Diameride, pills 4mg, 30pcs

Composition

1 tablet contains: Active ingredient:

glimepiride in terms of 100% substance — 4 mg

. excipients:

lactose monohydrate,

povidone,

poloxamer,

croscarmellose sodium,

microcrystalline cellulose,

magnesium stearate,

iron oxide red dye.

Pharmacological action

Diameride acts mainly by stimulating the secretion and release of insulin from pancreatic beta cells (pancreatic action). As with other sulfonylurea derivatives, this effect is based on an increase in the response of pancreatic beta cells to physiological glucose stimulation, while the amount of insulin secreted is significantly lower than with traditional drugs-sulfonylurea derivatives.

The lowest stimulating effect of glimepiride on insulin secretion also provides a lower risk of hypoglycemia. In addition to this, glimepiride has an extra-pancreatic effect – the ability to improve the sensitivity of peripheral tissues (muscle, fat) to the action of its own insulin, reduce the absorption of insulin by the liver; inhibits glucose production in the liver. Glimepiride selectively inhibits cyclooxygenase and reduces the conversion of arachidonic acid to thromboxane a2, which promotes platelet aggregation, thus having an antiplatelet effect.

Glimepiride helps to normalize the lipid content, reduces the concentration of malonaldehyde in the blood, which leads to a significant decrease in lipid peroxidation, this contributes to the anti-atherogenic effect of the drug.

Glimepiride increases the level of endogenous a-tocopherol, the activity of catalase, glutathione peroxidase and superoxide dismutase, which helps to reduce the severity of oxidative stress in the patient’s body, which is constantly present in type 2 diabetes mellitus.

Indications

Type 2 diabetes mellitus with ineffectiveness of the previously prescribed diet and physical activity.

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

Use during pregnancy and lactation

Glimepiride is contraindicated in pregnant women.

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

 Since 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.

Contraindications

• diabetes mellitus type 1;
• diabetic ketoacidosis, diabetic precoma and coma;
• conditions associated with malabsorption of food and hypoglycemia (including infectious diseases);
• leukopenia;
• severe liver dysfunction;
• severe renal dysfunction (including patients on hemodialysis);
• hypersensitivity to glimepiride or any of the inactive component of the drug, other sulfonylureas, or to sulfa drugs (risk of hypersensitivity reactions);
• pregnancy and lactation;
• lactose intolerance, lactase deficiency, glucose-galactose malabsorption;
• >children up to age 18 years.

With caution Conditions that require the transfer of the patient to insulin therapy (extensive burns, severe multiple injuries, major surgical interventions, as well as violations of the absorption of food and medicines in the gastrointestinal tract – intestinal obstruction, gastric paresis, etc. ).

Side effects

From the side of metabolism: hypoglycemic reactions may develop. These reactions mainly occur shortly after taking the drug, can have a severe form and course, and they can not always be easily stopped. The onset of these symptoms depends on individual factors, such as dietary patterns and dosage.

From the side of the organ of vision: during treatment (especially at its beginning), transient visual disturbances may occur due to changes in the concentration of glucose in the blood.

From the digestive system: nausea, vomiting, a feeling of heaviness or discomfort in the epigastrium, abdominal pain, diarrhea, very rarely leading to discontinuation of treatment; increased activity of “liver” enzymes, cholestasis, jaundice, hepatitis (up to the development of liver failure).

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

Allergic reactions: urticaria (pruritus, skin rash) may occur. Such reactions are usually moderate, but can progress, accompanied by a drop in blood pressure, shortness of breath, up to the development of anaphylactic shock. If urticaria occurs, you should immediately consult a doctor. Cross-allergy with other sulfonylureas, sulfonamides or other sulfonamides is possible, and allergic vasculitis may also develop.

Other side effects:  in exceptional cases, the development of headache, asthenia, hyponatremia, photosensitization, late skin porphyria is possible.

Interaction

Concomitant use of glimepiride with certain medications may cause both an increase and a decrease in the hypoglycemic effect of the drug. Therefore, other medications can only be taken after consultation with your doctor.

An increase in the hypoglycemic effect and the associated possible development of hypoglycemia can 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, etc. isophosphamide, fenfluramine, fibrates, fluoxetine, sympatholytics (guanethidine), monoamine oxidase inhibitors (MAO), miconazole, pentoxifylline (with high-dose parenteral use), phenylbutazone, azapropazone, oxyphenbutazone, probenecid, quinolone antibiotics, salicylates and aminosalicylic acid, sulfinpyrazone, some long-acting sulfonamides, tetracyclines, tritoqualin, and fluconazole.

Weakening of the hypoglycemic effect, and the associated increase in blood glucose concentration, can 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 nicotinic acid derivatives, estrogens, etc. progestogens, phenothiazine derivatives, including chlorpromazine, phenytoin, rifampicin, thyroid hormones, and lithium salts.

H2-histamine receptor blockers, clonidine and reserpine can both potentiate and weaken the hypoglycemic effect of glimepiride. Under the influence of b-blockers, clonidine, guanethidine and reserpine, there may be a weakening or absence of clinical signs of hypoglycemia. When taking glimepiride, there may be an increase or decrease in the effect of coumarin derivatives. When used concomitantly with drugs that inhibit bone marrow hematopoiesis, the risk of myelosuppression increases. Single or chronic alcohol use may either increase or decrease the hypoglycemic effect of glimepiride.

How to take, course of use and dosage

The drug Diamerid is used orally. The initial and maintenance doses of glimepiride are determined individually based on the results of regular monitoring of blood glucose concentrations. Starting dose and dose selection At the beginning of treatment,1 mg of glimepiride is prescribed once a day. 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 concentration (at intervals of 1-2 weeks) to 2 mg,3 mg or 4 mg per day. Doses of more than 4 mg per day are effective only in exceptional cases. The maximum recommended daily dose is 6 mg.

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

Duration of treatment

Treatment with glimepiride is long-term, under the control of blood glucose.

Use in combination with metmorphine

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

Use in combination with insulin

In cases where glycemic control cannot be achieved by taking the maximum dose of glimepiride alone 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 concentration. Combined treatment requires mandatory medical supervision.

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 carried out in stages in accordance with the recommendations given above. It is necessary to take into account the effectiveness, dose and duration of action of the hypoglycemic agent used. In some cases, especially when taking hypoglycemic drugs with a long half-life, it may be necessary to temporarily (for several days) stop treatment in order to avoid an additive effect that increases the risk of hypoglycemia.

Switching patients from insulin to glimepiride

In exceptional cases, when insulin therapy is performed in patients with type 2 diabetes mellitus, when the disease is compensated and when the secretory function of pancreatic b cells is preserved, it is possible to replace insulin with glimepiride. The transfer should be carried out under the close supervision of a doctor. In this case, the transfer of the patient to glimepiride begins with a minimum dose of 1 mg.

Overdose

After ingestion of a large dose of glimepiride, hypoglycemia may develop, lasting from 12 to 72 hours, which may recur after the initial restoration of blood glucose concentration. In most cases, monitoring in a hospital setting is recommended.

Symptoms of hypoglycemia: increased sweating, anxiety, tachycardia, increased blood pressure, palpitation, pain in the heart, arrhythmia, headache, dizziness, sudden increase in appetite, nausea, vomiting, apathy, drowsiness, anxiety, aggressiveness, impaired concentration, depression, confusion, tremor, paresis, impaired sensitivity, convulsions of central origin. Sometimes the clinical picture of hypoglycemia may resemble a stroke. Possible development of coma.

Treatment includes inducing vomiting, drinking copiously with activated carbon (an adsorbent) and sodium picosulfate (a laxative). When taking a large amount of the drug, gastric lavage is indicated, followed by taking sodium picosulfate and activated carbon. Dextrose should be administered as soon as possible, if necessary in the form of an intravenous jet of 50 ml of a 40% solution, followed by an infusion of a 10% solution, with careful monitoring of blood glucose concentrations. Further treatment should be symptomatic.

Special instructions

Diameride should be taken at the recommended doses and at the prescribed time. Errors in the use of the drug, such as skipping an appointment, can never be eliminated by taking a higher dose later. The doctor and the patient should discuss in advance the measures that should be taken in case of such errors (for example, skipping a drug or meal) or in situations where it is impossible to take the next dose of the drug at the set time. The patient should immediately inform the doctor in case of taking too high a dose of the drug.

 The development of hypoglycemia in a patient after taking 1 mg of glimepiride per day means that it is possible to control glycemia exclusively with the help of a diet. When compensation for type 2 diabetes is achieved, insulin sensitivity increases. In this regard, the need for glimepiride may decrease during treatment. To avoid the development of hypoglycemia, it is necessary to temporarily reduce the dose or cancel glimepiride.

Dose adjustment should also be made if the patient’s body weight, lifestyle changes, or if other factors appear that increase the risk of hypo – or hyperglycemia. An adequate diet, regular and sufficient exercise, and, if necessary, weight loss are just as important for achieving optimal blood glucose control as regular glimepiride supplementation. Clinical symptoms of hyperglycemia include: increased frequency of urination, extreme thirst, dry mouth and dry skin. This should also be done in the event of an intercurrent disease or a change in the patient’s lifestyle.

Symptoms of hypoglycemia may be smoothed out or completely absent in the elderly, in patients with autonomic neuropathy, or receiving simultaneous treatment with b-blockers, clonidine, reserpine, or guanethidine. Hypoglycemia can almost always be quickly stopped by immediate intake of carbohydrates (glucose or sugar, for example, in the form of a sugar cube, sweet fruit juice or tea). In this regard, the patient should always have at least 20 g of glucose (4 lumps of sugar). Sweeteners are ineffective in treating hypoglycemia. From the experience of using other sulfonylureas, it is known that despite the initial success of hypoglycemia relief, its recurrence is possible. In this regard, continuous and careful monitoring of the patient is necessary.

Severe hypoglycemia requires immediate treatment under the supervision of a doctor, and in certain circumstances, hospitalization of the patient. If a patient with diabetes is treated by different doctors (for example, during a hospital stay after an accident, or during a weekend illness), they must inform them about their illness and previous treatment. During treatment with glimepiride, regular monitoring of liver function and the peripheral blood picture (especially the number of white blood cells and platelets) is required.

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

Individual side effects (severe hypoglycemia, severe changes in the 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 severe reactions, the patient should immediately inform the attending physician about them and in no case continue taking the drug without his recommendation.

Form of production

Tablets

Storage conditions

Store in a dry place, protected from light, at a temperature not exceeding 25 °C

Shelf life

2 years

Active ingredient

Glimepiride

Conditions of release from pharmacies

By prescription

Dosage form

Tablets