Oral blood sugar lowering drug.
The drug is used to treat a type of diabetes mellitus (high blood sugar) called type 2 diabetes. In this type of diabetes, inadequate amounts of insulin is produced by the pancreas which is unable to act with enough potency on the cells of the liver, muscles and other tissues to make them take in the sugar and other food ingredients into the cells for its activities.
They act on specific potassium dependent enzyme channels on the Islets of Langerhans (Beta Cells) in the pancreas, and make them release their stores of insulin into the blood stream, thereby helping to increase the potency of insulin action on the cells to enhance penetration of glucose into the cells, increasing storage or burning of glucose, and preventing formation of new glucose from stored products (glycogen) or other food substances like proteins and fats. Glimepiride acts on only one of the enzyme systems in contrast to three of them as with the usual sulphonylureas (gliclazide etc.). This leads to minor differences in actions making it act where the other drugs may not work, as well as making it a shorter acting drug after a meal. This significantly reduces risk of low blood sugar episodes as compared to glibenclamide type of drugs.
This drug do not help patients who are incapable of producing any insulin (beta cell failure). In such cases, the blood glucose is best controlled by insulin injections, supplemented by an insulin re sensitizer (e.g. Metformin, Pioglitazone, Rosiglitazone) where needed.
Tablets of 0.5 mg, 1 mg, 2 mg and 4 mg.
The dose of glimepiride will be different for different patients. Follow your doctor’s orders. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.
- For oral dosage form (tablets):
- For treating type 2 diabetes:
- The usual starting dose of glimepiride as initial therapy is 1-2 mg once daily, taken with breakfast or the first main meal. The usual maintenance dose is 1 to 4 mg once daily. The maximum recommended dose is 8 mg once daily. After reaching a dose of 2 mg, dosage increases should be made in increments of no more than 2 mg at 1-2 week intervals based upon your blood glucose response. Long-term efficacy should be monitored by measurement of HbA1c levels, for example, every 3 to 6 months.
- Children–This type of diabetes treated with this medicine is rare in children. However, if a child needs this medicine, the dose would have to be determined by the doctor.
Before Using This Medicine
Your doctor needs to know some information about you before you are prescribed this drug. Tell him about the following:
- Allergies–Any unusual or allergic reaction to such drugs? Also tell your doctor if you are allergic to any other substances, such as foods, preservatives, or dyes.
- Pregnancy–No oral antidiabetic drug is recommended during pregnancy. If you are pregnant or contemplating pregnancy, you need to be on insulin for the duration of pregnancy, in the best interests of your baby.
- Breast-feeding–These drugs pass into breast milk. So far it has not been shown to cause problems in nursing babies.
- Children–Due to ethical reasons, studies on this medicine have been done only in adult patients, and there is no scientific information comparing use of such drugs in children with use in other age groups.
- Adolescents–Due to ethical reasons, studies on this medicine have been done only in adult patients, and there is no specific information comparing use of such drugs in teenagers with use in other age groups.
- Older adults–Older patients may have moderate to severe liver or kidney disease or other contraindications to the use of such drugs. Hence, it is generally to be used with caution in late age groups.
Other medicines— Such drugs interacts with many drugs and chemicals, whose simultaneous use must be done with caution if at all:
- Alcohol–May cause moderate to severe flushing
Some drugs interfere with the excretion of sulfonylureas or their own excretion rate is altered, leading to inappropriate drug action. They include the following:
- Anticoagulants (blood thinners)
- Aspirin type of drugs
- Oral antifungal antibiotics
- Systemic antibiotics like Chloramphenicol, Fluoroquinolones,
- Urine output enhancing drugs like Thiazide diuretics,
- Anti acidity drugs like Cimetidine, Ranitidine
- Heart drugs like Quinidine, Beta-adrenergic blocking agents (also directly raise blood sugar and prevent symptoms of low blood sugar from being recognized), Guanethidine
- Antimalarial drugs like Quinine
- Asthma medicines, Cough/ cold medicines/Hay fever or allergy medicines
- Anticancer medicines like Asparaginase
- Hormone preparations like Corticosteroids
- Miscellaneous drugs like Lithium, Cyclosporine, Monoamine oxidase (MAO) inhibitors, Octreotide, Pentamidine
Other medical problems–The following medical problems make changes within the body environment, which may increase risk of side effects. They include:
- Acidosis, Fever, Infection
- Severe burns, Surgery or injury leading to massive tissue destruction
- Diabetic coma or diabetic ketoacidosis
- Diarrhea, Vomiting or Slow stomach emptying
- Hormonal changes as seen in Puberty, pregnancy, or menstruation, Overactive adrenal gland
- Mental stress
Precautions While Using This Medicine
- Counseling–Teach your family members to recognize side effects like low blood sugar, and what to do about it.
- Seek a gynecologists opinion if planning for child. Women may need to be switched over to insulin during pregnancy and lactation.
- Travel–Carry a copy of your recent prescription, brief disease history, and a small packet of glucose to use in case of sudden low blood sugar. Take you meal at usual meal times as far as possible.
- Wear a locket or identification batch or keep a identification card in your wallet storing your disease details and drug history, including emergency medicines that should be given you in case you are unconscious or unable to communicate your needs.
- Keep a small pouch / bottle of glucose handy to treat low blood sugar. Ordinary sugar is sucrose, which needs to be broken down to glucose and fructose, then absorbed and then work …… a needless waste of time. Glimepiride is a very long acting drug and symptoms of low blood sugar may relapse (occur again) after an initial response to some sugar.
As told earlier, tell any doctor you go to, about your intake of glimepiride, including a radiologist or pathologist. Many drugs for other conditions, and investigation procedures demand modification of blood sugar therapy.
Symptoms of low blood sugar
- Anxious feeling, behaving as if drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty in concentrating, drowsiness, excessive hunger, fast heartbeat, headache, nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, and unusual tiredness or weakness.
Causes of developing low blood sugar
- Missing or markedly delaying a meal.
- Excessive exercising
- Too much alcohol.
- Drug interaction (see above)
- Illnesses like vomiting or diarrhea
Emergency measures for low blood sugar
- Learn to recognize a low blood sugar attack
- Eat a fistful of glucose if available. Otherwise eat two or three table spoons of sugar or a glass of fruit juice or a table spoon of honey.
Side Effects of This Medicine
||Convulsions (seizures); unconsciousness, Peeling of skin; skin redness, itching, or rash
|Chest pain; chills; coughing up blood; dark urine; fever; fluid-filled skin blisters; general feeling of illness; increased amounts of sputum (phlegm); increased sweating; light-colored stools; pale skin; sensitivity to the sun; shortness of breath; sore throat; thinning of the skin; unusual bleeding or bruising; unusual tiredness or weakness; yellow eyes or skin
||Low blood sugar, including anxious feeling, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty in concentrating, drowsiness, excessive hunger, fast heartbeat, headache, nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, unusual tiredness or weakness; unusual weight gain