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S-9.5 sulfonylureus-formualtions_Glimepiride

Posted byArman
Name of Medicine
Glimepiride
Presentation
  • Glimepiride is available in 1mg, 2mg, 3mg and 4m tablets.
Key Practice Points
Therapeutic Indications:
  • As an adjunct to healthy eating and physical activity in the treatment of type 2 diabetes.

For the latest PBS indications for glimepiride please see
https://www.pbs.gov.au/medicine/item/8450R-8451T-8452W-8533D

Dose:
    • Glimepiride is given as a once-a-day dose due to duration of action of 24 hours and has active metabolites. Initially the dose should be started at 1mg once daily and adjusted on an individual basis (person centred care) usually by 1mg, every one-to-two-week intervals depending on glucose response. Maximum dose of glimepiride is 4mg once a day.
    • Renal Impairment:
There is limited information available on the use of glimepiride in renal insufficiency. Individuals with impaired renal function may be more sensitive to the glucose lowering effect of glimepiride. In those with mild (CrCl > 50 mL/minute) to moderate (CrCl 30 to 50 mL/minute)renal impairment, a starting dose of 1 mg once daily must not be exceeded. The dose may then be carefully titrated upwards, if necessary, based on fasting blood glucose levels according to the protocol mentioned above (i.e., in increments of 1 mg at intervals of one to two weeks). No experience has been gained in the use of glimepiride in those using dialysis. These individuals should be changed over to insulin therapy to achieve optimum metabolic management.
  • Hepatic Impairment:
  No experience has been gained in the use of glimepiride in those with severe hepatic impairment. These individuals should be changed over to insulin therapy to achieve optimum metabolic management.
Elderly:
  • Glimepiride (duration of action 24 hours with active metabolites) may have an increased risk of prolonged hypoglycaemia in the elderly. Avoid use in this population.
Contraindications:
  • Hypersensitivity to glimepiride and other ingredients.
  • Severe impairment of renal function (CrCl < 30 mL/min).
  • Individuals on dialysis
  • Severe hepatic dysfunction.
  • Pregnancy or lactation
  • Type 1 diabetes, history of ketoacidosis.
  • Haemolytic anaemia- Treatment of individuals with glucose-6-phospate dehydrogenase (G6PD) deficiency with a sulfonylurea agent can lead to haemolytic anaemia. An alternative class of medicine should be considered.
Precautions:
    • Any blood glucose level under 4mmol/ L is known as a hypoglycaemic episode when being treated with a sulfonylurea. Counselling how to recognise and treat a hypoglycaemic episode is recommended when starting an individual on a sulfonylurea for the first time. Consideration should also be given to blood glucose monitoring for those who wish to participate.
    • Glimepiride is metabolised by cytochrome P450 2C9 (CYP2C9). This should be considered when glimepiride is administered with inducers, inhibitors, or substrates of CYP2C9. Please further investigate if prescribing with other medicines.
    • Glucose-6-phosphate Dehydrogenase Deficiency (G6PD)
Treatment of individuals with G6PD-deficiency with sulfonylurea agents can lead to haemolytic anaemia. Since glimepiride belongs to the chemical class of sulfonylurea drugs, caution should be used in those with G6PD-deficiency and a non-sulfonylurea alternate should be considered.
Adverse Effects:
  • Hypoglycaemia- this may be prolonged due to half life of glimepiride and should be carefully monitored in susceptible individuals.
  • Gastrointestinal reactions- Occasional (0.1 to 1%) -nausea, diarrhoea, abdominal pain, and vomiting.
  • Dermatologic reactions- Allergic skin reactions (e.g., pruritus, or urticaria). If the reaction continues, the medicine should be stopped. In the event of urticaria, a physician should be consulted.
Pharmacokinetic Properties-Summary
Absorption:
Glimepiride seems to almost be completely absorbed after oral administration. It does not appear to be influenced by weight, age, or sex of the individual.
Distribution:
Glimepiride is highly protein bound.
Excretion:
Glimepiride is excreted by both the liver and the kidneys.
More Information

For more detailed information on this product please consult the product information.

https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/PICMI?OpenForm&t=&q=glimepiride