Tolbutamide (Orinase), a sulfonylurea derivative, is an orally given hypoglycemic agent which has recently been added to the therapy of diabetes mellitus. The introduction of any new drug into the therapeutic armamentarium necessarily requires careful observation to detect any toxic manifestations. This applies even more to tolbutamide, since, in addition to being a new drug, it is chemically related to the sulfonamides which have many known undesirable side-effects, the site and mode of action are not clearly defined, its use requires a prolonged period of administration, and it is a substitute for insulin, a known nontoxic agent which has been used safely and successfully for the past 25 years. On the other hand, it is equally important not to attribute to a drug undesirable but coincidental clinical phenomena that are inherent in the course of the disease under treatment and, hence, unrelated to any injurious effects of the medicament per
Ellenberg M. DIABETIC NEUROPATHY PRECIPITATED BY DIABETIC CONTROL WITH TOLBUTAMIDE. JAMA. 1959;169(15):1755–1757. doi:10.1001/jama.1959.73000320009013d
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