Pharmacy/right choice medicine
sir age 53 height 5.7 diabetes moderate level around 200to 250 if diet control failed. metformin is not working because cont since 8 years acerbose and voglibose create digestive problem with stomac upset now compel to take Sulfonylureas the question is that which drug-glimepiride 1 mg or Gliclazide 30 mg film coated or dpp 4 is better in my case of vpc-heart rythem -undignostic( Echoo and trademil normaleventhough frequent vpc) problem???"
Your cardiologist is perhaps better to express an opinion, but my preference would be to try Gliclazide. Whilst it is an old drug, this means doctors have plenty of experience using it and the data on adverse effects will probably be far greater than other products. There are no significant reported cardiac side effects, so this would strengthen the case for it. Also, it is likely to be a cheaper treatment than other products.
Glimepiride is known to interact with other medications, including several cardiac drugs, so it might be best avoided if other cardiac drugs need to be introduced.
Gliptins (DPP-4 inhibitors) would be my last choice. They are still relatively new in the market place (hence potentially expensive) and have limited evidence from long term treatment. More worryingly, there are increasing reports of patients taking gliptins developing pancreatitis which has led to several alerts being issued by health regulators. In my experience, a product or class of drugs that become associated with serious side effects soon after marketing, rarely survive in the long term. There is always a suspicion that other problems may also appear and that information was not adequately collected or assessed during development.
I hope this helps.