Glimepiride + Metformin

Introduction: Glimepiride + Metformin is a combination medicine used to treat type 2 diabetes mellitus in adults. It helps control blood sugar levels and prevents serious complications of diabetes.

How it works: Glimepiride is a sulfonylurea which works by increasing the amount of insulin released by the pancreas to lower blood glucose. Metformin is a biguanide which works by lowering glucose production in the liver, delaying glucose absorption from intestines and increasing the body's sensitivity to insulin.

Important Information: Take with food. 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
• When monotherapy with glimepiride or metformin does not result in adequate glycemic control
• Replacement of combination therapy of glimepiride and metformin

Combination Oral hypoglycemic preparations

Sulfonylurea + Biguanide

Glimepiride is a sulfonylurea antidiabetic agent which decreases blood glucose concentration. The primary mechanism of action appears to be dependent on stimulating the release of insulin from functioning pancreatic beta cells. Metformin Hydrochloride is a biguanide type oral antihyperglycemic drug used in the management of type 2 diabetes. It lowers both basal and postprandial plasma glucose. Metformin Hydrochloride decreases hepatic glucose production, decreases intestinal absorption of glucose and improves insulin sensitivity by an increase in peripheral glucose uptake and utilization.

Glimepiride increases insulin secretion and Metformin reduces liver glucose production and improves insulin sensitivity to lower blood sugar levels.

Adult Dose:

• Each tablet contains glimepiride 1 mg or 2 mg and metformin SR 500 mg
• Initial: One tablet once daily
• Maximum glimepiride: 8 mg daily
• Maximum metformin: 2000 mg daily

Children: Data is insufficient

* Use as directed by the registered physician

Oral tablet. Take with food (with breakfast or first main meal). Swallow whole, do not chew or crush.

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and follow your regular schedule. Do not double the dose.

Common Side Effects:

• Hypoglycemia (low blood sugar)
• Taste change
• Nausea
• Diarrhea
• Stomach pain
• Headache
• Upper respiratory tract infection

Precautions:

• Hypoglycemia may occur when used with other antidiabetic medicines, alcohol or if you delay or miss a meal.
• Avoid alcohol (increases hypoglycemia risk).
• Inform doctor if you experience deep or rapid breathing, persistent nausea, vomiting, or stomach pain (signs of lactic acidosis).
• Regular kidney and liver function tests recommended.
• Not recommended in severe kidney disease.

Contraindications:

• Renal disease (creatinine ≥1.5 mg/dL males, ≥1.4 mg/dL females)
• Hepatic impairment
• Diabetic ketoacidosis (with or without coma)
• During radiologic studies with iodinated contrast materials
• Pregnancy and lactation

Drug Interactions:

• Cationic drugs (amiloride, digoxin, morphine, ranitidine) may decrease metformin elimination
• Miconazole and phenylbutazone increase hypoglycemic effect of glimepiride
• Thiazide diuretics decrease insulin sensitivity

Food Interactions:

• Unsafe to consume alcohol with Glimepiride + Metformin.

Use in Pregnancy: May be unsafe during pregnancy. Animal studies have shown harmful effects.

Use in Lactation: Probably safe during breastfeeding. Limited data suggests the drug does not represent significant risk to the baby.

Pediatric Use: Data is insufficient to recommend pediatric use.

Geriatric Use: Elderly patients are more likely to have decreased renal function - caution required.

Renal Impairment: GFR 45-59: Metformin max 2000 mg/day. GFR 30-44: max 1000 mg/day. GFR <30: Metformin contraindicated.

Hepatic Impairment: Start with low dose in mild to moderate liver disease. Not recommended in severe liver disease.

Overdose: Hypoglycemia from glimepiride. Lactic acidosis from metformin. Gastric lavage, activated charcoal and supportive care. Hemodialysis is effective.

Storage: Store below 25°C in a cool and dry place, protected from light. Keep out of reach of children.

Glimepiride + Metformin Tablet