glimepiride

(glye meh' 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

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As an adjunct to diet to lower blood glucose in patients with type 2 (non–insulindependent) diabetes mellitus whose hypoglycemia cannot be controlled by diet and exercise alone. In combination with metformin or insulin to better control glucose as an adjunct to diet and exercise in patients with type 2 diabetes mellitus. 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—if glimepiride is used during pregnancy, discontinue drug at least 1 mo before delivery; lactation, safety not established. Use cautiously with pregnancy.

Contraindications and cautions

Available forms

Tablets—1, 2, 4 mg
Dosages ADULTS

Usual starting dose is 1–2 mg PO once daily with breakfast or first meal of the day; usual maintenance dose is 1–4 mg PO once daily, depending on patient response and glucose levels. Do not exceed 8 mg/day. • Combination with insulin therapy: 8 mg PO daily with first meal of the day with low-dose insulin. • 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 Oral Onset 2–3 hr Peak 2–3 hr

Metabolism: Hepatic; T1/2: 5.5–7 hr Distribution: Crosses placenta; enters breast milk Excretion: Bile and urine
Adverse effects

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

Interactions

Drug-drug • 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 • Decreased effectiveness of both glimepiride and diazoxide if taken concurrently • Increased risk of hyperglycemia with rifampin, thiazides • Risk of hypoglycemia and hyperglycemia with ethanol; "disulfiram reaction" has also been reported • 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 • Increased risk of hypoglycemia if taken with juniper berries, ginseng, garlic, fenugreek, coriander, dandelion root, celery
Nursing considerations Assessment

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

Physical: Skin color, lesions; T; orientation, reflexes, peripheral sensation; R, adventitious sounds; liver evaluation, bowel sounds; urinalysis, BUN, serum creatinine, liver function tests, blood glucose, CBC Monitor urine or serum glucose levels frequently to determine effectiveness of drug and dosage being used. Transfer to insulin therapy during periods of high stress (eg infections, surgery, trauma). Use IV glucose if severe hypoglycemia occurs as a result of overdose. Arrange for consultation with dietitian to establish weight-loss program and dietary control. Arrange for thorough diabetic teaching program, including disease, dietary control, exercise, signs and symptoms of hypoglycemia and hyperglycemia, avoidance of infection, hygiene. Take this drug once a day with breakfast or the first main meal of the day. Do not discontinue this drug without consulting your health care provider; continue with diet and exercise program for diabetes control. Monitor urine or blood for glucose and ketones as prescribed. Do not use this drug if you are pregnant. Avoid alcohol while using this drug. Report fever, sore throat, unusual bleeding or bruising, rash, dark urine, lightcolored stools, hypoglycemic or hyperglycemic reactions.

Interventions

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Teaching points

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Adverse effects in Italic are most common; those in Bold are life-threatening.

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