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 in the ineffectiveness of previously prescribed diet and exercise.

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

Active ingredient

Composition

1 tablet contains:

active ingredient:

glimepiride in terms of 100% substance – 3 mg.

accompanies:

lactose monohydrate,

povidone,

poloxamer,

croscarmellose sodium,

Microcrystalline cellulose,

Magnesium stearate,

Red iron oxide dye.

How to take, the dosage

The drug Diameride is administered orally. Initial and maintenance doses of glimepiride are established individually on the basis of the results of regular monitoring of blood glucose concentration. Initial dose and dose selection
At the beginning of treatment, 1 mg of glimepiride is prescribed once daily. When the optimal therapeutic effect is achieved, it is recommended to take this dose as a maintenance dose.

In the absence of glycemic control, the daily dose should be gradually increased under regular monitoring of blood glucose concentrations (at intervals of 1-2 weeks) to 2 mg, 3 mg or 4 mg daily. Doses above 4 mg daily are effective only in exceptional cases. The maximum recommended daily dose is 6 mg.

The time and frequency of the daily dose is determined by the physician, taking into account the patient’s lifestyle. The daily dose is prescribed in one dose immediately before or during a solid breakfast, or the first main meal. Glimepiride tablets are taken whole, without chewing, with enough liquid (about 0.5 cup). It is not recommended to skip meals after taking glimepiride.

The duration of treatment

The treatment with glimepiride is long, under control of blood glucose content.

Use in combination with metmorphine

In the absence of glycemic control in patients taking metmorphine, concomitant therapy with glimepiride may be initiated. If the dose of metformin is maintained at the same level, treatment with glimepiride is started with the minimum dose, and then the dose is gradually increased depending on the desired level of glycemic control, up to the maximum daily dose. Combination therapy should be conducted under close medical supervision.

In combination with insulin

In cases when glycemic control cannot be achieved by taking the maximum dose of glimepiride in monotherapy or in combination with the maximum dose of metformin, a combination of glimepiride with insulin is possible. In this case, the last dose of glimepiride prescribed to the patient remains unchanged. In this case, treatment with insulin begins with a minimum dose, with a possible subsequent gradual increase in its dose under the control of blood glucose concentrations. Combined treatment requires mandatory monitoring by a physician.

Transfer of a patient from another oral hypoglycemic drug to glimepiride

. When transferring a patient from another oral hypoglycemic drug to glimepiride, the initial daily dose of the latter should be 1 mg (even if the patient is transferred to glimepiride from the maximum dose of another oral hypoglycemic drug). Any increase in the dose of glimepiride should be made in stages in accordance with the above recommendations. It is necessary to take into account the effectiveness, dose and duration of action of the used hypoglycemic agent. In some cases, especially when taking hypoglycemic drugs with a long half-life, it may be necessary to temporarily (for several days) discontinue treatment to avoid additive effects that increase the risk of hypoglycemia.

Transfer of patients from insulin to glimepiride

In exceptional cases of insulin therapy in patients with type 2 diabetes, with compensation of the disease and with preserved secretory function of the pancreatic b-cells, insulin may be replaced with glimepiride. The transfer should be carried out under the close supervision of a doctor. In this case, transfer of the patient to glimepiride is started with a minimum dose of 1 mg.

Interaction

Simultaneous use of glimepiride with some drugs may cause both strengthening and weakening of the hypoglycemic effect of the drug. Therefore, other drugs may be taken only after agreement with the doctor.

. Increased hypoglycemic action and, associated with this, the possible development of hypoglycemia may be observed with the 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, trophosphamide and isophosphamide, phenflouramine, fibrates, fluoxetine, sympatholytic drugs (guanethidine), monoamine oxidase inhibitors (MAOIs), miconazole, pentoxifylline (when given parenterally in high doses), phenylbutazone, azapropazone oxyphenbutazone, probenecid, quinolone antibiotics, salicylates and aminosalicylic acid, sulfinpyrazone, some long-acting sulfonamides, tetracyclines, tritoqualine, fluconazole.

. Weakening of hypoglycemic action, and the associated increase in blood glucose concentrations may be observed with the simultaneous use of glimepiride with acetazolamide, barbiturates, glucocorticosteroids, diazoxide, saluretics, thiazide diuretics, epinephrine and other sympathomimetic agents, glucagon, laxatives (with prolonged use), nicotinic acid (in high doses) and derivatives of nicotinic acid, 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 effects of glimepiride. Under the influence of b-adrenoblockers, clonidine, guanethidine, and reserpine, clinical signs of hypoglycemia may be weakened or absent. Against the background of glimepiride administration, enhancement or weakening of the effect of coumarin derivatives may be observed.

Concomitant use with drugs that inhibit bone marrow hematopoiesis increases the risk of myelosuppression. Single or chronic use of alcohol may both enhance and weaken the hypoglycemic effect of glimepiride.

Special Instructions

Diameride should be taken in the recommended doses and at the prescribed times. Mistakes in the use of the drug, such as skipping a dose, should never be corrected by taking a higher dose at a later time. The physician and the patient must agree in advance on the measures to be taken in case of such errors (e.g. skipping a dose or eating) or in situations in which the next dose cannot be taken at the prescribed time. The patient must inform the physician immediately if the dose of the medication is too high.

The development of hypoglycemia in a patient after taking 1 mg of glimepiride per day means that it is possible to control glycemia solely by diet. When compensation for type 2 diabetes is achieved, insulin sensitivity increases. Due to this, the need for glimepiride may decrease during treatment. In order to avoid the development of hypoglycemia, it is necessary to temporarily reduce the dose or cancel glimepiride. Dose adjustment should also be carried out in case of changes in the patient’s body weight, lifestyle, or in the emergence of other factors that contribute to an increased risk of hypo- or hyperglycemia.

The adequate diet, regular and sufficient exercise and, if necessary, weight reduction are as important in achieving optimal blood glucose control as regular glimepiride administration. The clinical symptoms of hyperglycemia are: increased frequency of urination, intense thirst, dry mouth and dry skin. This should also be done in case of an intercurrent disease or a change in the patient’s lifestyle.

The symptoms of hypoglycemia may be subdued or absent in the elderly, in patients with autonomic neuropathy, or those receiving concomitant treatment with b-adrenoblockers, clonidine, reserpine, guanethidine. Hypoglycemia can almost always be quickly controlled by immediate intake of carbohydrates (glucose or sugar, for example, in the form of a piece of sugar, sweet fruit juice or tea). The patient should therefore always carry at least 20 glucose (4 sugars). Sugar substitutes are ineffective in the treatment of hypoglycemia.

It is known from experience with other sulfonylurea drugs that despite 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 in certain circumstances, hospitalization of the patient. If a patient with diabetes mellitus is treated by different doctors (e.g. during a hospital stay after an accident, when he gets sick on weekends), he must necessarily inform them about his illness and the previous treatment. Regular monitoring of liver function and peripheral blood count (especially leukocyte and platelet count) is required during treatment with glimepiride.

In stressful situations (e.g., trauma, surgery, infectious diseases accompanied by fever) it may be necessary to temporarily transfer the patient to insulin therapy. There is no experience in the use of glimepiride in patients with severe hepatic and renal dysfunction or patients on hemodialysis. Patients with severe renal and hepatic dysfunction should be transferred to insulin therapy. During treatment with glimepiride, regular monitoring of blood glucose concentration as well as glycosylated hemoglobin concentration is necessary.

Some adverse effects (severe hypoglycemia, serious changes in blood picture, severe allergic reactions, liver failure) may, under certain circumstances, pose a threat to the patient’s life. In case of development of undesirable or serious reactions the patient should immediately inform the attending physician about them and never continue taking the drug without his/her recommendation.

Contraindications

Side effects

Metabolic reactions: hypoglycemic reactions may occur. These reactions mainly occur shortly after taking the drug, may have a severe form and course and are not always easy to stop. The onset of these symptoms depends on individual factors, such as diet and dosing.

VIight: transient visual disturbances due to changes in blood glucose concentration may occur during treatment (especially at the beginning).

Digestive system disorders: nausea, vomiting, sensation of heaviness or discomfort in epigastrium, abdominal pain, diarrhea, very rarely leading to discontinuation of treatment; increased activity of “liver” enzymes, cholestasis, jaundice, hepatitis (up to liver failure).

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

Allergic reactions: possible urticaria (itching, skin rash). These reactions are usually moderate in severity, but may progress, accompanied by a drop in blood pressure, shortness of breath, up to the development of anaphylactic shock. If hives occur, seek medical attention immediately. Cross-allergy with other sulfonylurea derivatives, sulfonamides or other sulfonamides is possible; allergic vasculitis may also develop.

Other side effects: in exceptional cases development of headache, asthenia, hyponatremia, photosensitization, late cutaneous porphyria are possible.

Overdose

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

The symptoms of hypoglycemia: increased sweating, anxiety, tachycardia, increased blood pressure, palpitations, heart pain, arrhythmia, headache, dizziness, sudden increase in appetite, nausea, vomiting, apathy, sleepiness, restlessness, aggressiveness, impaired concentration, depression, confusion, tremors, paresis, sensory disturbances, convulsions of central genesis. Sometimes the clinical picture of hypoglycemia may resemble a stroke. It is possible to develop a coma.

The treatment includes induction of vomiting, copious drinking with activated carbon (adsorbent) and sodium picosulfate (laxative). If large amounts of the drug are taken, gastric lavage is indicated, followed by administration of sodium picosulfate and activated charcoal. As soon as possible begin administration of dextrose, if necessary by intravenous injection of 50 ml of 40% solution, followed by infusion of 10% solution, with careful monitoring of blood glucose concentration. Further treatment should be symptomatic.

Pregnancy use

Glimepiride is contraindicated in pregnant women.

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

Because glimepiride penetrates 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.

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