Overview
Glimepiride is a second-generation sulfonylurea oral antidiabetic agent used in the management of type 2 diabetes mellitus. It stimulates insulin secretion from pancreatic beta cells and improves peripheral insulin sensitivity.
Mechanism of Action
Glimepiride binds to sulfonylurea receptors on pancreatic beta cells, leading to closure of ATP-sensitive potassium channels, depolarization of the cell membrane, opening of voltage-dependent calcium channels, and subsequent insulin secretion. It also has extrapancreatic effects including increased peripheral glucose uptake and decreased hepatic glucose production.
Indications
- Type 2 diabetes mellitus as an adjunct to diet and exercise
- May be used in combination with other antidiabetic agents when monotherapy is insufficient
Dosage
Initial dose: 1-2 mg once daily with breakfast or first main meal. Maintenance dose: 1-4 mg once daily. Maximum dose: 8 mg once daily. Dose adjustments should be based on glycemic response.
Contraindications
- Hypersensitivity to glimepiride or sulfonylureas
- Diabetic ketoacidosis
- Type 1 diabetes mellitus
- Severe renal impairment
- Severe hepatic impairment
Side Effects
- Hypoglycemia
- Headache
- Dizziness
- Nausea
- Weight gain
- Allergic skin reactions
- Hematologic effects (thrombocytopenia, leukopenia, hemolytic anemia)
- Hepatic dysfunction
- Photosensitivity reactions
Interactions
- Beta-blockers, clonidine, reserpine, guanethidine (mask hypoglycemia symptoms)
- NSAIDs, salicylates, sulfonamides, chloramphenicol, probenecid (increase hypoglycemic effect)
- Thiazides, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, isoniazid (decrease hypoglycemic effect)
- Alcohol (disulfiram-like reaction, increased hypoglycemia risk)
- Warfarin (altered anticoagulant effect)