Favorable effects of glibenclamide in a patient exhibiting idiosyncratic hepatotoxic reactions to both chlorpropamide and tolbutamide.

A middle-aged diabetic woman after four weeks of chlorpropamide treatment developed cholestatic hepatitis with systemic manifestations of idiosyncratic reaction. After recovery, unintended rechallenge with the same drug induced a brisk exacerbation of the symptoms and signs that reversed completely following chlorpropamide withdrawal. Tolbutamide medication was subsequently well tolerated for several weeks, followed by another flare of cholestatic liver lesion and cutaneous eruption with eosinophilia (after each reaction the patient was treated with insulin). Eventually glibenclamide (glyburide) was instituted resulting in very satisfactory control of diabetes, with no untoward reaction.