The alpha-glucosidase-hydroxyvlase enzyme inhibitor acarbose can be the first choice of drug in the: antidiabetic treatment under strict control when insulin therapy is not aceepted by the patient or insulin could not be applied by other reasons. Only gliclazide could be the second choice of drug in liver injury since it has a weaker hypoglycaemic effect than glibenclamide or glipizide, and liver-damage was not observed during its application up to the present.
Nevertheless, an increased risk of hypoglycaemia is to be minded under such circumstances, too.
All form of sulphonylurea treatment must to be avoided during hepatocanalicular alterations or during severe parenchymatous hepatic injuries. Furthermore, control of hepatic functions is yearly recommended during sulphonylurea treatment to avoid eventual hepatic damages.
Suspension of sulphonylurea treatment is to be considered during liver or bile pain when the possibility of liver injury could not been avoided.
Biguanide therapy is forbidden in cases of liver diseases.