Dieta 1

Generic

Glimepiride

 

Indications

Glimepiride is indicated in the following conditions: 

• Glimepiride is indicated as an addition to diet and exercise in individuals with noninsulin dependent (Type II) diabetes mellitus (NIDDM) whose hyperglycemia cannot be managed by diet and exercise alone.
• Glimepiride and metformin can be taken together if diet, exercise, and Glimepiride or metformin alone do not result in sufficient glycemic control.
• Glimepiride is also approved for use in combination with insulin to reduce blood glucose levels in individuals whose hyperglycemia cannot be managed with diet and exercise in addition to an oral hypoglycemic medication.
• The use of Glimepiride and insulin together may raise the risk of hypoglycemia.

 

Pharmacology

Glimepiride is a sulfonylurea anti-diabetic medication that lowers blood glucose levels. Glimepiride's principal mode of action appears to be based on increasing the release of insulin from active pancreatic beta cells. Glimepiride works in tandem with glucose to increase beta cell sensitivity to physiological glucose stimulation, resulting in insulin production. Glimepiride's action may also be influenced by extrapancreatic effects such as reduced baseline hepatic glucose production, enhanced peripheral tissue sensitivity to insulin, and glucose absorption. A single dosage of Glimepiride has a 24-hour hypoglycemic effect in non-fasting diabetic individuals.

 

Dosage & Administration

The dose of Glimepiride is determined by the target blood sugar level. Glimepiride dosage should be as low as possible while still achieving the necessary metabolic regulation. The initial and maintenance dosages are determined based on the results of frequent glucose tests in blood and urine. Glucose levels in blood and urine can also be used to indicate either main or secondary treatment failure.

Beginning dosage and dose titration: The normal initial dose is 1 mg once day, which can be raised if necessary. Any increase should be moderate, i.e., at intervals of 1 to 2 weeks, and carried out progressively, as follows: 1 mg -> 2 mg -> 3 mg -> 4 mg -> 6 mg.

Dose in individuals with well-controlled diabetes: In people with well-controlled diabetes, the typical dose range is 1 to 4 mg daily.

Dose distribution: The physician determines the timing and distribution of dosages based on the patient's existing lifestyle. A one daily dosage is usually adequate. This should be taken right before a large breakfast, or if none is consumed right before the first main meal. It is critical not to skip meals after taking the medication.

Secondary dose adjustment: As diabetes management improves, insulin sensitivity rises; hence, Glimepiride need may decrease as therapy progresses. To prevent hypoglycemia, Glimepiride treatment should be reduced or discontinued as soon as possible. A dose modification must also be considered anytime the patient's weight or life stage changes, or when other variables emerge that enhance the patient's sensitivity to hypo or hyperglycemia.

Transition from other oral diabetes medications to Glimepiride: There is no specific dose link between Glimepiride and other oral blood sugar lowering medications. When Glimepiride is substituted for other similar medicines, the initial daily dose is 1 mg; this applies even when switching from the highest dose of other oral blood sugar reducing medications. Any dose increase should be done in accordance with the guidelines outlined in the 'initial dose and dose titration' section above. The prior blood sugar lowering agent's strength and duration of effect must be taken into account. It may be essential to discontinue therapy in order to avoid cumulative effects that raise the risk of hypoglycemia.

 

Interaction

The following interactions must be evaluated based on Glimepiride experience and known interactions with other sulfonylureas.

In addition to insulin and other oral antidiabetic agents, drugs which may potentiate the hypoglycaemic action of Glimepiride include: ACE inhibitors, aminosalicylic acid, anabolic steroids and male sex hormones, azapropazone, chloramphenicol, ciofibrate, coumarin derivatives, cyclophosphamide, disopyramide, fenfluramine, fenyramidol, fibrates, fluconazole, fluoxetine, guanethidine, ifosfamide, MAO-inhibitors, miconazole, oxpentifylline (high dose parenteral), oxyphenbutazone, para-aminosalicylic acid, phenylbutazone, probenecid, quinolones, salicylates, sulphinpyrazone, sulfonamide antibiotics, tetracyclines, tritoqualine, trofosfamide.

Glimepiride's hypoglycemic effect may be mitigated by the following medications:

• Acetazoiamide, barbiturates, calcium channel blockers, corticosteroids, diazoxide, diuretics, glucagon, isoniazid, laxatives, nicotinic acid (high doses), oestrogens, phenothiazines, phenytoin, progestagens, rifampicin, sympathomimetic agents, thyroid hormones.
• H2 receptor antagonists, beta-blockers, clonidine and reserpine may lead to either potentiation or weakening of the blood-glucose-lowering effect.
• Concomitant treatment with a beta-receptor blocker, clonidine, guanethidine or reserpine may mask the warning symptoms of a hypoglycaemic attack.
• Acute and chronic aicohol intake may either potentiate or attenuate the activity of Glimepiride in an unpredictable fashion.

 

Contraindications

Glimepiride is not recommended for the treatment of insulin-dependent (type I) diabetes mellitus, diabetic ketoacidosis, or diabetic coma. Glimepiride should not be taken in individuals who are hypersensitive to it, other sulfonylureas, other sulfonamides, significant hepatic dysfunction, severe renal function impairment, or dialysis patients.

 

Side Effects

Hypoglycemia, transient vision impairment, nausea, vomiting, diarrhoea, stomach discomfort, urticaria, and a drop in blood pressure are all symptoms of hypoglycemia.

 

Pregnancy & Lactation

Glimepiride should not be used during pregnancy; instead, insulin should be used. Patients who are contemplating a pregnancy must notify their doctor and switch to insulin. Glimepiride ingestion combined with breast milk feeding may be harmful to the infant. As a result, nursing mothers should avoid using Glimepiride. A transition or full stop of breastfeeding is required.

 

Precautions & Warnings

The risk of hypoglycemia may be raised in the first few weeks of therapy, necessitating cautious monitoring. If such a danger exists, the dosage of Glimepiride may need to be adjusted. Hypoglycemia can be nearly immediately corrected by rapid carbohydrate consumption (glucose or sugar).

 

Therapeutic Class

Sulfonylureas

 

Storage Conditions

Store at temperatures no higher than 30°C. Keep away from light and out of children's reach.

 

Pharmaceutical Name

Pacific Pharmaceuticals Ltd.