Buy Amaryl Online

Glimepiride (glimepiride)

OTHER BRAND NAMES

Amaryl

THERAPEUTIC CLASS

Sulfonylurea (2nd generation)

DEA CLASS

RX

INDICATIONS

Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus (DM).

ADULT DOSAGE

Type 2 Diabetes Mellitus

Initial: 1mg or 2mg qd
Titrate: After reaching 2mg/day, may further increase dose in increments of 1mg or 2mg based on glycemic response, not more frequently than every 1-2 weeks
Max: 8mg qd

DOSING CONSIDERATIONS

Concomitant Medications
Colesevelam: Administer at least 4 hrs prior to colesevelam

Renal Impairment
Initial: 1mg qd
Titrate: Adjust conservatively
Max: 8mg qd

Elderly
Initial: 1mg qd
Titrate: Adjust conservatively
Max: 8mg qd

ADMINISTRATION

Oral route

Administer w/ breakfast or the 1st main meal of the day

HOW SUPPLIED

Tab: 3mg*, 6mg*, 8mg*; (Amaryl) 1mg*, 2mg*, 4mg* *scored

WARNINGS/PRECAUTIONS

Not for treatment of type 1 DM or diabetic ketoacidosis. Patients being transferred from longer T1/2 sulfonylureas (eg, chlorpropamide) may have overlapping drug effect for 1-2 weeks; monitor for hypoglycemia. May cause severe hypoglycemia, which may impair mental/physical abilities; caution in patients predisposed to hypoglycemia. Early warning symptoms of hypoglycemia may be different/less pronounced in patients with autonomic neuropathy and in the elderly. Hypersensitivity reactions (eg, anaphylaxis, angioedema, Stevens-Johnson syndrome) reported; if suspected, promptly d/c therapy, assess for other potential causes for the reaction, and institute alternative treatment. May cause hemolytic anemia; caution with G6PD deficiency and consider the use of a non-sulfonylurea alternative. Increased risk of cardiovascular mortality. Caution in elderly.

ADVERSE REACTIONS

Dizziness, nausea, asthenia, headache, hypoglycemia, flu syndrome.

DRUG INTERACTIONS

See Dosage. Oral antidiabetic medications, pramlintide acetate, insulin, ACE inhibitors, H2-receptor antagonists, fibrates, propoxyphene, pentoxifylline, somatostatin analogues, anabolic steroids and androgens, cyclophosphamide, phenyramidol, guanethidine, fluconazole, sulfinpyrazone, tetracyclines, clarithromycin, disopyramide, quinolones, and drugs that are highly protein-bound (eg, fluoxetine, NSAIDs, salicylates, sulfonamides, chloramphenicol, coumarins, probenecid, MAOIs) may increase glucose-lowering effect; monitor for hypoglycemia during coadministration and for worsening glycemic control during withdrawal of these drugs. Danazol, glucagon, somatropin, protease inhibitors, atypical antipsychotics (eg, olanzapine, clozapine), barbiturates, diazoxide, laxatives, rifampin, thiazides and other diuretics, corticosteroids, phenothiazines, thyroid hormones, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics (eg, epinephrine, albuterol, terbutaline), and isoniazid may reduce glucose-lowering effect; monitor for worsening glycemic control during coadministration and for hypoglycemia during withdrawal of these drugs. β-blockers, clonidine, reserpine, and alcohol intake may potentiate or weaken glucose-lowering effect. Signs of hypoglycemia may be reduced or absent with sympatholytic drugs (eg, β-blockers, clonidine, guanethidine, reserpine). Potential interaction leading to severe hypoglycemia reported with oral miconazole. May interact with inhibitors (eg, fluconazole) and inducers (eg, rifampin) of CYP2C9. Colesevelam may reduce levels.

PREGNANCY AND LACTATION

Category C, not for use in nursing.

MECHANISM OF ACTION

Sulfonylurea (2nd generation); lowers blood glucose by stimulating insulin release from pancreatic β cells.

PHARMACOKINETICS

Absorption: Tmax=2-3 hrs. Distribution: (IV) Vd=8.8L; plasma protein binding (>99.5%). Metabolism: Complete by oxidation; cyclohexyl hydroxy methyl derivative (M1) (via CYP2C9) and carboxyl derivative (M2) (major metabolites). Elimination: Urine (60%, 80-90% metabolites), feces (40%, 70% metabolites).

ASSESSMENT

Assess for hypersensitivity to drug or sulfonamide derivatives, predisposition to hypoglycemia, autonomic neuropathy, G6PD deficiency, pregnancy/nursing status, and possible drug interactions.

MONITORING

Monitor for hypoglycemia, hypersensitivity reactions, hemolytic anemia, and other adverse reactions.

PATIENT COUNSELING

Inform about importance of adherence to dietary instructions, a regular exercise program, and regular testing of blood glucose. Advise about potential side effects (eg, hypoglycemia, weight gain). Inform about the symptoms and treatment of hypoglycemia, and the conditions that predispose to it. Inform that ability to concentrate and react may be impaired as a result of hypoglycemia; caution when driving/operating machinery. Advise to inform physician if pregnant/breastfeeding or contemplating pregnancy/breastfeeding.

STORAGE

20-25°C (68-77°F). (Amaryl) 25°C (77°F); excursions permitted to 20-25°C (68-77°F).

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