glimepiride
glimepiride (glimep´
rīd),drug class: oral antidiabetic;
action: a sulfonylurea type action;
use: non insulin-dependent diabetes, sometimes in combination with insulin support.
glimepiride Warning - High-alert drug!
Amaryl
Pharmacologic class: Sulfonylurea
Therapeutic class: Hypoglycemic
Pregnancy risk category C
Action
Lowers blood glucose level by stimulating insulin release from pancreas, increasing insulin sensitivity at receptor sites, and decreasing hepatic glucose production. Also increases peripheral tissue sensitivity to insulin and causes mild diuresis.
Availability
Tablets: 1 mg, 2 mg, 4 mg
⊘Indications and dosages
➣ Adjunct to diet and exercise to lower blood glucose level in type 2 (non-insulin-dependent) diabetes mellitus
Adults: Initially, 1 to 2 mg P.O. daily given with first main meal; usual maintenance dosage is 1 to 4 mg P.O. daily. When patient reaches 2 mg/day, increase no more than 2 mg q 1 to 2 weeks, depending on glycemic control. Maximum dosage is 8 mg/day.
➣ Adjunct to insulin therapy in type 2 diabetes mellitus when diet, exercise, or glimepiride alone prove ineffective
Adults: 8 mg P.O. daily with low-dose insulin, given with first main meal. Based on glycemic control, raise insulin dosage weekly as prescribed.
➣ Adjunct to metformin therapy in type 2 diabetes mellitus when diet, exercise, and glimepiride or metformin alone prove ineffective
Adults: 1 to 4 mg/day P.O. with first main meal, increased gradually to a maximum of 8 mg/day P.O. Give with metformin if response to glimepiride monotherapy isn't adequate; adjust dosage based on glycemic response to determine minimum effective dosage.
Dosage adjustment
• Renal or hepatic impairment
• Adrenal or pituitary insufficiency
Contraindications
• Hypersensitivity to drug
• Diabetic coma or ketoacidosis
• Severe renal, hepatic, or endocrine disease
• Pregnancy or breastfeeding
Precautions
Use cautiously in:
• mild to moderate hepatic or renal disease; cardiovascular disease; impaired thyroid, pituitary, or adrenal function
• elderly patients.
Administration
• Check baseline creatinine level for normal renal function before giving first dose.
• Give with first meal of day.
| Route | Onset | Peak | Duration |
| P.O. | 1 hr | 2-3 hr | >24 hr |
Adverse reactions
CNS: dizziness, drowsiness, headache, weakness
CV: increased CV mortality risk
EENT: blurred vision
GI: nausea, vomiting, diarrhea, constipation, cramps, heartburn, epigastric distress, anorexia
Hematologic: aplastic anemia, leukopenia, pancytopenia, thrombocytopenia, agranulocytosis
Hepatic: cholestatic jaundice, hepatitis
Metabolic: hyponatremia, hypoglycemia
Skin: rash, erythema, maculopapular eruptions, urticaria, eczema, angioedema, photosensitivity
Other: increased appetite
Interactions
Drug-drug. Androgens (such as testosterone), chloramphenicol, clofibrate, guanethidine, MAO inhibitors, nonsteroidal anti-inflammatory drugs (except diclofenac), salicylates, sulfonamides, tricyclic antidepressants: increased risk of hypoglycemia
Beta-adrenergic blockers: altered response to glimepiride, necessitating dosage change; prolonged hypoglycemia (with nonselective agents)
Calcium channel blockers, corticosteroids, estrogens, hydantoins, hormonal contraceptives, isoniazid, nicotinic acid, phenothiazines, phenytoin, rifampin, sympathomimetics, thiazide diuretics, thyroid preparations: decreased hypoglycemic effect of glimepiride
Warfarin: initially increased, then decreased, effects of both drugs
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, cholesterol, liver function tests: increased values
Glucose, granulocytes, hemoglobin, platelets, white blood cells: decreased values
Drug-herbs. Agoral marshmallow, aloe (oral), bitter melon, burdock, chromium, coenzyme Q10, dandelion, eucalyptus, fenugreek: additive hypoglycemic effects
Glucosamine: impaired glycemic control
Drug-behaviors. Alcohol use: disulfiram-like reaction
Sun exposure: increased risk of photosensitivity
Patient monitoring
• Monitor CBC with white cell differential, electrolyte levels, and blood chemistry results.
• Monitor blood glucose level regularly. Assess glycosylated hemoglobin level every 3 to 6 months.
• Evaluate kidney and liver function test results frequently, especially in patients with impairments.
• Assess neurologic status. Report cognitive or sensory impairment.
Patient teaching
• Instruct patient to self-monitor his blood glucose level as prescribed.
• Teach patient how to recognize signs and symptoms of hypoglycemia and hyperglycemia.
• Stress importance of diet and exercise to help control diabetes.
• Instruct patient to wear or carry medical identification describing his condition.
• Advise patient to keep sugar source readily available at all times in case of hypoglycemia.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Tell patient he'll undergo regular blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.
glimepiride
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