Lupimet

Type 2 DM, whenever blood sugar levels cannot be controlled adequately by diet, physical exercise & wt reduction. Replacement therapy in diabetic patients stabilized on glimepiride (1 or 2 mg) w/ metformin (500 mg).

Patient ≥18 yr 1 tab once daily. Max daily dose: Metformin 2,000 mg & glimepiride 8 mg once daily.

Should be taken with food: Swallow whole, do not chew/crush.

Hypersensitivity to metformin HCl, glimepiride, sulfonylureas, or other sulfonamides. Not suitable for type 1 DM (eg, w/ history of ketoacidosis), or of diabetic pre-coma/coma. Acute complications (severe infections, major operations, & trauma); before x-ray exam w/ iodinated contrast materials; liver damage, alcoholism; vit B₁₂, folic acid & Fe deficiencies; ketosis-prone diabetes; severe CV or resp disease; general ill health (malnutrition, dehydration); diabetes w/ significant late complications (nephropathy, retinopathy). Renal impairment. Pregnancy.

Avoid during lactation. Elderly. Glimepiride: Dosage adjustment may be necessary if risk factors for hypoglycemia are present. Severe hypoglycemia. Temporary change to insulin may be necessary in exceptional stress situations (eg, trauma, surgery, infection w/ fever). Regularly check blood & urine glucose levels; proportion of glycated Hb. May impair ability to drive or operate machinery. Metformin: Increased risk of lactic acidosis w/ hepatic impairment, renal dysfunction, hypoxemia, dehydration, sepsis, & excessive alcohol intake. Discontinue immediately in patients w/ lactic acidosis; if hypoxic states occur. Stop treatment at least 2 days before x-ray exam w/ iodinated contrast material. Discontinue treatment 48 hr before elective surgery, involving general, spinal or peridural anesth & restarted no earlier than 48 hr. Periodically monitor fasting blood glucose & glycosylated Hb levels. Concomitant therapies that may affect renal function or interfere w/ the disposition (eg, cationic drugs). Excessive alcohol intake (acute or chronic). Combination w/ sulfonylureas &/or alcohol. Annually measure vit B₁₂, folic acid & Fe for deficiencies during long-term treatment. Avoid in patients w/ hepatic diseases.

Hypoglycemia; temporary visual impairment (especially at the start of treatment); nausea, vomiting, epigastric sensations of pressure or fullness, abdominal pain & diarrhea. Allergic or pseudo-allergic reactions eg, itching, urticaria or rashes.

Glimepiride: Hypoglycemia w/ insulin & other oral antidiabetics, ACE inhibitors, allopurinol, anabolic steroids & male sex hormones, chloramphenicol, coumarin derivatives, cyclophosphamide, disopyramide, fenfluramine, fenyramidol, fibrates, fluoxetine, guanethidine, isofamide, MAOIs, miconazole, para-aminosalicylic acid, pentoxifylline (high dose parenteral), phenylbutazone, azapropazone, oxyphenbutazone, probenecid, quinolones, salicylates, sulfinpyrazone, sulfonamides, tetracyclines, tritoqualine, trofosfamide. Hyperglycemia w/ acetazolamide, barbiturates, corticosteroids, diazoxide, diuretics, epinephrine (adrenaline) & other sympathomimetic agents, glucagons, laxatives (after protracted use), nicotinic acid (high doses), estrogens & progestogens, phenothiazines, phenytoin, rifampicin, thyroid hormones. Potentiation or weakening of the blood sugar lowering effect w/ H₂-receptor antagonists, clonidine, & reserpine. May increase tendency to hypoglycemia w/ β-blockers. May potentiate or weaken effects of coumarin derivatives. Metformin: May partly offset anti-hyperglycemic effect w/ hyperglycemic agents (eg, thiazides, corticosteroids). Potentiated action on lactate metabolism & anti-hyperglycemic effect w/ alcohol. Increased plasma levels w/ furosemide & nifedipine. Reduced absorption w/ acarbose & guar gum. Cimetidine.

Antidiabetic Agents

A10BD02 - metformin and sulfonylureas ; Belongs to the class of combinations of oral blood glucose lowering drugs. Used in the treatment of diabetes.

Rx