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A New Oral Hypoglycemic Agent: Preliminary Report

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A New Oral Hypoglycemic Agent: Preliminary Report Henry Ford Hospital Medical Journal Volume 9 Number 4 Article 5 12-1961 A New Oral Hypoglycemic Agent: Preliminary Report F. W. Whitehouse W. L. Lowrie Follow this and additional works at: https://scholarlycommons.henryford.com/hfhmedjournal Part of the Life Sciences Commons, Medical Specialties Commons, and the Public Health Commons Recommended Citation Whitehouse, F. W. and Lowrie, W. L. (1961) "A New Oral Hypoglycemic Agent: Preliminary Report," Henry Ford Hospital Medical Bulletin : Vol. 9 : No. 4 , 528-529. Available at: https://scholarlycommons.henryford.com/hfhmedjournal/vol9/iss4/5 This Article is brought to you for free and open access by Henry Ford Health System Scholarly Commons. It has been accepted for inclusion in Henry Ford Hospital Medical Journal by an authorized editor of Henry Ford Health System Scholarly Commons. A NEW ORAL HYPOGLYCEMIC AGENT PRELIMINARY REPORT F. W. WHITEHOUSE, M.D.* and W. L. LOWRIE, M.D.* Division of Metabolic Diseases This is a preliminary report on the use of a new oral hypoglycemic agent. I(p-acetyl benzenesulfonyl)-3-cyclohcxylurea (acelohexamide) is closely related chemically to tolbutamide (Orinase) and chlorpropamide (Diabinese). Acelohexamide is well-absorbed from the gastrointestinal tract. Sixty percent of an oral dose is reduced in the liver to its alphahvdroxyl derivative, which is then excreted, along with acelohexamide, in the urine. Bolh compounds have hypoglycemic activity in the dog and the rat. Figure I shows the chemical structure of acelohexamide. CH3-C N-C-N H H 0 ACETOHEXAMIDE Figure 1 Ten patients have taken acetohexamide, eight for more than three months. During this period, failure of hypoglycemic activity forced discontinuation of the drug in Ihree patienls; a fourth paiient developed a mild maculopapular eruption seven days afler initiation of therapy, and the amelioration of the diabetic state in a fifth has permilled iherapy with diet alone. Table I summarizes the clinical data of Ihe 10 patients. All patienls have lipoplethoric (adult-type) diabetes. Six palienis were receiving other oral agents at initiation of therapy with acetohexamide; one was taking insulin, and three others were treated with diet only. When acelohexamide was started, all patients needed more than quantitative diet to achieve good control of the diabetes. Five patients were successfully controlled with diet and acelohexamide. A skin reaction prevented further therapy in one patient, though melabolic control was good at the lime of cessation of the drug. Two patients, following a secondary failure to tolbutamide, and one patient, following a primary failure with both tolbutamide and chlorpropamide, were refractory to acetohexamide. •Division of Metabolic Diseases. 1 528 Hypoglycemic Agent Acelohexamide is well loleraled orally. ExcepI for the skin reaction mentioned above, we have seen no systemic toxicity. Kirtley reports none.' In patients with insulin-deficient diabeles, acelohexamide, like the olher sulfonylurea preparations, is ineffective. Acetohexamide may be tried when a secondary failure with eilher tolbutamide or chlorproamide has occurred and oral therapy is still desirable. Our experience is loo limited to make any comments on Ihe possibility of success in this situation. In daily doses of 0.5 lo 1.5 gms., laken with breakfast, acelohexamide is an effective oral agent in Ireatment of the lipoplethoric diabetic who requires Table I CLINICAL DATA ON TEN DIABETICS TREATED WITH ACETOHEXAMIDE Duration of Prior Acetohexamide Case Age Sex Amount** Result Diabetes* Treatment Duration 1 70 F 5 tolbutamide 1.5 6 mo failure 2° failure 56 F 12 chlorprt>pamide 1.0 6 mo good 250 mg/d 3 67 F I diet 0.5 6 mo good 4 54 M 15 tolbutamide 1.5 9 mo good 2" failure 5 57 F 18 PZI-28 u. LO 7 d skin rash 6 68 F 10 chlorpropamide 1.5 14 d failure tolbutamide (P failure) 7 79 F 6 chlorpropamide 0.25 3 mo good too mg. 8 55 M 1 diet 0.5 3 mo good 9 60 M 8 tolbutamide 1.5 3 mo failure 2" failure 10 64 M new diet 1.0 6 mo good in years. in grams per day. more than diet for adequate control. The availability of acetohexamide probably will fail to broaden significantly the applicability of oral therapy in diabetes, but It will add greater depth. REFERENCES I. Kirtley, W. R., Personal Communications. ACETOHEXAMIDE was generously supplied by the Eli Lilly Laboratories 529 .
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