The University Group Diabetes Program study drew attention to the high cardiovascular mortality among type 2 diabetic patients treated with tolbutamide. A retrospective study of our Diabetic Outpatient Clinic, involving 1047 patients, reported a markedly shorter survival time both after acute myocardial infarction and first attack of angina pectoris in diabetics treated with carbutamide, chlorpropamide or tolbutamide, while those on glibenclamide therapy had considerably better survival. In searching for a sufficient explanation for these data, further differences could be detected among the hypoglycemic sulphonylurea compounds. Carbutamide, tolbutamide and gliclazide were found to exert an inotropic effect in dogs, to increase the number of ventricular ectopic beats and the time of transitional ventricular fibrillation in acute myocardial infarction in rats, as well as to increase the toxicity of strophantidin in rabbits.Glibenclamide and glipizide, on the other hand, showed a mild negative inotropic effect in dogs, decreased the number of ventricular ectopic beats and time of transitional ventricular fibrillation due to myocardial is-chaemia in rats and decreased the toxicity of strophan-tidin in rabbits. The divergent effects of the sulphonyl-ureas on the arrhythmogeneity of the heart could explain the differences described in clinical studies relating to survival after acute myocardial infarction. Nevertheless, it remains to be elucidated whether different direct cardiac affects or potentially centrally mediated actions of the sulphonylurea are responsible for their opposite action on arrhythmo-genesis. Therefore, the present study compared the acute effects of different sulphonylureas on the heart rate and arterial blood pressure alterations induced by the electrical stimulation of the vagal nerve in the dog. Find most trusted pharmacy that will give you in the amounts required without any need for a prescription. You will see that shopping with a place you can already trust over and over again is very affordable and always nice.