Glimepiride

Introduction: Glimepiride is a medicine used to treat type 2 diabetes mellitus in adults. It belongs to a group of medicines called sulfonylureas and helps control blood sugar levels in people with diabetes.

How it works: Glimepiride stimulates the insulin release from pancreatic beta-cells and reduces glucose output from the liver. It also increases insulin sensitivity at peripheral target sites.

Important Information: Take just before or with the first meal of the day. Take it regularly at the same time each day. Do not stop without consulting your doctor. Regular blood sugar monitoring is recommended.

• Type 2 diabetes mellitus - as an adjunct to diet and exercise
• May be used concomitantly with metformin
• May be used in combination with insulin

Sulfonylureas

Sulfonylurea antidiabetic

Glimepiride is a sulfonylurea antidiabetic agent which decreases blood glucose concentration. The primary mechanism of action of Glimepiride appears to be dependent on stimulating the release of insulin from functioning pancreatic beta cells. Glimepiride acts in concert with glucose by improving the sensitivity of beta cells to physiological glucose stimulus, resulting in insulin secretion. In addition, extrapancreatic effects like reduction of basal hepatic glucose production, increased peripheral tissue sensitivity to insulin and glucose uptake may also play role in the activity of Glimepiride. In non-fasting diabetic patients, the hypoglycaemic action of a single dose of Glimepiride persists for 24 hours.

Glimepiride increases insulin secretion from the pancreas and reduces liver glucose production to lower blood sugar levels.

Adult Dose:

• Initial: 1-2 mg daily
• May be increased in increments of 1-2 mg at intervals of 1-2 weeks
• Maintenance: 4 mg daily
• Maximum: 6 mg daily

Elderly: Initial 1 mg once daily

Children: Safety and efficacy not established

Renal Impairment: 1 mg once daily, titrate based on fasting blood glucose

Severe Hepatic/Renal: Contraindicated

* Use as directed by the registered physician

Oral tablet. Take with food or just before food (with breakfast or first main meal). Swallow whole, do not chew or crush. Swallow with sufficient amount of liquid.

If a meal is skipped, skip the dose, and add a dose if you eat an extra meal.

Common Side Effects:

• Hypoglycemia (low blood sugar)
• Headache
• Nausea
• Dizziness
• Temporary visual impairment

Other Side Effects:

• Vomiting, diarrhea, abdominal pain
• Urticaria, fall in blood pressure
• Thrombocytopenia, leukopenia (rare)

Precautions:

• Risk of hypoglycemia may be increased in the first weeks of treatment - careful monitoring required.
• Irregular meals, skipping meals or fasting may cause hypoglycemia.
• Avoid alcohol (increases hypoglycemia risk).
• Regular blood sugar and liver function monitoring required.
• Caution in severe kidney or liver disease.

Contraindications:

• Type 1 diabetes mellitus
• Diabetic ketoacidosis (with or without coma)
• Severe hepatic dysfunction
• Severe renal impairment and dialysis patients
• Hypersensitivity to Glimepiride or sulfonylureas

Drug Interactions:

• May increase hypoglycemic effect with ACE inhibitors, anabolic steroids, chloramphenicol, coumarin derivatives, disopyramide, fluconazole, MAOIs, miconazole, quinolones, salicylates, sulfonamide antibiotics
• May decrease hypoglycemic effect with barbiturates, corticosteroids, diuretics, phenothiazines, phenytoin, rifampicin, thyroid hormones
• Beta-blockers may mask warning symptoms of hypoglycemia

Food Interactions:

• Unsafe to consume alcohol with Glimepiride.

Use in Pregnancy: Must not be taken during pregnancy; changeover to insulin is necessary. Patients planning pregnancy must inform their physician and change to insulin.

Use in Lactation: Must not be taken during breastfeeding (may harm the child). Either changeover to insulin or complete discontinuation of breastfeeding is necessary.

Pediatric Use: Safety and efficacy in children have not been established.

Geriatric Use: Initial dose 1 mg once daily. May be more sensitive to hypoglycemia.

Renal Impairment: 1 mg once daily, titrate based on fasting blood glucose. Not recommended in severe kidney disease.

Hepatic Impairment: Not recommended in severe liver disease.

Overdose: Hypoglycemia may occur. Mild hypoglycemia: oral glucose and dose adjustment. Severe hypoglycemia: IV glucose (50%), then 10% glucose infusion. Monitor for at least 24-48 hours.

Storage: Do not store above 30°C. Keep away from light and out of reach of children.

Glimepiride Tablet