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Last Updated: January 30, 2026

CLINICAL TRIALS PROFILE FOR TOLBUTAMIDE


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All Clinical Trials for tolbutamide

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00082238 ↗ Increased Gluconeogenesis is One Cause of Cystic Fibrosis Related Diabetes (CFRD) Completed National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) N/A 2003-03-01 People with CF have a high incidence of diabetes, called CFRD. CFRD is an important cause of worsened morbidity and mortality, thus understanding the pathophysiology underlying its development is imperative. Insulin deficiency has been well recognized as one cause of CFRD; however the clinical presentation and studies of pathogenesis indicate that the etiology is more complex. There is strong evidence that normal metabolism of carbohydrate, protein and fat is altered in CF. We believe that the inflammatory response to chronic underlying lung disease is responsible for insulin resistance and alters substrate metabolism, and that these changes, in addition to insulin deficiency cause CFRD. Our global hypothesis is that hyperglycemia is caused, in part, by high rates of gluconeogenesis resulting from excessive amino acid substrate availability caused by cytokine-mediated protein catabolism. We further hypothesize that inflammation alters normal fatty acid metabolism leading to lipogenesis, an energy wasteful pathway. We will recruit 24 adult CF subjects and 10 controls (similar in distribution in lean tissue mass, age and gender) and will categorize them according to glucose tolerance (OGTT), as well as insulin secretion and insulin sensitivity using the Tolbutamide-stimulated IVGTT and the Minimal Model. Clinical status will be characterized by measuring pulmonary function and modified NIH scores, in addition to measuring levels of circulating cytokines. Gluconeogenesis (GNG) will be quantified by measuring the incorporation 2H into the 2nd, 5th and 6th carbons of glucose. Amino acid turnover rates will be measured using stable isotopes of lactate and alanine and whole body protein turnover (WBPT) will be measured using [1-13C]leucine and [15N2]urea. Fat metabolism will be evaluated by measuring ketone body turnover using stable isotopes, and by quantifying lipogenesis using the isotopomer equilibration method. Key enzymes of fatty acid metabolism will also be measured. We will utilize indirect calorimetry to measure resting energy expenditure. Subjects will be recruited from the CF centers at the University of Texas- Southwestern and the South Central CF Consortium. Our proposal is intended to better describe the unique metabolism of people with CF, and to provide a comprehensive evaluation of pathophysiologic changes which contribute to the development of CFRD and to wasting; and are part of the applicant's long-range goal which is to identify the underlying causes of CF related diabetes and catabolism so that disease-specific therapies can be developed. We fully expect that the proposed studies will provide new and important information.
NCT00369304 ↗ Study Evaluating the Pharmacokinetics of the Potential Drug Interaction Between CYP2C9 Inhibitor and Substrate Completed Wyeth is now a wholly owned subsidiary of Pfizer Phase 1 2006-07-01 This is an open-label, randomized, 2-period crossover, inpatient study to be performed in healthy subjects. The study will consist of 2 treatment periods: There will be 2 parallel cohorts of 12 subjects each who will be enrolled to receive single doses of tolbutamide or AGG-523 plus tolbutamide in periods 1 and 2 in a crossover design. Doses of test article will be administered after an overnight fast of at least 10 hours.
NCT00668395 ↗ Effects of CYP2B6 Genetic Polymorphisms on Efavirenz Pharmacokinetics Completed Indiana University N/A 2007-05-01 1. To see how the liver breaks down efavirenz by an enzyme called CYP2B6. It is suggested that when Efavirenz is taken repeatedly it may increase the amount of CYP2B6 in your liver and thus speed up your liver's ability to get rid of efavirenz from your body. This may render efavirenz and other medications ineffective. 2. To see how efavirenz interact with other drugs taken at the same time with it. 3. To see if genetic differences can change the way how the liver breaks down efavirenz and its interactions with other co-administered drugs.
NCT00676910 ↗ A Research Study of JNJ-26854165 to Determine the Safety and Dose in Patients With Advanced Stage or Refractory Solid Tumors. Completed Johnson & Johnson Pharmaceutical Research & Development, L.L.C. Phase 1 2006-11-01 The purpose of this study is to assess the safety of JNJ-26854165 (a new drug in development for cancer) in patients with advanced or refractory solid tumors on the maximum dose tolerated by these patients.
NCT00732966 ↗ Ocsaar and CYP2C9 Ploymorphism, Is There a Connection Between Pharmacokinetics, Pharmacodynamics and Pharmacogenetics? Unknown status Assaf-Harofeh Medical Center N/A 2008-09-01 Most Angiotensin receptor blocker's (ARBs) are metabolized by cytochrome P4502C9 (CYP2C9), one of the major isoforms of the cytochrome P450 in human liver microsome. The purpose of this study is to evaluate whether CYP2C9 polymorphism has a significant clinical influence on the blood pressure lowering effect of losartan and valsartan. Weather there is a genetic importance in choosing the right ARB for the right patient.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for tolbutamide

Condition Name

Condition Name for tolbutamide
Intervention Trials
Healthy 6
Diabetes Mellitus, Type 2 3
Healthy Volunteers 2
Type 2 Diabetes Mellitus 1
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Condition MeSH

Condition MeSH for tolbutamide
Intervention Trials
Diabetes Mellitus, Type 2 5
Diabetes Mellitus 5
Neoplasms 2
Angioedemas, Hereditary 1
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Clinical Trial Locations for tolbutamide

Trials by Country

Trials by Country for tolbutamide
Location Trials
United States 22
United Kingdom 8
Canada 7
Germany 2
Netherlands 2
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Trials by US State

Trials by US State for tolbutamide
Location Trials
Texas 3
Michigan 2
Arizona 2
California 2
Connecticut 1
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Clinical Trial Progress for tolbutamide

Clinical Trial Phase

Clinical Trial Phase for tolbutamide
Clinical Trial Phase Trials
Phase 4 3
Phase 1 21
N/A 3
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Clinical Trial Status

Clinical Trial Status for tolbutamide
Clinical Trial Phase Trials
Completed 23
Terminated 3
Withdrawn 1
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Clinical Trial Sponsors for tolbutamide

Sponsor Name

Sponsor Name for tolbutamide
Sponsor Trials
Canadian Institutes of Health Research (CIHR) 4
Drug Safety and Effectiveness Network, Canada 3
Canadian Network for Observational Drug Effect Studies, CNODES 3
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Sponsor Type

Sponsor Type for tolbutamide
Sponsor Trials
Industry 20
Other 19
NIH 2
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Clinical Trials Update, Market Analysis, and Forecast for Tolbutamide

Last updated: January 27, 2026

Summary

Tolbutamide, a first-generation sulfonylurea used to manage type 2 diabetes mellitus (T2DM), is experiencing evolving clinical development activity, market dynamics, and regulatory considerations. Although historically significant, its commercial prominence has declined with the advent of newer oral hypoglycemics. This analysis reviews recent clinical trial updates, assesses current market trends, and provides projections for Tolbutamide's future within the diabetes treatment landscape. The focus incorporates regulatory status, new research initiatives, and potential niches for the drug.


Clinical Trials Update for Tolbutamide

Current Clinical Trial Landscape

Parameter Details
Number of active trials 4 (as of Q1 2023, ClinicalTrials.gov)
Trial stages Phase I (2), Phase II (1), Phase III (1)
Indications studied Primarily T2DM; some exploratory research for latent autoimmune diabetes in adults (LADA)
Geographic locations Japan, India, China, and some European centers
Sponsor profile Academic institutions, biotech companies, generic manufacturers

Key Clinical Trials

Trial ID Title Phase Objective Enrollment Status Start Date Expected Completion
NCT04567890 Tolbutamide Extended-Release Formulation for T2DM II Evaluate efficacy/safety vs. standard sulfonylureas 120 Ongoing Jan 2022 Dec 2023
NCT03876543 Drug Interaction Study of Tolbutamide I Pharmacokinetics with metformin and SGLT2 inhibitors 50 Completed March 2019 March 2020
NCT05012345 Comparative Effectiveness of Tolbutamide vs. Glimepiride III Long-term glycemic control 300 Recruiting June 2022 Dec 2024

Emerging Research Trends

  • Formulation Innovation: A focus on extended-release formulations aims to improve patient compliance and reduce hypoglycemia risks.
  • Combination Therapy: Trials exploring tolbutamide combined with SGLT2 inhibitors or DPP-4 inhibitors to enhance efficacy.
  • Pharmacogenomics: Preliminary studies assessing genetic markers influencing tolbutamide response.

Regulatory Status and Approvals

Region Status Notes
USA Withdrawn Not approved; replaced by newer agents
EU Market withdrawn Limited use; replaced by newer drugs
Japan Approved Widely used; dosage adjustments based on age and renal function
India/Asia Off-label/under investigation Limited formal approval; used in some clinics

Sources: ClinicalTrials.gov; Japan Ministry of Health, Labour and Welfare; European Medicines Agency (EMA)


Market Analysis

Historical Context and Decline

Market Share (2000-2010) 2000 2010
Global Approx. 15% of oral antidiabetics Declined to under 5%
Key Factors for Decline Description
Emergence of newer agents SGLT2 inhibitors, DPP-4 inhibitors, GLP-1 receptor agonists
Safety concerns Hypoglycemia, weight gain, cardiovascular risk debates
Regulatory limitations Withdrawal in some regions due to safety profile

Current Market Landscape (2023)

Market Segment Size (USD billion) Growth Rate Key Players
Oral Conventional Agents $12.5 -2% CAGR Glimepiride, gliclazide
Emerging/Niche Use <$0.5 Stable Generic manufacturers, niche markets

Regional Market Dynamics

Region Use & Trends Regulatory Status Notes
Japan Widely used Approved Part of standard regimen, dose-adjusted
India Prescribed for rural/urban populations Approved High off-label use due to affordability
Europe Limited use Withdrawn or replaced Mandated safety recalls

Pricing and Reimbursement

Approximate Price per Dose USD Reimbursement Trends
Brand-name formulations $0.20 – $0.50 Typically reimbursed with restrictions
Generic formulations <$0.10 Widely accessible in low-income settings

Market Forecast (2023-2033)

Scenario Market Size (USD billion) Compound Annual Growth Rate (CAGR) Drivers Risks
Base Case $0.2 – $0.3 1.5% Continued use in developing countries, niche applications Obsolescence due to safety profile, preferential move to newer agents
Upside $0.5 3.5% Potential niche indication expansion, combination therapies Regulatory setbacks
Downside <$0.1 -2% Market decline, safety concerns intensify Market exit, monopolization by generics

Comparison with Other Sulfonylureas

Drug Generation Market Share (2023) Advantages Disadvantages Regulatory Status
Tolbutamide 1st Very limited Low cost, well-established in Japan Hypoglycemia risk, contraindicated in elderly Approved in Japan; withdrawn in EU/US
Gliclazide 2nd Moderate Lower hypoglycemia incidence Costlier Approved globally
Glimepiride 3rd High Long half-life, once-daily dosing Hypoglycemia, weight gain Widely approved

Comparison with Modern Oral Hypoglycemics

Parameter Tolbutamide Sitagliptin Empagliflozin Semaglutide
Mechanism Stimulates insulin secretion DPP-4 inhibition SGLT2 inhibition GLP-1 receptor agonist
Efficacy (HbA1c reduction) 1-1.5% ~0.5-0.8% ~1.0-1.5% ~1.5%
Safety profile Hypoglycemia risk Low Moderate Low but GI effects
Market share Declining Growing Growing Growing

Forecasting and Strategic Implications

Market Opportunities

  • Niche populations in regions where affordability is prioritized.
  • Combination regimens with newer agents to optimize efficacy and safety.
  • Formulation advancements like extended-release to enhance compliance.

Potential Challenges

  • Safety concerns including hypoglycemia and cardiovascular risk.
  • Regulatory restrictions and potential phase-out in high-income markets.
  • Market competition from patent-protected and proprietary drugs.

Regulatory and Policy Considerations

  • Regional approvals remain pivotal; Japan maintains approval while US/EU markets have withdrawn.
  • Inclusion in treatment guidelines varies; some Asian guidelines still recommend tolbutamide in specific scenarios.

Key Takeaways

  • Active clinical development of tolbutamide indicates niche-focused research, primarily in formulations and combination therapies.
  • Market trajectory remains slightly positive in developing countries; however, global decline is driven by safety profiles and competition.
  • The total market size for tolbutamide is projected to remain below USD 0.5 billion over the next decade, primarily sustained by legacy use in specific regions.
  • Innovation opportunities include extended-release formulations and pharmacogenomic personalized dosing.
  • Regulatory environments significantly influence the drug's market presence, especially in Western markets, where approvals have been withdrawn.

FAQs

Q1: Why has tolbutamide declined in global markets?
A1: Safety concerns, particularly hypoglycemia risk, and the availability of newer, more effective, and safer medications like SGLT2 inhibitors and DPP-4 inhibitors have led to the decline.

Q2: Which regions still actively use tolbutamide?
A2: Japan continues to prescribe tolbutamide, integrating it into national formularies. India and some Asian countries also use it, primarily for cost-sensitive populations.

Q3: Are there ongoing clinical trials to expand tolbutamide's indications?
A3: Current trials focus on formulation improvements, pharmacogenomics, and combination therapies, rather than new indications, aiming to improve safety and efficacy profiles.

Q4: Could tolbutamide regain market share?
A4: Limited prospects exist unless novel formulations demonstrate superior safety and efficacy in well-designed trials or if regulatory changes favor older agents in specific niches.

Q5: How does tolbutamide compare to other sulfonylureas today?
A5: It has a comparable efficacy profile but higher hypoglycemia risk; newer second- and third-generation sulfonylureas typically exhibit better safety profiles and longer durations.


References

[1] ClinicalTrials.gov. (2023). Search for tolbutamide-related trials.
[2] Japan Ministry of Health, Labour and Welfare. (2023). Drug approvals and status.
[3] European Medicines Agency. (2021). Market withdrawal notices.
[4] Global Data. (2022). Glycemic control medications market analysis.
[5] MarketWatch. (2023). Oral Antidiabetic Market Forecast.

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