Glimepiride

A to Z Drug Facts

 Action Decreases blood glucose by stimulating insulin release from pancreas. May also decrease hepatic glucose production as well as increase sensitivity to insulin.

 Indications Adjunct to diet and exercise in type II diabetics whose hyperglycemia cannot be controlled by diet and exercise alone; in combination with insulin for type II diabetics with secondary failure to oral sulfonylureas.

 Contraindications Hypersensitivity to sulfonylureas; diabetic ketoacidosis with or without coma.

 Route/Dosage

ADULTS: PO 1 to 2 mg qd with breakfast or the first main meal of the day. Increase by 1 to 2 mg/dose. Titrate at 1 to 2 week intervals based on blood glucose response. Maintenance: 1 and 4 mg daily (maximum 8 mg/day). Combination therapy with insulin is appropriate for secondary failure to oral sulfonylureas. The same dosing recommendations apply.

 Interactions

Alcohol: Produces disulfiram-like reaction (facial flushing, headache, breathlessness). Chloramphenicol, clofibrate, fenfluramine, histamine H2 antagonists, miconazole, monoamine oxidase inhibitors, probenecid, salicylates, sulfinpyrazone, sulfonamides, tricyclic antidepressants, urinary acidifiers: May increase hypoglycemic effect. Betablockers, cholestyramine, diazoxide, rifampin, thiazide diuretics, urinary alkalinizers: May decrease hypoglycemic effect.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Although issue is controversial, oral sulfonylureas may have increased risk of cardiovascular morbidity when compared with patients treated with diet alone. CNS: Dizziness. DERM: Allergic skin reactions (pruritus, erythema, urticaria, morbilliform or maculopapular rash); porphyria cutanea tarda; photosensitivity. EENT: Blurred vision. GI: Nausea; vomiting; gastrointestinal pain; diarrhea. HEMA: Leukopenia; agranulocytosis; thrombocytopenia; hemolytic anemia; aplastic anemia; pancytopenia. HEPA: Cholestatic jaundice; elevated liver function tests. META: Hypoglycemia. OTHER: Headache; asthenia; hyponatremia with or without syndrome of inappropriate antidiuretic hormone (SIADH).

 Precautions

Pregnancy: Category C. Insulin is recommended to maintain blood glucose levels during pregnancy. Prolonged severe neonatal hypoglycemia can occur if sulfonylureas are administered at time of delivery. Lactation: Undetermined. Children: Safety and efficacy not established. Elderly and debilitated patients: Increased risk for development of hypoglycemia. Hypoglycemia may be difficult to detect in elderly patients. Hepatic and renal impairment: Use with caution; lower doses may be adequate.

 Administration/Storage

• Give the dose with breakfast or the first meal of the day.
• Store at room temperature.

 Assessment/Interventions

• Obtain patient history.
• Assess patient for evidence of hypoglycemic reaction; hypoglycemia may be difficult to detect in the elderly.
• Note hepatic or renal impairment.

 Patient/Family Education

• Instruct patient in signs, symptoms, and treatment of hypoglycemic reaction.
• Review dietary and exercise guidelines for diabetes with patient.
• Instruct patient to take drug with breakfast.
• Teach patient to self-monitor urine or blood glucose.
• Instruct patient to inform all health careproviders involved in his/her care that he/she is taking this drug and to carry medical identification (eg, Medi-Alert bracelet).
• Instruct patient to notify health careprovider if symptoms of hypoglycemia occur (fatigue, excessive hunger, profuse sweating, numbness of extremities) or if blood glucose is below 60 mg/dl.
• Tell patient to notify health careprovider if symptoms of hyperglycemia occur (excessive thirst or urination, urinary glucose or ketones).
• Instruct patient to report these symptoms to health careprovider: Nausea, vomiting, diarrhea, heartburn, sore throat, rash, unusual bleeding or bruising, or other physical complaints.
• Advise patient not to take any medication, including otc, or alcohol without consulting health careprovider.
• Advise patient to avoid exposure to sunlight or sunlamps and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts