided into 2 doses. Administer with meals to ensure best diabetic control and to minimize gastric irritation. Do not administer after last meal of the day

» Tablets may be crushed and taken with fluids if patient has difficulty swallowing

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