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glimepiride

glimepiride

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Published by: api-3797941 on Oct 17, 2008
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glimepiride
(glyemeh' per ide)
Amaryl
Pregnancy Category C
Drug classes
Antidiabetic
Sulfonylurea (second generation)
Therapeutic actions

Stimulates insulin release from functioning beta cells in the pancreas; may improve
binding between insulin and insulin receptors or increase the number of insulin receptors;
thought to be more potent in effect than first-generation sulfonylureas

Indications
\u2022

As an adjunct to diet to lower blood glucose in patients with type 2 (non\u2013insulin-
dependent) diabetes mellitus whose hypoglycemia cannot be controlled by diet
and exercise alone.

\u2022
In combination with metformin or insulin to better control glucose as an adjunct
to diet and exercise in patients with type 2 diabetes mellitus.
Contraindications and cautions
\u2022

Contraindicated with allergy to sulfonylureas; diabetes complicated by fever,
severe infections, severe trauma, major surgery, ketosis, acidosis, coma (insulin is
indicated in these conditions); type 1 (insulin-dependent), serious hepatic or renal
impairment, uremia, thyroid or endocrine impairment, glycosuria, hyperglycemia
associated with primary renal disease; labor and delivery\u2014if glimepiride is used
during pregnancy, discontinue drug at least 1 mo before delivery; lactation, safety
not established.

\u2022
Use cautiously with pregnancy.
Available forms
Tablets\u20141, 2, 4 mg
Dosages
ADULTS

Usual starting dose is 1\u20132 mg PO once daily with breakfast or first meal of the day; usual
maintenance dose is 1\u20134 mg PO once daily, depending on patient response and glucose
levels. Do not exceed 8 mg/day.

\u2022
Combination with insulin therapy: 8 mg PO daily with first meal of the day with
low-dose insulin.
\u2022
Transfer from other hypoglycemic agents: No transition period is necessary.
PEDIATRIC PATIENTS
Safety and efficacy not established.
PATIENTS WITH RENAL IMPAIRMENT
Usual starting dose is 1 mg PO once daily; titrate dose carefully, lower maintenance
doses may be sufficient to control blood sugar.
Pharmacokinetics
Route
Onset
Peak
Oral
2\u20133 hr
2\u20133 hr

Metabolism: Hepatic; T1/2: 5.5\u20137 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Bile and urine

Adverse effects
\u2022
CNS: Drowsiness, asthenia, nervousness, tremor, insomnia
\u2022
CV: Increased risk of cardiovascular mortality(possible)
\u2022
Endocrine:Hypoglycemia,SIADH
\u2022
GI: Anorexia, nausea,vomit ing, epigastric discomfort, heartburn, diarrhea
\u2022
Hematologic: Leukopenia, thrombocytopenia, anemia
\u2022
Hypersensitivity: Allergic skin reactions, eczema, pruritus, erythema, urticaria,
photosensitivity, fever, eosinophilia, jaundice
\u2022
Other: Diuresis, tinnitus, fatigue
Interactions
Drug-drug
\u2022

Increased risk of hypoglycemia with androgens, anticoagulants, azole antifungals,
chloramphenicol, clofibrate, fenfluramine, fluconazole, gemfibrozil, H2 blockers,
magnesium salts, MAOIs, methyldopa, oxyphenbutazone, phenylbutazone,
probenecid, salicylates, sulfinpyrazone, sulfonamides, TCAs, urinary acidifiers

\u2022
Decreased effectiveness of both glimepiride and diazoxide if taken concurrently
\u2022
Increased risk of hyperglycemia with rifampin, thiazides
\u2022
Risk of hypoglycemia and hyperglycemia with ethanol; "disulfiram reaction" has
also been reported
\u2022

Possible decreased hypoglycemic effect with beta blockers, calcium channel blockers, cholestyramine, corticosteroids, diazoxide, estrogens, hydantoins, hormonal contraceptives, isoniazid, nicotinic acid, phenothiazines, rifampin, sympathomimetics, thiazide diuretics, thyroid agents, urinary alkalinizers

Drug-alternative therapy
\u2022
Increased risk of hypoglycemia if taken with juniper berries, ginseng, garlic,
fenugreek, coriander, dandelion root, celery
Nursing considerations
Assessment
\u2022
History: Allergy to sulfonylureas; diabetes complicated by fever, severe

infections, severe trauma, major surgery, ketosis, acidosis, coma (insulin is
indicated in these conditions); type 1 diabetes, serious hepatic or renal
impairment, uremia, thyroid or endocrine impairment, glycosuria, hyperglycemia
associated with primary renal disease; pregnancy

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