If a sulfonylurea is used in older adults, which is preferred over long-acting agents?

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

Answer: (D)

In older adults, the risk of hypoglycemia is higher and can be more dangerous, so if a sulfonylurea is used, a shorter-acting one with a lower risk of prolonged low blood sugar is preferred. Glipizide fits this role because it is a shorter-acting sulfonylurea with no active metabolites that linger as long in the body, reducing the chance of prolonged hypoglycemia, especially in those with reduced kidney function.

Glyburide (glyburide), by contrast, has a longer duration and active metabolites that can remain in the system, increasing hypoglycemia risk in the elderly. Glimepiride is longer-acting than glipizide, so it carries a greater potential for extended low glucose. Gliclazide is also longer-acting or less clearly favored in this specific Beers Criteria context. Therefore, the safer choice among these options for older adults is glipizide.