Glimecomb, 40 mg+500 mg tablets 60 pcs

How to take, the dosage

The drug Glimecomb is administered orally, during or immediately after a meal. The dose of the drug is determined by the doctor individually for each patient depending on the blood glucose level.

In general, the starting dose is 1 to 3 tablets daily with gradual dose adjustment until stable compensation of the disease is achieved.

The drug is usually taken 2 times a day (in the morning and in the evening). The maximum daily dose is 5 tablets.

Interaction

Strengthening of hypoglycemic action of the drug Glimecomb is observed when concomitant use with ACE inhibitors (captopril, enalapril), blockers of histamine H2-receptors (cimetidine), antifungal drugs (miconazole, fluconazole), NSAIDs (phenylbutazone, azapropazone, oxyphenbutazone), with fibrates (clofibrate, besafibrate), anti-tuberculosis drugs (etionamide), salicylatesCoumarin-type anticoagulants, anabolic steroids, beta-adrenoblockers, MAO inhibitors, long-acting sulfonamides, with cyclophosphamide, chloramphenicol, fenfluramine, fluoxetine, guanethidine, pentoxifylline, tetracycline, theophylline, tubule secretion blockers, reserpine, bromocriptine, disopyramide, pyridoxine, with other hypoglycemic drugs (incl.including acarbose, biguanides, insulin), allopurinol, oxytetracycline.

. Decrease of hypoglycemic action of Glimecomb preparation is observed when concomitant use with barbiturates, GCS, adrenomimetics (epinephrine, clonidine), antiepileptic drugs (phenytoin), slow calcium channel blockers, carbohydrase inhibitors (acetazolamide), thiazide diuretics, Chlorthalidone, furosemide, triamterene, asparaginase, baclofen, danazol, diazoxide, isoniazid, morphine, ritodrine, salbutamol, terbutaline, glucagon, rifampicin, thyroid hormones, lithium salts, high-dose nicotinic acid, chlorpromazine, oral contraceptives and estrogens.

Increases the risk of ventricular extrasystole on a background of cardiac glycosides.

Drugs that depress medullary hematopoiesis increase the risk of myelosuppression.

Ethanol increases the likelihood of lactacidosis.

Pharmacokinetic interaction

Metformin decreases Cmax in plasma and T1/2 of furosemide by 31 and 42.3%, respectively.

Furosemide increases Cmax of metformin by 22%.

Nifedipine increases absorption, increases plasma Cmax, and slows metformin excretion.

The cationic drugs (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene and vancomycin) that are secreted in the tubules compete for tubular transport systems and can increase Cmax of metformin in plasma by 60% with long-term therapy.

Contraindications

• diabetes mellitus type 1 (insulin dependent);
• diabetic ketoacidosis;
• diabetic precoma, diabetic coma;
• hypoglycemia;
• severe renal dysfunction;
• acute conditions that may lead to changes in renal function: dehydration, severe infection, shock;
• acute or chronic diseases accompanied by tissue hypoxia: heart failure, respiratory failure, recent myocardial infarction, shock;
• hepatic failure;
• porphyria;
• Pregnancy;
• lactation (breastfeeding) period;
• concurrent use of miconazole;
• circumstances requiring insulin therapy, including.ч.
• circumstances requiring insulin therapy
• Chronic alcoholism
• acute alcohol intoxication
• lactacidosis (incl.
• lactacidosis (including history);
• use for at least 48 hours before and 48 hours after radioisotopic or radiological studies with iodine contrast agent;

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• hypocaloric diet (less than 1000 calories/day)
• high sensitivity to the components of the drug
• high sensitivity to other sulfonylurea derivatives.

The drug is not recommended for patients older than 60 years of age who perform heavy physical work, because of the increased risk of lactacidosis.

The drug should be used with caution in febrile syndrome, adrenal insufficiency, hypothyroidism, and thyroid disease with impaired thyroid function.

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Side effects

Endocrine system: hypoglycemia (in case of violation of the dosing regimen and inadequate diet) – headache, fatigue, hunger, excessive sweating, sudden weakness, palpitation, dizziness, impaired coordination of movements, temporary neurological disorders; with progression of hypoglycemia loss of self-control, loss of consciousness is possible.

Metabolic disorders: in some cases – lactacidosis (weakness, myalgia, respiratory disorders, drowsiness, abdominal pain, hypothermia, decreased BP, bradyarrhythmia).

Digestive system disorders: dyspepsia (nausea, diarrhea, feeling of heaviness in epigastrium, “metal” taste in mouth), decreased appetite (intensity of these reactions decreases if the drug is taken with food); rarely – hepatitis, cholestatic jaundice (drug withdrawal is required), increased liver transaminase activity, ALP.

With the hematopoietic system: rarely – inhibition of medullary hematopoiesis (anemia, thrombocytopenia, leukopenia).

Allergic reactions: itching, urticaria, maculopapular rash.

Others: visual impairment.

In cases of side effects, the dose should be reduced or the drug temporarily stopped.

General side effects of sulfonylurea derivatives: erythropenia, agranulocytosis, hemolytic anemia, pancytopenia, allergic vasculitis, life-threatening liver failure.

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Overdose

Symptoms: lactacidosis is possible (because the drug contains metformin), hypoglycemia.

Treatment: if symptoms of lactacidosis occur, the drug should be stopped. Lactacidosis is a condition requiring emergency medical care; treatment is carried out in a hospital. The most effective method of treatment is hemodialysis.

In case of mild or moderate hypoglycemia, glucose (dextrose) or sugar solution is taken orally. In cases of severe hypoglycemia (loss of consciousness), a 40% solution of dextrose (glucose) or glucagon is administered by IV, IM or p/u. After recovery of consciousness, the patient should be given food rich in carbohydrates, in order to avoid the recurrence of hypoglycemia.

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