What side effects are possible with this medication?
A side effect is an unwanted response to a medication when it is taken in normal doses. It can be mild or severe, temporary or permanent, but does not occur in everyone. The following side effects have been reported by at least 1% of people taking this medication. If you develop any of these side effects (or any other side effects not listed here) or they change in intensity, speak to your doctor or pharmacist for advice on managing them and on the risks and benefits of the medication.
- abdominal bloating
- changes in taste sensation
- constipation
- diarrhea
- dizziness
- headache
- heartburn
- increased or decreased appetite
- low blood sugar symptoms, including:
- blurred vision
- cold sweats
- confusion
- cool, pale skin
- difficulty concentrating
- drowsiness
- excessive hunger
- nausea
- shakiness
- slurred speech
- unusual tiredness or weakness
- nausea
- skin itching and rash
- unusual weight gain
- vomiting
Click here to learn about serious side effects that can potentially occur with any medication. These examples are provided for information purposes only and are not meant to be exhaustive. Always consult your doctor for sound medical advice specific to your particular medication and treatment.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online or by phone at 1-800-332-1088.
Are there any other precautions or warnings for this medication?
Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.
Alcohol: Unpleasant reactions to alcohol (flushing, sensation of warmth, giddiness, nausea, and occasionally racing heart rate) may occur in people taking tolbutamide. This reaction can be prevented by avoiding the use of alcohol.
Blood sugar control: Over a period of time, you may become progressively
less responsive to a particular treatment for diabetes because of a worsening
of your diabetes. If tolbutamide fails to lower blood glucose to target levels,
the medication should be stopped and replaced, or another medication added to
it.
Loss of blood sugar control may occur during illness (such as fever or infection) or stressful situations (such as trauma or surgery). Under these conditions, your doctor may consider stopping the medication and prescribing insulin until the situation improves.
Cardiovascular death: The use of oral hypoglycemic medications has been reported to be associated with increased cardiovascular death as compared to treatment with diet alone or diet plus insulin.
Diet and exercise: This medication should be used along with diet and exercise to improve control of your blood sugar. It is important to follow instructions concerning diet, adhere to a regular exercise program, and to test your blood sugar levels regularly. Caloric restriction and weight loss are essential in overweight diabetic patients.
Drowsiness/reduced alertness: Use caution when driving or operating dangerous machinery until your blood sugar is under control, or when
changing doses of medication, or when the tablets have not been taken regularly, as alertness and
reaction time may be reduced.
Hemolytic anemia: Some people with a condition known as glucose 6-phosphate dehydrogenase (G6PD) deficiency have experienced hemolytic anemia (decreased red blood cells) when taking sulfonylurea medications. If you have G6PD deficiency, talk with your doctor about whether you should take this medication. Hemolytic anemia has also occurred in some patients without G6PD deficiency.
Low blood sugar: As with other sulfonylurea medications like tolbutamide, symptoms of hypoglycemia (low blood sugar) including dizziness, lack of energy, drowsiness, headache, and sweating have been observed with use of this medication. Weakness, nervousness, shakiness, and numbness or tingling have also been reported. Severe hypoglycemia can result from taking any of the sulfonylurea medications.
Seniors, those with reduced liver or kidney function or thyroid diseases, and those who are fragile or malnourished are more likely to experience low blood sugar with these medications. Low blood sugar is more likely to occur when food intake is inadequate or after strenuous or prolonged physical exercise, when alcohol is ingested or when more than one glucose-lowering medication is used. Blood glucose should be monitored regularly and emergency glucose (and glucagon kit) should be kept available in case the need arises to increase blood sugar levels.
Pregnancy: This medication should not be used during pregnancy unless
the benefits outweigh the risks. If you become pregnant while taking this medication,
contact your doctor immediately.
Breast-feeding: This medication passes into breast milk. If you are
a breast-feeding mother and are taking tolbutamide, it may affect your baby.
Talk to your doctor about whether you should stop breast-feeding or stop taking this medication.
Children: The safety and effectiveness of this medication have not been
established for children.
What other drugs could interact with this medication?
There may be an interaction between tolbutamide and any of the following:
- alcohol
- "azole" anti-fungals (e.g., fluconazole, ketoconazole, miconazole)
- beta-blockers (e.g., nadolol, propranolol)
- birth control pills
- calcium channel blockers
- chloramphenicol
- cimetidine
- corticosteroids (e.g., prednisone)
- cyclosporine
- diuretics (water pills)
- estrogens
- isoniazid
- monoamine oxidase (MAO) inhibitors (e.g., phenelzine, tranylcypromine)
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- nicotinic acid
- nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen)
- octreotide
- phenothiazines
- phenytoin
- probenecid
- quinolones (e.g., ciprofloxacin, ofloxacin)
- rifampin
- salicylates (e.g., aspirin)
- sulfonamides
- sympathomimetic amines (e.g., pseudoephedrine, ephedrine)
- thiazides
- thyroid medications
- warfarin
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If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.