Diameride, tablets 3 mg 30 pcs

Diameride acts primarily by stimulating the secretion and release of insulin from pancreatic beta cells (pancreatic action). As with other sulfonylurea derivatives, this effect is based on increasing the response of pancreatic beta cells to physiological glucose stimulation, and the amount of insulin secreted is significantly lower than that of traditional sulfonylurea derivatives.

The least stimulating effect of glimepiride on insulin secretion also provides a lower risk of hypoglycemia. In addition, glimepiride has extrapancreatic action – the ability to improve the sensitivity of peripheral tissues (muscle, fat) to the action of its own insulin, reduce insulin absorption by the liver; it inhibits the production of glucose in the liver. Glimepiride selectively inhibits cyclooxygenase and reduces the conversion of arachidonic acid into thromboxane A2, which promotes platelet aggregation, thus having an antiplatelet effect.

Glimepiride promotes normalization of lipids, reduces the concentration of malonic aldehyde in blood, which leads to a significant reduction in lipid peroxidation, this promotes the anti-atherogenic effect of the drug. Glimepiride increases the level of endogenous a-tocopherol, catalase activity, glutathione peroxidase and superoxide dismutase that helps to decrease the intensity of oxidative stress in the patient’s organism, which is constantly present at diabetes type 2.

Indications

Type 2 diabetes mellitus when previously prescribed diet and exercise are ineffective.

If monotherapy with glimepiride is ineffective, it can be used in combination therapy with metformin or insulin.

Pharmacological effect

Diameride acts primarily by stimulating the secretion and release of insulin from the beta cells of the pancreas (pancreatic action). As with other sulfonylureas, this effect is based on an increase in the response of pancreatic beta cells to physiological stimulation by glucose, while the amount of insulin secreted is significantly less than with traditional sulfonylurea drugs.

The least stimulating effect of glimepiride on insulin secretion also provides a lower risk of developing hypoglycemia. In addition to this, glimepiride has an extrapancreatic effect – the ability to improve the sensitivity of peripheral tissues (muscle, fat) to the action of its own insulin, reduce the absorption of insulin by the liver; inhibits glucose production in the liver. Glimepiride selectively inhibits cyclooxygenase and reduces the conversion of arachidonic acid to thromboxane A2, which promotes platelet aggregation, thus exerting an antiplatelet effect.

Glimepiride helps normalize lipid levels, reduces the concentration of malonaldehyde in the blood, which leads to a significant reduction in lipid peroxidation, which contributes to the antiatherogenic effect of the drug. Glimepiride increases the level of endogenous a-tocopherol, the activity of catalase, glutathione peroxidase and superoxide dismutase, which helps reduce the severity of oxidative stress in the patient’s body, which is constantly present in type 2 diabetes mellitus.

Special instructions

Diameride should be taken in recommended doses and at the prescribed time. Errors in use of the drug, such as missing doses, should never be corrected by subsequent administration of a higher dose. The doctor and the patient should discuss in advance the measures that should be taken in case of such errors (for example, skipping a drug dose or meal) or in situations where it is impossible to take the next dose of the drug at the prescribed time. The patient should immediately inform the doctor if the dose of the drug is too high.

The development of hypoglycemia in a patient after taking 1 mg of glimepiride per day means that glycemia can be controlled solely through diet. When compensation for type 2 diabetes mellitus is achieved, insulin sensitivity increases. In this regard, the need for glimepiride may decrease during treatment. To avoid the development of hypoglycemia, it is necessary to temporarily reduce the dose or discontinue glimepiride. Dose adjustment should also be carried out if the patient’s body weight changes, his lifestyle changes, or if other factors appear that increase the risk of developing hypo- or hyperglycemia.

An adequate diet, regular and sufficient exercise and, if necessary, weight loss are as important for achieving optimal blood glucose control as regular use of glimepiride. Clinical symptoms of hyperglycemia are: increased frequency of urination, extreme thirst, dry mouth and dry skin. This must also be done in the case of an intercurrent illness or a change in the patient’s lifestyle.

Symptoms of hypoglycemia may be smoothed out or completely absent in the elderly, in patients with autonomic neuropathy or receiving concomitant treatment with beta-blockers, clonidine, reserpine, guanethidine. Hypoglycemia can almost always be quickly reversed by immediate intake of carbohydrates (glucose or sugar, for example in the form of a sugar cube, sweet fruit juice or tea). In this regard, the patient should always have at least 20 g of glucose (4 lumps of sugar) with him. Sweeteners are ineffective in treating hypoglycemia.

From the experience of using other sulfonylurea drugs, it is known that despite the initial success in relieving hypoglycemia, its recurrence is possible. In this regard, continuous and careful monitoring of the patient is necessary. Severe hypoglycemia requires immediate treatment under medical supervision, and under certain circumstances, hospitalization of the patient. If a patient with diabetes is treated by different doctors (for example, while staying in the hospital after an accident, when sick on the weekend), he must inform them about his illness and previous treatment. During treatment with glimepiride, regular monitoring of liver function and peripheral blood patterns (especially the number of leukocytes and platelets) is required.

In stressful situations (for example, trauma, surgery, infectious diseases accompanied by fever), it may be necessary to temporarily transfer the patient to insulin therapy. There is no experience with the use of glimepiride in patients with severely impaired liver and kidney function or patients on hemodialysis. Patients with severely impaired renal and liver function are advised to switch to insulin therapy. During treatment with glimepiride, regular monitoring of blood glucose concentrations, as well as the concentration of glycosylated hemoglobin, is necessary.

Certain side effects (severe hypoglycemia, serious changes in the blood picture, severe allergic reactions, liver failure) may, under certain circumstances, pose a threat to the patient’s life. In the event of the development of undesirable or severe reactions, the patient must immediately inform the attending physician about them and in no case continue to take the drug without his recommendation.

Active ingredient

Glimepiride

Composition

1 tablet contains:

active substance:

glimepiride in terms of 100% substance – 3 mg.

excipients:

lactose monohydrate,

povidone,

poloxamer,

croscarmellose sodium,

microcrystalline cellulose,

magnesium stearate,

red iron oxide dye.

Pregnancy

Glimepiride is contraindicated for use in pregnant women.

In case of planned pregnancy or if pregnancy occurs, the woman should be transferred to insulin therapy.

Since glimepiride passes into breast milk, it should not be prescribed to women during lactation. In this case, it is necessary to switch to insulin therapy or stop breastfeeding.

Contraindications

type 1 diabetes mellitus;
diabetic ketoacidosis, diabetic precoma and coma;
conditions accompanied by impaired absorption of food and the development of hypoglycemia (including infectious diseases);
leukopenia;
severe liver dysfunction;
severe renal impairment (including patients on hemodialysis);
hypersensitivity to glimepiride or to any inactive component of the drug, to other sulfonylurea derivatives or to sulfonamide drugs (risk of developing hypersensitivity reactions);
pregnancy and lactation;
lactose intolerance, lactase deficiency, glucose-galactose malabsorption;
children under 18 years of age.

With caution

Conditions requiring transfer of the patient to insulin therapy (extensive burns, severe multiple injuries, major surgical interventions, as well as impaired absorption of food and drugs in the gastrointestinal tract – intestinal obstruction, gastric paresis, etc.).

Side Effects

Metabolism: hypoglycemic reactions may develop. These reactions mainly occur soon after taking the drug, can be severe in form and course, and cannot always be easily controlled. The onset of these symptoms depends on individual factors, such as diet and dosage.

On the part of the organ of vision: during treatment (especially at the beginning), transient visual impairment may be observed due to changes in the concentration of glucose in the blood.

From the digestive system: nausea, vomiting, feeling of heaviness or discomfort in the epigastrium, abdominal pain, diarrhea, which very rarely lead to cessation of treatment; increased activity of “liver” enzymes, cholestasis, jaundice, hepatitis (up to the development of liver failure).

From the hematopoietic system: thrombocytopenia (moderate to severe), leukopenia, hemolytic or aplastic anemia, erythrocytopenia, granulocytopenia, agranulocytosis and pancytopenia.

Allergic reactions: possible appearance of urticaria (itching, skin rash). Such reactions are usually moderate, but can progress, accompanied by a drop in blood pressure, shortness of breath, and even the development of anaphylactic shock. If hives appear, you should consult a doctor immediately. Cross-allergy with other sulfonylurea derivatives, sulfonamides or other sulfonamides is possible, and the development of allergic vasculitis is also possible.

Other side effects: in exceptional cases, headache, asthenia, hyponatremia, photosensitivity, and porphyria cutanea tarda may develop.

Interaction

The simultaneous use of glimepiride with certain drugs can cause either an increase or decrease in the hypoglycemic effect of the drug. Therefore, other medications can only be taken after consultation with your doctor.

An increase in hypoglycemic effect and, associated with this, the possible development of hypoglycemia can be observed with simultaneous use of glimepiride with insulin, metformin or other oral hypoglycemic drugs, angiotensin-converting enzyme (ACE) inhibitors, allopurinol, anabolic steroids and male sex hormones, chloramphenicol, coumarin derivatives, cyclophosphamide, trophosfamide and isofosfamide, fenfluramine, fibrates, fluoxetine, sympatholytics (guanethidine), monoamine oxidase inhibitors (MAOIs), miconazole, pentoxifylline (when administered parenterally in high doses), phenylbutazone, azapropazone, oxyphenbutazone, probenecid, quinolone antibiotics, salicylates and aminosalicylic acid, sulfinpyrazone, some long-acting sulfonamides, tetracyclines, tritoqualine, fluconazole.

A weakening of the hypoglycemic effect, and an associated increase in the concentration of glucose in the blood, can be observed with the simultaneous use of glimepiride with acetazolamide, barbiturates, glucocorticosteroids, diazoxide, saluretics, thiazide diuretics, epinephrine and other sympathomimetic agents, glucagon, laxatives (with long-term use), nicotinic acid (in high doses) and nicotinic acid derivatives, estrogens and progestogens, phenothiazine derivatives, including chlorpromazine, phenytoin, rifampicin, thyroid hormones, lithium salts.

H2-histamine receptor blockers, clonidine and reserpine can both potentiate and weaken the hypoglycemic effect of glimepiride. Under the influence of beta-blockers, clonidine, guanethidine and reserpine, clinical signs of hypoglycemia may be weakened or absent. While taking glimepiride, an increase or decrease in the effect of coumarin derivatives may be observed.

When used simultaneously with drugs that inhibit bone marrow hematopoiesis, the risk of myelosuppression increases. Single or chronic consumption of alcohol can either enhance or weaken the hypoglycemic effect of glimepiride.

Overdose

After ingestion of a large dose of glimepiride, hypoglycemia may develop, lasting from 12 to 72 hours, which may recur after the initial restoration of blood glucose concentrations. In most cases, observation in a hospital setting is recommended.

Symptoms of hypoglycemia: increased sweating, anxiety, tachycardia, increased blood pressure, palpitations, pain in the heart, arrhythmia, headache, dizziness, sudden increase in appetite, nausea, vomiting, apathy, drowsiness, anxiety, aggressiveness, impaired concentration, depression, confusion, tremor, paresis, sensory disturbances, convulsions of central origin. Sometimes the clinical picture of hypoglycemia can resemble a stroke. Coma may develop.

Treatment includes inducing vomiting, drinking plenty of activated charcoal (an adsorbent) and sodium picosulfate (a laxative). When taking a large amount of the drug, gastric lavage is indicated, followed by sodium picosulfate and activated charcoal. Dextrose is started as soon as possible, if necessary in the form of an intravenous bolus of 50 ml of a 40% solution, followed by an infusion of a 10% solution, with careful monitoring of blood glucose concentrations. Further treatment should be symptomatic.

Storage conditions

In a dry place, protected from light, at a temperature not exceeding 25 °C

Shelf life

2 years

Manufacturer

Akrikhin JSC, Russia