GLIM 2/MG TAB 30/TAB

Indications

Approved Uses

Type 2 diabetes mellitus in adults as an adjunct to diet and exercise; may be used as monotherapy or in combination with other antidiabetic agents (e.g., metformin, insulin).

Dosage & Administration

Dosing by Condition

Type 2 diabetes mellitus (adults, oral): Start 1-2 mg once daily with breakfast/first main meal; titrate by 1-2 mg every 1-2 weeks; usual maintenance 1-4 mg once daily; maximum 8 mg once daily.

Initial Dose

1-2 mg once daily with the first main meal

Maintenance Dose

1-4mg once daily; some patients may require up to 8mg daily.

Maximum Dose

8 mg per day

Children's Dosage

Not recommended; safety and efficacy not established in pediatric patients.

Dose Adjustment Notes

Titrate by 1-2 mg no more frequently than every 1-2 weeks based on glucose; use lower starting doses and cautious titration in elderly and in renal or hepatic impairment due to hypoglycemia risk; when adding insulin, consider reducing sulfonylurea dose and titrate insulin per response.

How to Take

Swallow whole with water; take with the first main meal of the day; do not crush or chew

Side Effects

Common Side Effects

Hypoglycemia, weight gain, dizziness, headache, nausea (± other GI upset such as abdominal pain/diarrhea).

Safety & Warnings

Contraindications

Hypersensitivity to glimepiride/other sulfonylureas (or excipients); type 1 diabetes; diabetic ketoacidosis (± coma/pre-coma); severe hepatic impairment; severe renal impairment; pregnancy; breastfeeding

Warnings & Precautions

High hypoglycemia risk (elderly, malnourished, irregular meals, renal/hepatic impairment); educate on recognition/treatment and monitor glucose; beta-blockers may mask symptoms; G6PD deficiency-risk of hemolysis; cross-sensitivity with sulfonamides possible; during stress/acute illness or surgery may need temporary insulin; caution with alcohol; consider class warning of possible increased CV mortality seen with older sulfonylureas

Age Restriction

Not approved under 18 years.

Driving Warning

May impair ability to drive or operate machinery due to risk of hypoglycemia

Drug Interactions

Drug Interactions

Key clinically relevant interactions: CYP2C9 inhibitors (e.g., fluconazole) ↑ effect/hypoglycemia; CYP inducers (e.g., rifampicin) ↓ effect; other hypoglycemics and potentiators (NSAIDs/salicylates, sulfonamides, fluoroquinolones, some ACE inhibitors) ↑ hypoglycemia; beta-blockers mask hypoglycemia; corticosteroids/thiazides/thyroid hormones ↑ glucose (reduce effect); alcohol can cause hypo- or hyperglycemia; miconazole (especially systemic/oromucosal) can cause severe hypoglycemia; bile-acid sequestrants (e.g., colesevelam) can reduce absorption-separate dosing

Interaction Severity

MAJOR: Miconazole (especially systemic/oromucosal) and other strong CYP2C9 inhibitors (e.g., fluconazole) can markedly increase hypoglycemia risk. MODERATE: Alcohol (can precipitate hypoglycemia and impair control), NSAIDs/salicylates and other potentiators of hypoglycemia, beta-blockers (mask symptoms), corticosteroids/thiazides (reduce effect), rifampin (reduced effect via induction), bile-acid sequestrants such as colesevelam (reduced absorption-separate dosing).

Food Interaction

Take once daily with breakfast or the first main meal; avoid skipping or delaying meals after dosing to reduce hypoglycemia risk.

Alcohol Interaction

Avoid

Special Populations

Pregnancy

Category C

Breastfeeding

Consult Doctor

Children

Not recommended; safety and efficacy not established in pediatric patients.

Elderly

Start at 1 mg once daily; titrate slowly with careful blood glucose monitoring; increased risk of hypoglycemia; renal function should be assessed before and during treatment

Kidney Impairment

Renal impairment: start at 1 mg once daily and titrate cautiously with close glucose monitoring; in severe renal impairment/ESRD, avoid or use extreme caution (many guidelines prefer alternative agents/insulin)

Liver Impairment

Mild-moderate hepatic impairment: use with caution, start low (e.g., 1 mg daily) and titrate slowly; severe hepatic impairment: avoid/contraindicated (prefer insulin)

Storage & Patient Advice

Stopping the Medicine

Do not stop or change dose without clinician supervision; monitor glucose and arrange alternative therapy, and during acute stress (infection/fever/trauma/surgery) temporary insulin may be required

Overdose

Potentially prolonged severe hypoglycemia (sweating, tremor, confusion, seizures, coma); treat immediately with oral fast-acting carbohydrate if conscious, and IV dextrose (with ongoing infusion/monitoring) ± glucagon if unable to take orally; hospital observation is often required due to long duration/recurrence

Patient Counseling

Take with breakfast/first main meal and do not skip meals; recognize and treat hypoglycemia (carry fast-acting glucose); avoid or limit alcohol; monitor glucose as directed; use sun protection if photosensitivity occurs; inform clinicians before surgery/when adding interacting medicines.

Monitoring Requirements

Monitor self-measured blood glucose as clinically indicated and HbA1c about every 3 months until stable then every 3-6 months; periodically assess renal function and consider liver function tests; monitor for hypoglycemia and weight gain.

Pharmacology

Mechanism of Action

Stimulates insulin release by closing ATP-sensitive K+ channels (SUR1) on pancreatic beta cells leading to depolarization and Ca2+ influx; also has minor extrapancreatic effects improving insulin sensitivity.

Onset of Action

Onset of glucose-lowering effect within ~2-3 hours (with peak effect around the time of peak concentrations).

Duration of Effect

24 hours.

Bioavailability

100%.

Metabolism

Hepatic metabolism primarily via CYP2C9 to two main metabolites (M1 active, M2 inactive).

Protein Binding

>99% (highly protein bound).

Product Information

Available Dosage Forms

Tablet.

Composition per Dose

Each tablet: 2 mg glimepiride

Generic Availability

Yes

OTC Alternatives

No OTC alternative

Diabetes Type

Type 2

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