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September 7, 1979, Vol 242, No. 10 >
ARTICLE | September 7, 1979

Drug Substitution

Kenneth L. Beers, MD
JAMA. 1979;242(10):1031-1032. doi:10.1001/jama.1979.03300100013008.
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ABSTRACT

To the Editor.—  This is a report of a clinical failure with substituted tolbutamide. My letter is prompted by the potentially serious situation that was created when one of my diabetic patients permitted substitution without my knowledge of a refill prescription for a specific brand of tolbutamide.

Report of a Case.—  The patient was a 71-year-old woman whose diabetes had been stabilized for seven years with diet and a daily dosage of tolbutamide (Orinase), 500 mg four times a day. The patient's fasting and postprandial blood glucose levels were generally maintained within a range of 100 to 140 mg/dL, and no noteworthy clinical complications associated with blood glucose control had occurred during her relatively long history of diabetes mellitus.During a routine visit to my office, the patient's blood glucose level was found to be 400 mg/dL, and she mentioned that she had not been feeling well. Careful questioning of

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