Dosage and Administration:
In initiating treatment for non-insulin-dependent diabetes, diet and exercise should be emphasized as the primary form of treatment. There is no fixed dosage regimen for the management of diabetes mellitus with Glimepiride (Getryl) or any other hypoglycemic agent. The patient’s fasting blood glucose and HbA1c must be measure periodically to determine the minimum effective dose for the patient. Short-term administration of Glimepiride (Getryl) may be sufficient during period of transient loss of control in patients usually well controlled on diet and exercise.
Usual Starting Dose
The usual staring dose of Glimepiride (Getryl) as initial therapy is 1-2mg once daily, administered with breakfast or the first main meal. Those patients who may be more sensitive to hypoglycemic drugs should be started at 1mg once daily, and should be titrated carefully. The maximum starting dose of Glimepiride (Getryl) should not be more than 2 mg.
Usual Maintenance Dose
The usual maintenance dose of Glimperide (Getryl) is 1 to 4 mg once daily. The maximum recommendation dose is 8mg once daily. After reaching a dose of 2 mg, dose increases should be made in increments of no more than 2 mg at 1-2 week intervals based upon the patient’s blood glucose response. Long-term efficacy should be monitored by measurement of HbA1c levels, for example, every 3 to 6 months.
Glimepiride (Getryl)- Metformin Combination Therapy
If patients do not respond adequately to the maximal dose of Glimepiride (Getryl) monotherapy, addition of metformin may be considered. With concomitant Glimepiride (Getryl) and metformin therapy, the desired control of blood glucose may be obtained by adjusting the dose of each drug.
Glimepiride (Getryl) – Insulin Combination Therapy
Combination therapy with Glimepiride (Getryl) an insulin may also be used in secondary failure patients. The fasting glucose level for instituting combination therapy is in the range of >150 mg/dL in plasma or serum depending on the patient. The recommended Glimepiride (Getryl) dose is 8 mg once daily administered with the first main meal. After starting with low-dose insulin, upward adjustments of insulin can be done approximately weekly as guided by frequent measurements of fasting blood glucose.
Special Populations
In elderly, debilitated or malnourished patients, or in patients with hepatic insufficiency, the initial dosing, dose increments, and maintenance dosage should be conservative to avoid hypoglycemic reactions.
Renal impaired patients
In patients with mild to moderate renal impairment, a starting dose of 1mg once daily must not be exceeded. The dose may then be carefully titrated upwards if necessary based on fasting blood glucose levels in increments of 1 mg at intervals of one to two weeks.