Non-insulin dependent (type-II) diabetes, whenever blood sugar levels cannot be
controlled adequately by diet, physical exercise and weight reduction.
Secrin (Glimepiride) is also indicated for use in combinaton with insulin to lower blood
glucose in patients whose hyperglycaemia can not be controlled by diet and exercise or
in conjunction with an oral hyperglycaemic agent.
Dosage and Administration:
In principal, the dosage of Glimepiride is governed by the desired blood sugar level. The
dosage of Glimepiride must be the lowest which is sufficient to achieve the desired
The initial and the maintenance dosage are set based on the results of regular check of
glucose in blood and urine. Monitoring of glucose levels in blood and urine also serves
to detect either primary or secondary failure of therapy.
Initial dose and dose titration : the usual initial dose is 1 mg once daily. If necessary, the
daily dose can be increased. Any increased can be based on regular blood sugar
monitoring, and should be gradual, i.e., at intervals of one to two weeks, and carried out
stepwise, as follows : 1 mg -2 mg-3 mg-4 mg-6 mg.
Dose range in patients with well controlled diabetes : this usual dose range in patients
with well controlled diabetes is 1 to 4 mg daily.
Distribution of doses : timing and distribution of doses are decide by the physician, in
consideration of the patient’s current life-style. Normally, a single daily dose is sufficient.
This should be taken immediately before a substantial breakfast or – if none is taken –
immediately before the first main meal. It is very important not to skip meals after taking
Secondary dosage adjustment : as the controlled of diabetes improves, sensitivity to
insulin increases ; therefore, Glimepiride requirement may fall as treatment proceeds.
To avoid hypoglycaemia, timely dose reduction or cessation of Glimepiride therapy
must be considered.
A dose adjustment must also be considered whenever the patient’s weight or life-style
changes, or other factors arise which cause and increased susceptibility to hypo or
Change over from other oral antidiabetics to Glimepiride :
There is no exact dosage relationship between Glimepiride and other oral blood sugar
lowering agents. When substituting Glimepiride for other such agents, the initial daily
dose is 1 mg ; this applies even in changeovers from the maximum dose of another oral
blood sugar lowering agents. Any dose increase should be in accordance with guideline
given above in ‘initial dose and dose titration’.
Consideration must be given to the potency and duration of action of the previous blood
sugar lowering agent. It may be necessary to interrupt treatment to avoid additive
effects which would increase the risk of hypoglycaemia.
Glimepiride tablets must be swallowed without chewing and with sufficient amounts of
liquid (approximately one or two glass).
Glimepiride is not suitable for the treatment of insulin dependent (type-I) diabetes
mallitus, or of diabetic precoma or coma. Glimepiride must not be used in patients
hypersensitive Glimepiride, other sulphonylureas, other sulphonamides. In patients with
severe impairment of renal or hepatic function, a changeover to insulin is indicated.
In the initial weeks of treatment, the risk of hypoglycaemia may be increased and
necessitates especially careful monitoring. If such risk is present it may be necessary to
adjust the dosage of Glimepiride. Hypoglycaemia can almost always be promptly
controlled by immediate intake of carbohydrates (glucose or sugar, e.g., in the form of
sugar lumps, sugar-sweetened fruit juice or sugar-sweetened tea.
Hypoglycaemia, temporary visual impairment, nausea, vomiting, diarrhoea, abdominal
pain, urticaria, fall in blood pressure.
Potentiation of the blood-sugar-lowering effect may occur with insulin and other oral
anti-diabetic, ACE inhibitors, allopurinol, anabolic steroids and male sex hormones,
chlormphenicol, coumarin derivatives, fluoxetine, MAO inhibitors, miconazole, paraaminosalicylic
acid, pentoxifylline (high dose parenteral) , phenylbutazone,
oxyphenbutazone, quinolones, salicylates, sulfonamides, tetracyclines, beta blockers.
Weakening of the blood sugrar-lowering effect may occur with acetazolamide,
barbiturates, corticosteriods, diazoxide, diuretics, epinephrine and other
sympathomimetic agents, laxatives, oestrogens and progestogens,
phenothiazines,phenytoin, rifampicin, thyroid hormones, H2- receptor antagonists,
clonidine and reserpine may lead to either Potentiation or weakening of the bloodsugar-lowering
Both acute and chronic alcohol intake may potentiate or weaken the blood-sugarlowering
action of glimepiride unpredictably.
Use in pregnancy and lactation:
Pregnancy: Glimepiride must not be taken during pregnancy ; a changeover to insulin
is necessary. Patients planning a pregnancy must inform their physician, and should
changeover to insulin.
Nursing mothers: Ingestion of Glimepiride with breast milk may harm the child.
Therefore, Glimepiride must not be taken by breast-feeding women. Either a
changeover or a complete discontinuation of breast-feeding is necessary.