Gliclazide and Metformin

Hypoglycaemic excluding Insulin · Biguanide/Sulphonylurea

Indications

Adjunct to diet & exercise in NIDDM when gliclazide or metformin monotherapy results in inadequate glycaemic control.

Dosage

Adults: The dosage administered according to individual glucose blood level. Usual initial dosage is 80 mg gliclazide and 500 mg metformin. Subsequently the adjustments are done on the basis of glucose blood level achieved. Children: Not recommended.

Adverse Effects

GLICLAZIDE: Hypoglycaemia, GI disturbances including nausea, dyspepsia, diarrhoea and constipation. Skin reactions, hepatic failure, hepatitis, jaundice, blood dyscrasias. METFORMIN: GI upset, taste disturbance, rarely lactic acidosis, abnormal liver function tests, hepatitis, skin reactions, reduced B12 absorptions.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Contraindicated in pregnancy. Lactation: Contraindicated or not recommended. Contraindications: GLICLAZIDE: Type I diabetes, diabetic ketoacidosis, pre-coma and coma, severe renal or hepatic insufficiency. Surgery, severe trauma, infections. Porphyria. METFORMIN: Diabetic ketoacidosis or precoma, renal or hepatic impairment. Acute conditions predisposing to renal impairment. Cardiac or respiratory failure, recent MI, alcoholism. Administration of iodinated contrast materials. Discontinue for 48 hours before and after elective surgery. Precautions: Gliclazide: Children. Mild to moderate renal or hepatic impairment, obesity, G6PD deficiency, risk factors for hypoglycaemia ( incl malnourishment, severe vascular disease, adrenal or pituitary insufficiency, hypothyroidism). METFORMIN: Assess risk factors for lactic acidosis; discontinue immediately if metabolic acidosis suspected.…

Interactions

GLICLAZIDE: Miconazole, phenylbutazone, alcohol, insulin, acarbose, biguanides, beta-blockers, fluconazole, ACE inhibitors, H2 receptor antagonists, MAOIs, sulphonamides, NSAIDs, danazol, chlorpromazine, glucocorticoids, ritodrine, salbutamol, terbutaline, anticoagulants, salicylates, disopyramide, chloramphenicol, azole antifungal, quinolones, clarithromycin, cimetidine, corticosteroids, diuretics, phenothiazines, B2 agonists, tetracyclines, oral contraceptives, thyroid hormones, danazol, St John's wort. METFORMIN: Alcohol, iodinated contrast agents, diuretics, corticosteroids, ACE inhibitors, sympathomimetics, NSAIDs, other hypoglycaemics. Inhibitors of OCT2 (e.g., cimetidine, dolutegravir, ranolazine, trimethoprim).

Advice to Patient

Take with meals.

Pharmacokinetics

GLICLAZIDE: Duration: 10-24 hrs. Absorption: Readily absorbed from GI tract but may have wide inter- and intra-individual variability. Metabolism: Hepatic. Bioavailability: Low. Half-life elimination: 10-12 hrs. Time to peak, plasma: 4-6 hrs. Excretion: Urine (60%-70%). Faeces (10-20%). METFORMIN: Onset of action: Within days, max effects up to 2 wks. Metabolism: Not metabolized by the liver. Bioavailability: Absolute: Fasting: 50%-60%. Half-life elimination: Plasma: 4-9 hrs. Blood: Approx. 17.6 hrs. Time to peak, serum: Immediate release: 2-3 hrs. Extended release: 7 hrs. (Range: 4-8 hrs). Excretion: Urine.

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.