Glimepiride

When ATH:
A10BB12

Characteristic.

White or yellowish-white crystalline powder almost odorless, practically insoluble in water.

Pharmacological action.
Hypoglycemic.

Application.

Diabetes mellitus type 2.

Contraindications.

Hypersensitivity, diabetes mellitus type 1, diabetic ketoacidosis, diabeticheskaya coma and coma, lack of liver and kidney function, kaxeksija, pregnancy, lactation.

Restrictions apply.

Childhood (the safety and effectiveness of its use in children have not been determined).

Pregnancy and breast-feeding.

Category actions result in FDA - C. (The study of reproduction in animals has revealed adverse effects on the fetus, and adequate and well-controlled studies in pregnant women have not held, However, the potential benefits, associated with drugs in pregnant, may justify its use, in spite of the possible risk.)

If pregnancy occurs, it is necessary to transfer the patient to insulin treatment as soon as possible.

At the time of treatment should stop breastfeeding.

Side effects.

Cardio-vascular system and blood (hematopoiesis, hemostasis): rarely - decreased blood pressure, thrombocytopenia, leukopenia, granulocytopenia, agranulocytosis, erythropenia, pancytopenia, hemolytic and aplastic anemia.

From the nervous system and sensory organs: dizziness, headache, transient blurred vision.

From the digestive tract: nausea, vomiting, abdominal pain, a feeling of heaviness in the epigastric region, diarrhea, intrahepatic cholestasis.

Metabolism: gipoglikemiâ.

Other: transaminase elevation, giponatriemiya, allergic skin reactions, Late each porphyria, asthenia. Rarely - shortness of breath, hepatitis, sensitization vasculitis, photosensitivity.

Cooperation.

Hypoglycemia is enhanced by NSAIDs and other drugs with a high degree of binding to plasma proteins (sulfonamides, chloramphenicol, kumarinы, probenecid), MAO inhibitors, insulin, beta-blockers, mikonazol, allopurinol, ACE inhibitors, PAS, pentoxifylline (when administered parenterally in high doses), khinolony, anabolic steroid, male sex hormones, salicilaty, tetracikliny, tritoqualine, triphosphamide. The effect is weakened (cause hyperglycemia) thiazide diuretics, corticosteroids, fenotiazinы, thyroid hormones, Estrogens, oral contraceptives, phenytoin, a nicotinic acid, sympathomimetic, Isoniazid, barbiturates, aцetazolamid, rifampicin, laxatives (prolonged use). Alcohol can enhance, and reduce hypoglycemic activity. Propranolol increases Cmax_max, AUC and T_1/2 (on average 20%). Decreases (insignificantly) hypocoagulation, caused by warfarin. Recombinant alpha interferons increase the risk of developing thyroid dysfunction.

Overdose.

Symptoms: gipoglikemiâ, until the development of coma.

Treatment: IV bolus administration 50% glucose solution, zatem infusion 10% glucose solution. If the patient is conscious, sweet hot drink recommended. Constant monitoring and maintenance of vital functions is required, blood glucose concentration (at the level 5,5 mmol / l) for at least 24–48 hours (possible repeated episodes of hypoglycemia).

Dosing and Administration.

Inside, drinking a sufficient amount of liquid once before the first large meal (usually before breakfast). Initial daily dose: 1–2 mg, in the future it is possible to gradually (2-3 weeks) increase to 4–6 mg. The maximum daily dose - 6 mg. In patients with renal insufficiency (more sensitive to hypoglycemic effects) recommended starting dose 1 mg followed by gradual titration.

Precautions.

Treatment begins only if, if diet and exercise do not normalize blood glucose levels. At the beginning of therapy, when selecting a dose, it is recommended to determine the glucose concentration on an empty stomach and every 4 no; in the future, it is necessary to monitor fasting glucose levels and glucose levels in daily urine, periodically (every 3-6 months) determine glycosylated hemoglobin. In case of insufficient effect or weakening of the effect (secondary resistance) combination with insulin is recommended. With constant use, hyperglycemia is possible as a result of various stress effects - fever, trauma, infection, surgical intervention (in these cases, insulin is temporarily prescribed). A high risk of developing hypoglycemia exists in weakened and malnourished patients, with adrenal, pituitary or liver failure. Вероятность гипогликемии повышают алкоголь, skipping meals, дефицит калорий в питании, heavy and prolonged exercise. Be wary of during the drivers of vehicles and people, skills relate to the high concentration of attention.

Cooperation