Pregnancy Risk Category C
How supplied
Tablets: 1 mg, 2 mg, 4 mg
Action
Exact mechanism unknown. Lowers blood glucose levels, possibly by stimulating release of insulin from functioning pancreatic beta cells. Drug can also lead to increased sensitivity of peripheral tissues to insulin.
Indications & dosage
Adjunct to diet and exercise to lower blood glucose levels in patients with type 2 non-insulin-dependent diabetes mellitus whose hyperglycemia can't be managed by diet and exercise alone--
Adults: initially, 1 to 2 mg P.O. once daily with first main meal of day; usual maintenance dose is 1 to 4 mg P.O. once daily. After reaching dosage of 2 mg, dosage is increased in increments not exceeding 2 mg q 1 to 2 weeks, based on patient's blood glucose level response. Maximum dose is 8 mg/day.
Adjunct to insulin therapy in patients with type 2 diabetes mellitus whose hyperglycemia can't be managed by diet and exercise with oral hypoglycemics--
Adults: 8 mg P.O. once daily with first main meal of day; used with low-dose insulin. Insulin adjusted upward weekly, p.r.n., based on patient's blood glucose level response.
Adjunct to metformin therapy in patients with type 2 diabetes mellitus whose hyperglycemia can't be managed by diet, exercise, and glimepiride or metformin alone--
Adults: 8 mg P.O. once daily with first main meal of day with metformin if patient doesn't respond adequately to glimepiride monotherapy. Adjust dosages based on patient's blood glucose level to determine minimum effective dose of each drug.
Adjust-a-dose: For renally impaired patients, initial dose 1 mg P.O. once daily with first main meal of day; then appropriate dosage adjusted, p.r.n.
Adverse reactions
CNS: dizziness, asthenia, headache.
EENT: changes in accommodation.
GI: nausea.
GU: elevated BUN and creatinine levels.
Hematologic: leukopenia, hemolytic anemia, agranulocytosis, thrombocytopenia, aplastic anemia, pancytopenia.
Hepatic: cholestatic jaundice, elevated transaminase and alkaline phosphatase levels.
Metabolic: hypoglycemia, dilutional hyponatremia.
Skin: pruritus, erythema, urticaria, morbilliform or maculopapular eruptions.
Interactions
Drug-drug. Beta blockers: may mask symptoms of hypoglycemia. Monitor blood glucose level.
Drugs that tend to produce hyperglycemia (such as corticosteroids, estrogens, isoniazid, nicotinic acid, oral contraceptives, other diuretics, phenothiazines, phenytoin, sympathomimetic thiazides, thyroid products): may lead to loss of glucose control. Adjust dosage, as ordered.
Insulin: may increase potential for hypoglycemia. Avoid concomitant use.
NSAIDs, other drugs that are highly
protein-bound (such as beta blockers, chloramphenicol, coumarins, MAO inhibitors, probenecid, salicylates, sulfonamides): may potentiate hypoglycemic action of sulfonylureas such as glimepiride. Monitor blood glucose levels carefully.
Drug-lifestyle. Alcohol use: altered glycemic control, most commonly hypoglycemia. May also cause disulfiram-like reaction. Discourage concomitant use.
Effects on diagnostic tests
None reported.
Contraindications
Contraindicated in patients with hypersensitivity to drug and in those with diabetic ketoacidosis, which should be treated with insulin.
Nursing considerations
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING