Glimepiride

Indications & Dose:

 Diabetes mellitus, type 2 

DOSE

Adults: Initially 1mg daily adjusted at breakfast according to response. Titration in dose is carried out step wise as follows: 1mg-2mg-3mg-4mg-6mg at the intervals of 1-2 weeks. Normally a single daily dose is sufficient and it should be taken immediately before a substantial breakfast or before the first main meal. 

Children: Not recommended.

Note. If changing from other oral hypoglycaemic drugs, the strength and half-life of the previous drug must be taken into account and, if necessary, a washout period of a few days between drugs should be considered to minimise the risk of hypoglycaemia

Contraindications:

Diabetes mellitus, type 1; ketoacidosis . 

Side Effects:

Cautions:

Precautions:

Elderly, cardiac disease, severe renal disease, severe Hepatic disease; thyroid disease, adrenal or pituitary insufficiency, debilitated or malnourished patients

Interaction:

Drugs

Anabolic steroids: Enhanced hypoglycemic response

Angiotensin converting enzyme inhibitors: Increased risk of hypolycemia

Antacids: Enhanced rate of absorption

Aspirin: Enhanced hypoglycemic effect

ß-Adrenergic blockers: Alteredresponse to hypoglycemia; prolonged recovery of normoglycemia, hypertension, blockade of tachycardia; may increase blood glucose concentration

Clofibrate: Enhanced effects of oral hypoglycemic drugs

Corticosteroids: Increased blood glucose in diabetic patients

Cyclosporine: Increased cyclosporine levels

Ethanol: Excessive intake may lead to altered glycemic control; “Antabuse” -like reaction may occur

Gemfibrozil: Increased risk of hypoglycemia

H2-receptor antagonists: Enhanced rate of absorption

MAOIs: Excessive hypoglycemia may occur in patients with diabetes

Phenylbutazole: Increases serum concentrations of oral hypoglycemic drugs

Proton pump blockers: Enhanced rate of absorption

Rifampin: Reduced sulfonylurea concentrations

Sulfonamides: Enhanced hypoglycemic effects of sulfonylureas

Thiazide diuretics: Potential increased dosage requirement of antidiabetic drugs 

Warnings:

Adverse Effects:

Lactations:

Inappropriate for use during pregnancy due to inadequacy for blood glucose control, potential for prolonged neonatal hypoglycemia, and risk of congenital abnormalities; insulin is the drug of choice for control of blood sugars during pregnancy breast milksecretion, unknown; the potential for neonatal hypoglycemia dictates caution in nursing mothers 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Dizziness, drowsiness, headache, paresthesia
EENT: Blurred vision, tinnitus, vertigo 
GI: Cholestatic jaundice, constipation, diarrhea, elevated liver function tests, gastralgia, nausea
HEME : Agranulocytosis, aplastic anemia, hemolytic anemia, hepatic Porphyria,leukopenia pancytopenia, thrombocytopenia
METAB: Hypoglycemia, hyponatremia, SIADH
MS: Fatigue, weakness
SKIN: Eczema, erythema, morbilli form or maculopapular eruptions, pruritus, urticaria

Patient And Carer Advice: