Among sulfonylureas, which is preferred if a sulfonylurea is used in older adults?

• A. Gliclazide
• B. Glimepiride
• C. Glipizide
• D. Glyburide

Answer: (C)

In older adults, safety with sulfonylureas hinges on the risk of hypoglycemia and how the drug is cleared. Glyburide has active metabolites and a longer duration of action, which can lead to prolonged and harder-to-dain hypoglycemia in the elderly, especially with reduced kidney function. Glipizide, by contrast, has a shorter half-life and no active metabolites, so it is less likely to cause prolonged hypoglycemia and is generally safer for older patients. Therefore, if a sulfonylurea is used in older adults, glipizide is the preferred option. (Gliclazide is also relatively safer than glyburide, but glipizide is the most consistently favored choice for elderly safety.)