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Question
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???"

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Mr P

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.

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Nigel Simmons

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I am happy to answer general questions on medicines and hospital care. If possible, please use approved / chemical names rather than brands which are not internationally recognised. Like all health professionals I am bound by a duty of care which prevents me giving detailed information about medication or treatment of people other than the questioner. I will endeavour to help wherever possible or point towards more appropriate advice. If however your question crosses too far into patient confidentiality, I hope you will understand why I cannot answer your question. Consider.. would you want me to discuss your care with a friend or relative without your knowledge?

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