Geriatric patients may be more susceptible to the hypoglycemic effects of glyburide. Hypoglycemia can also be more difficult to detect in the older adult, and these patients are also more likely to have renal dysfunction that may impair drug elimination. Therefore, geriatric patients should receive conservative initial and maintenance doses of glyburide to avoid hypoglycemic reactions. Due to the long duration of glyburide and associated increased risk of hypoglycemic episodes reported in geriatric adults, other sulfonylurea agents such as tolbutamide, glipizide, or glimepiride may be preferred. According to the Beers Criteria, glyburide is considered a potentially inappropriate medication (PIM) for use in geriatric patients and should be avoided due to a greater risk of severe and prolonged hypoglycemia in older adults than in younger adult patients. The federal Omnibus Budget Reconciliation Act (OBRA) regulates medication use in residents of long-term care facilities (LTCFs). According to OBRA, the use of antidiabetic medications should include monitoring (., periodic blood glucose) for effectiveness based on desired goals for that individual and to identify complications of treatment such as hypoglycemia or impaired renal function. Glyburide is not considered a hypoglycemic agent of choice in older adults because of the long half-life and/or duration of action and the increased risk of prolonged and serious hypoglycemia, with symptoms including tachycardia, palpitations, irritability, headache, hypothermia, visual disturbances, lethargy, confusion, seizures, and/or coma. Sulfonylureas such as glyburide can cause SIADH and result in hyponatremia.