Pioglitazone and Glimepiride

Hypoglycaemic excluding Insulin · Sulphonylurea/Thiazolidinedione

Indications

For type II diabetes, particularly overweight patients, inadequately controlled by diet and exercise for whom metformin is inappropriate. In combination in patients with an intolerance or contraindication to metformin, for type II diabetes inadequately controlled by maximal tolerated doses of either metformin or a sulphonylureas.

Dosage

Adults: One tab of 30 mg/2 mg once daily or 15 mg/4 mg once daily, the dosage of glimepiride is to be reduced if hypoglycaemia. The dosage can be increased to 30 mg/4 mg once daily. Children: Not recommended.

Adverse Effects

Pioglitazone: Monotherapy: Visual disturbance, upper respiratory tract infection, weight gain, hypoesthesia. With metformin: Anaemia, weight gain, headache, visual disturbance, arthralgia, haematuria, erectile dysfunction, oedema. With a sulphonylureas: Weight gain, dizziness, flatulence, oedema, arthralgia. Triple therapy: Raised creatine kinase, hypoglycaemia, arthralgia. With insulin: Hypoglycaemia, back pain, arthralgia, dyspnoea, cardiac failure. Glimepiride: Hypoglycaemia, signs of adrenergic counterregulation, hepatitis, liver failure, thrombocytopenia, haemolytic anaemia, GI upset, skin reactions, blood dyscrasias, transient visual disturbances.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Contraindicated in pregnancy. Lactation: Contraindicated or not recommended. Contraindications: Pioglitazone: Dialysis, hepatic impairment. Cardiac failure or history of cardiac failure, diabetic ketoacidosis. Bladder cancer or history of bladder cancer, uninvestigated haematuria. Glimepiride: Insulin-dependent (type 1) diabetes mellitus, diabetic ketoacidosis, diabetic precoma or coma, hypersensitivity to glimepiride or other sulfonylureas or sulfonamides, serious renal or hepatic dysfunction, dialysis patients. Precautions: Pioglitazone: Monitor for fluid retention or other signs of cardiac failure (discontinue if deteriorates). Monitor for signs of hepatic dysfunction and check liver enzymes prior to therapy and every 2 months thereafter for at least 12 months. Monitor body-wt. Glimepiride: Regular monitoring of glucose levels in blood and urine. Milder or absent symptoms…

Interactions

Pioglitazone: Insulin (contraindicated), NSAIDs, gemfibrozil, rifampicin. Glimepiride: Insulin, oral antidiabetics, ACE-inhibitors, allopurinol, anabolic steroids and male sex hormones, probenecid, quinolones, salicylates, sulfinpyrazone, sulfonamides, tetracyclines, tritoqualine, trofosfamide, acetazolamide, barbiturates, corticosteroids, diazoxide, diuretics, epinephrine and other sympathomimetic agents, glucagon, laxatives, nicotinic acid (in high doses), oestrogens, phenothiazines, phenytoin, rifampicin, thyroid hormones, H2-receptor antagonists, clonidine, reserpine, acute and chronic alcohol intake, NSAIDs, phenylbutazone, anticoagulants, MAOIs, beta blockers, chloramphenicol, disopyramide, fibrates, azole antifungals, clarithromycin, cyclophosphamide, pentoxifylline, colesevelam.

Pharmacokinetics

PIOGLITAZONE: Onset: Delayed. Absorption: Oral: Rapid. Metabolism: Hepatic. Bioavailability: > 80%. Half-life elimination: 3-7 hrs. Time to peak, plasma: 2 hrs. Excretion: Urine (15%-30%). Faeces (mainly). GLIMEPIRIDE: Onset of action: Peak effect: Blood glucose reductions: 2-3 hrs. Duration: 24 hrs. Absorption: 100%. Metabolism: Hepatic. Half-life elimination: 5-9 hrs. Time to peak, plasma: 2-3 hrs. Excretion: Urine, faeces.

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

Always consult a pharmacist or doctor.