AMARYL FOR TYPE 2 DIABETES
AMARYL (glimepiride) is a sulfonylurea. 1, 2, 4mg
Mechanism of Action
The primary mechanism of action of glimepiride is stimulating the release of insulin from functioning pancreatic beta cells. In addition, glimepiride administration can lead to increased sensitivity of peripheral tissues to insulin.
After oral administration, glimepiride is completely (100%) absorbed from the GI tract.
Recommended Dose and Dosage Adjustment
Usual Starting Dose: 1 mg once daily, administered with breakfast or the first main meal.
Usual Maintenance Dose: 1 to 4 mg once daily. Maximum: 8 mg once daily.
AMARYL-Metformin Combination Therapy: Combination therapy with AMARYL and metformin may be used in patients who do not respond adequately to the maximal dose of AMARYL or in secondary failure patients.
· Study indicated that the combination of metformin and glimepiride was more effective than either treatment alone, with regards to improving HbA1C, fasting blood glucose and postprandial blood glucose levels.
AMARYL-Insulin Combination Therapy: Combination therapy with AMARYL and insulin may be used in secondary failure patients. The recommended AMARYL dose is 8 mg once daily administered with the first main meal. After starting with low-dose insulin, upward adjustments of insulin can be done approximately weekly as guided by frequent measurements of fasting blood glucose.
Changeover from Other Oral Hypoglycemic Agents: It is recommended that the procedure be the same as for initial dosage starting with daily doses of 1 mg.
Over a period of time, patients may become progressively less responsive to therapy with oral hypoglycemic agents because of deterioration of their diabetic state. This is detected with regular blood glucose monitoring. Options include switching to another sulfonylurea, adding a different antidiabetic, or insulin.
Hypoglycemia
All sulfonylurea drugs are capable of producing severe hypoglycemia. Signs of severe hypoglycemia can include disorientation, loss of consciousness, and seizures. Hypoglycemia is more likely to occur when caloric intake is deficient, after severe or prolonged exercise, when alcohol is ingested, or when other drugs with blood-glucose lowering potential are used.
It has been suggested, based on a study conducted by the University Group Diabetes Program (UGDP), that certain sulfonylurea antidiabetic agents increase cardiovascular mortality in diabetic patients, a population at greater risk of cardiovascular disease.
Alertness and reactions may be impaired due to hypo- or hyperglycemia, especially when beginning or after altering treatment or when AMARYL (glimepiride) is not taken regularly.
Glimepiride is metabolized by cytochrome P450 2C9 (CYP2C9). This should be taken into account when glimepiride is coadministered with inducers (e.g. rifampicin) or inhibitors (e.g. fluconazole) of CYP 2C9.
Both acute and chronic alcohol intake may potentiate or weaken the blood-glucose-lowering action of AMARYL in an unpredictable fashion.
Although ASA increases clearance and decreases blood levels of Amaryl, blood glucose concentrations remain stable.
Some drugs produce hyperglycemia and may lead to loss of glycemic control.
- Thiazides
- Corticosteroids
- Epinephrine and other sympathomimetic agents
- Glucagon
- Estrogen and progestagens
- Thyroids