Drug General Information (ID: DDI4V2ML1Y)
Drug Name			Tolbutamide		Drug Info		Calcium carbonate		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antidiabetic Agents				Antacids/Minerals And Electrolytes
Structure

Mechanism of Tolbutamide-Calcium carbonate Interaction (Severity Level: Moderate)
Altered gastric pH Click to Show/Hide Mechanism Graph
Drug Name		Tolbutamide				Calcium carbonate
Mechanism		Gastric pH sensitive				Gastric alkalinizer
Key Mechanism Factor 1
		Factor Name		Gastric pH
		Factor Description		The normal pH range of gastric acid is between 1.5 and 3.5 and is highly acidic, consisting mainly of hydrochloric acid. Changes in the pH of the stomach can alter the absorption of drugs.
Mechanism Description		Decreased absorption of Tolbutamide due to altered gastric pH caused by Calcium carbonate

Recommended Action
Management		Sulfonylureas should be administered at least two hours before or after antacids when possible. Regular monitoring of blood sugar is advisable. In addition, patients should be apprised of the signs and symptoms of hypoglycemia (e.g., headache, dizziness, drowsiness, nausea, hunger, tremor, weakness, sweating, palpitations), how to treat it, and to contact their physician if it occurs.

References
1	Prendergast BD "Glyburide and glipizide, second-generation oral sulfonylurea hypoglycemic agents." Clin Pharm 3 (1984): 473-85. [PMID: 6435940]
2	Product Information. Diabeta (glyburide). Hoechst Marion-Roussel Inc, Kansas City, MO.
3	Product Information. Micronase (glyburide). Pharmacia and Upjohn, Kalamazoo, MI.