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Glimepiride

Glimepiride is a second-generation sulfonylurea used to treat type 2 diabetes by stimulating the pancreas to release more insulin. It works by improving the binding of insulin to receptors or increasing the number of receptors. Common side effects include hypoglycemia, drowsiness, and nausea. It should not be used in pregnancy, type 1 diabetes, or severe liver or kidney disease. Nursing care involves frequent monitoring of blood glucose levels, dietary teaching, and managing hypoglycemia.

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2K views3 pages

Glimepiride

Glimepiride is a second-generation sulfonylurea used to treat type 2 diabetes by stimulating the pancreas to release more insulin. It works by improving the binding of insulin to receptors or increasing the number of receptors. Common side effects include hypoglycemia, drowsiness, and nausea. It should not be used in pregnancy, type 1 diabetes, or severe liver or kidney disease. Nursing care involves frequent monitoring of blood glucose levels, dietary teaching, and managing hypoglycemia.

Uploaded by

api-3797941
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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glimepiride

(glye meh' per ide)


Amaryl

Pregnancy Category C

Drug classes
Antidiabetic
Sulfonylurea (second generation)

Therapeutic actions
Stimulates insulin release from functioning beta cells in the pancreas; may improve
binding between insulin and insulin receptors or increase the number of insulin receptors;
thought to be more potent in effect than first-generation sulfonylureas

Indications
• As an adjunct to diet to lower blood glucose in patients with type 2 (non–insulin-
dependent) diabetes mellitus whose hypoglycemia cannot be controlled by diet
and exercise alone.
• In combination with metformin or insulin to better control glucose as an adjunct
to diet and exercise in patients with type 2 diabetes mellitus.

Contraindications and cautions


• Contraindicated with allergy to sulfonylureas; diabetes complicated by fever,
severe infections, severe trauma, major surgery, ketosis, acidosis, coma (insulin is
indicated in these conditions); type 1 (insulin-dependent), serious hepatic or renal
impairment, uremia, thyroid or endocrine impairment, glycosuria, hyperglycemia
associated with primary renal disease; labor and delivery—if glimepiride is used
during pregnancy, discontinue drug at least 1 mo before delivery; lactation, safety
not established.
• Use cautiously with pregnancy.

Available forms
Tablets—1, 2, 4 mg

Dosages
ADULTS
Usual starting dose is 1–2 mg PO once daily with breakfast or first meal of the day; usual
maintenance dose is 1–4 mg PO once daily, depending on patient response and glucose
levels. Do not exceed 8 mg/day.
• Combination with insulin therapy: 8 mg PO daily with first meal of the day with
low-dose insulin.
• Transfer from other hypoglycemic agents: No transition period is necessary.
PEDIATRIC PATIENTS
Safety and efficacy not established.
PATIENTS WITH RENAL IMPAIRMENT
Usual starting dose is 1 mg PO once daily; titrate dose carefully, lower maintenance
doses may be sufficient to control blood sugar.

Pharmacokinetics
Route Onset Peak
Oral 2–3 hr 2–3 hr

Metabolism: Hepatic; T1/2: 5.5–7 hr


Distribution: Crosses placenta; enters breast milk
Excretion: Bile and urine

Adverse effects
• CNS: Drowsiness, asthenia, nervousness, tremor, insomnia
• CV: Increased risk of cardiovascular mortality (possible)
• Endocrine: Hypoglycemia, SIADH
• GI: Anorexia, nausea, vomiting, epigastric discomfort, heartburn, diarrhea
• Hematologic: Leukopenia, thrombocytopenia, anemia
• Hypersensitivity: Allergic skin reactions, eczema, pruritus, erythema, urticaria,
photosensitivity, fever, eosinophilia, jaundice
• Other: Diuresis, tinnitus, fatigue

Interactions
Drug-drug
• Increased risk of hypoglycemia with androgens, anticoagulants, azole antifungals,
chloramphenicol, clofibrate, fenfluramine, fluconazole, gemfibrozil, H2 blockers,
magnesium salts, MAOIs, methyldopa, oxyphenbutazone, phenylbutazone,
probenecid, salicylates, sulfinpyrazone, sulfonamides, TCAs, urinary acidifiers
• Decreased effectiveness of both glimepiride and diazoxide if taken concurrently
• Increased risk of hyperglycemia with rifampin, thiazides
• Risk of hypoglycemia and hyperglycemia with ethanol; "disulfiram reaction" has
also been reported
• Possible decreased hypoglycemic effect with beta blockers, calcium channel
blockers, cholestyramine, corticosteroids, diazoxide, estrogens, hydantoins,
hormonal contraceptives, isoniazid, nicotinic acid, phenothiazines, rifampin,
sympathomimetics, thiazide diuretics, thyroid agents, urinary alkalinizers
Drug-alternative therapy
• Increased risk of hypoglycemia if taken with juniper berries, ginseng, garlic,
fenugreek, coriander, dandelion root, celery

Nursing considerations
Assessment
• History: Allergy to sulfonylureas; diabetes complicated by fever, severe
infections, severe trauma, major surgery, ketosis, acidosis, coma (insulin is
indicated in these conditions); type 1 diabetes, serious hepatic or renal
impairment, uremia, thyroid or endocrine impairment, glycosuria, hyperglycemia
associated with primary renal disease; pregnancy
• Physical: Skin color, lesions; T; orientation, reflexes, peripheral sensation; R,
adventitious sounds; liver evaluation, bowel sounds; urinalysis, BUN, serum
creatinine, liver function tests, blood glucose, CBC

Interventions
• Monitor urine or serum glucose levels frequently to determine effectiveness of
drug and dosage being used.
• Transfer to insulin therapy during periods of high stress (eg infections, surgery,
trauma).
• Use IV glucose if severe hypoglycemia occurs as a result of overdose.
• Arrange for consultation with dietitian to establish weight-loss program and
dietary control.
• Arrange for thorough diabetic teaching program, including disease, dietary
control, exercise, signs and symptoms of hypoglycemia and hyperglycemia,
avoidance of infection, hygiene.

Teaching points
• Take this drug once a day with breakfast or the first main meal of the day.
• Do not discontinue this drug without consulting your health care provider;
continue with diet and exercise program for diabetes control.
• Monitor urine or blood for glucose and ketones as prescribed.
• Do not use this drug if you are pregnant.
• Avoid alcohol while using this drug.
• Report fever, sore throat, unusual bleeding or bruising, rash, dark urine, light-
colored stools, hypoglycemic or hyperglycemic reactions.

Adverse effects in Italic are most common; those in Bold are life-threatening.

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