Glimepiride + Metformin
Indications
Glimepiride + Metformin is used for:
Type 2 diabetes mellitus
Adult Dose
Oral
Type 2 diabetes mellitus
Adult: Each tablet contains glimepiride 1 mg or 2 mg and metformin sustained release 500 mg
The initial recommended dose is one tablet once daily
Maximum Recommended Dose
The maximum recommended dose for glimepiride is 8 mg daily. The maximum recommended daily dose for metformin sustained-release is 2000 mg in adults.
Dosage should be individualized on the basis of both effectiveness and tolerance.
Child Dose
Renal Dose
Administration
Should be taken with breakfast or first main meal of the day.
Contra Indications
Renal disease or renal dysfunction, as suggested by serum creatinine levels ≥1.5 mg/dL [males],
≥1.4 mg/dL [females] or abnormal creatinine clearance, which may also result from conditions such as cardiovascular collapse (shock), acute myocardial infarction, and septicaemia.
Hepatic impairment.
Known hypersensitivity to this product or any of its components.
Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma. Diabetic ketoacidosis should be treated with insulin.
Patients undergoing radiologic studies involving intravascular administration of iodinated contrast materials, because the use of such products may result in acute alteration of renal function
Pregnancy, lactation.
Precautions
Renal and hepatic impairment. Avoid alcohol consumption. Hypoglycaemic episodes.
Pregnancy-Lactation
Interactions
Cationic drugs: Certain medications used concomitantly with metformin may increase the risk of lactic acidosis. Cationic drugs that are eliminated by renal tubular secretions (e.g: amiloride, digoxin, morphine, procainamide, quinidine, ranitidine, or vancomycin) may decrease metformin elimination by competing for common renal tubular transport systems. Hence, careful patient monitoring and dose adjustment of metformin/cationic drug is recommended.
Miconazole (systemic route, oromucosal gel) and Phenylbutazone (systemic route):
Increases hypoglycemic effect of glimepiride.
Thiazide:
Interactions between thiazide diuretics and oral antidiabetic agents decreases insulin sensitivity thereby leading to glucose intolerance and hyperglycemia. Hence diabetic patients should be monitored closely.
Other:
Concomitant administration of angiotensin enzyme inhibitors (captopril, enalapril), other antidiabetic drugs (insulin, acarbose) beta-blockers, fluconozole, monoamine oxidase inhibitors (MAOIs), sulphonamides and NSAIDs, increasessensitivity to insulin and potentiates blood glucose lowering effect and may in some 6 instances, cause hypoglycemia. Patients receiving estrogens or oral contraceptives, phenytoin, quinolones should be closely monitored for loss of diabetic control.
Potentially Fatal: NSAIDS, salicylates, sulfonamides, chloramphenicol, coumarins, probenecid, MAOs, and beta blockers potentiate the hypoglycemic action of glimepiride.
Adverse Effects
Side effects of Glimepiride + Metformin :
Diarrhoea, vomiting, metallic taste, rash, isolated transaminase elevations, cholestatic jaundice, allergic skin reactions, photosensitivity reactions, leukopaenia, agranulocytosis, thrombocytopaenia, haemolytic anaemia, aplastic anaemia, pancytopaenia, blurred vision.
Potentially Fatal: Lactic acidosis.
Mechanism of Action
Glimepiride stimulates the insulin release from functioning pancreatic β-cells and inhibits gluconeogenesis at hepatic cells. It also increases insulin sensitivity at peripheral target sites.
Metformin decreases hepatic gluconeogenesis, decreases intestinal absorption of glucose and improves insulin sensitivity (increases peripheral glucose uptake and utilisation).