Adverse Reactions:
Glimepiride is generally well tolerated. However, following are the side effects reported during treatment with glimepiride.
Hypoglycaemia: Hypoglycaemia is the greatest potential risk with all sulfonylureas.
Visual reactions: There may be temporary visual impairment (e.g. changes in accommodation and/or blurred vision) due to the change in blood glucose levels, especially at the start of treatment.
Gastrointestinal reaction: Occasionally gastrointestinal symptoms such as nausea, vomiting, sensations of pressure or fullness in the epigastrium, abdominal pain, and diarrhea may occur.
Haematologic reactions: Rarely, thrombocytopenia, and in isolated cases, leucopenia may develop. In isolated instances, thrombocytopenic purpura, agranulocytosis, pancytopenia due to myelosuppression, eosinophilia, haemolyti anemia aplastic anemia, erythrocytopenia and granulocytopenia may occur.
Dermatologic reactions: Occasionally, allertic or pseudo-allergic skin reactions (e.g. pruritus, erythema, urticaria, erythematous and maculopapular and bullous skin eruptions or psoriasiforom drug eruption) may occur in patients treated with sulfonylureas
Hepatic reactions: Increased liver enzymes (AST,ALT), abnormal liver function, cholestasis, cholestatis hepatitis, granulomatous hepatitis, bilirubinaemia aernia and liver failure have been reported with sulfonylurea in isolate cases.
Electrolyte imbalance: In isolated cases, hyponatremia has been reported in patients receiving glimepiride and other sulfonylureas, most often in patients who are on other medications or have medical conditions known to cause hyponatremia or to increase release of anti-diuretic hormone.
Others: Isolated cases of allergic vasculitis have been reported with sulfonylureas.
Contraindications:
• Glimperide is contraindicated in patients with known hypersensitivity to the drug.
• Diabetic ketoacidosis, with or without coma. This condition should be treated with insulin.
Precautions:
The patient’s fasting blood glucose and HbA1C must be measured periodically to determine the minimum effective dose for the patient; to detect primary failure, i.e. inadequate lowering of blood glucose at the maximum recommended dose of medication; and to detect secondary failure, i.e., loss of adequate blood glucose lowering response. After an initial period of effectiveness glycosylated hemoglobin levels should be performed to monitor the patient’s response to therapy.
Hypoglycemia
All sulfonylurea drugs are capable of producing severe hypoglycemia. Proper patient selection, dosage, and instructions are important to avoid hypoglycemic episodes. Debilitated patients, malnourished patients and patients with adrenal, pituitary, renal, or hepatic insufficiency are particularly susceptible to the hypoglycemic action of sulfonylureas and should therefore be carefully monitored. The dosage of glimepiride should be carefully adjusted in these patients. Hepatic insufficiency may cause increased serum concentrations of glimepiride and may diminish gluconeogenic capacity, both of which increase the risk of severe hypoglycemic reactions. Alcohol ingestion, severe or prolonged exercise, deficient caloric intake or use of more than one antidiabetic agent may predispose patients to the development of hypoglycaemia.
