Home Drug Guide Glimepiride

Drug Guide

Generic Name

Glimepiride

Brand Names Amaryl

Classification

Therapeutic: Antidiabetic agent, oral—Antidiabetic (sulfonylurea)

Pharmacological: Sulfonylurea, insulin secretagogue

FDA Approved Indications

  • Monotherapy or combination therapy for type 2 diabetes mellitus to improve glycemic control.

Mechanism of Action

Stimulates release of insulin from pancreatic beta cells by binding to sulfonylurea receptors, leading to closure of ATP-sensitive potassium channels, which causes cell depolarization and insulin secretion.

Dosage and Administration

Adult: Initial dose is generally 1-2 mg once daily, titrated based on blood glucose response up to a maximum of 8 mg once daily.

Pediatric: Not approved for pediatric use.

Geriatric: Start at lower end of dosing range; monitor closely due to increased risk of hypoglycemia.

Renal Impairment: Use with caution; dosage adjustments may be necessary.

Hepatic Impairment: Use with caution; monitor closely due to decreased metabolism risk.

Pharmacokinetics

Absorption: Well absorbed from gastrointestinal tract.

Distribution: Widely distributed; protein-bound (~99%).

Metabolism: Primarily hepatic via CYP2C9 and CYP3A4 enzymes.

Excretion: Excreted mainly in urine as metabolites; minimal unchanged drug.

Half Life: Approximately 1.5-3 hours, but hypoglycemic effect lasts longer due to active metabolites.

Contraindications

  • Type 1 diabetes mellitus
  • Diabetic ketoacidosis
  • Hypersensitivity to sulfonylureas or meglitinides

Precautions

  • Use with caution in renal or hepatic impairment; risk of hypoglycemia; in elderly patients, risk of hypoglycemia is increased.

Adverse Reactions - Common

  • Hypoglycemia (Common)
  • Weight gain (Common)
  • Gastrointestinal disturbances (nausea, epigastric pain) (Less common)

Adverse Reactions - Serious

  • Severe hypoglycemia (Rare)
  • Allergic reactions (rash, pruritus, swelling) (Rare)

Drug-Drug Interactions

  • Other sulfonylureas, insulin, meglitinides (risk of hypoglycemia)
  • CYP2C9 inhibitors (e.g., fluconazole, warfarin) may increase glimepiride levels.

Drug-Food Interactions

  • Excessive alcohol intake can potentiate hypoglycemia.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood glucose levels regularly; observe for signs of hypoglycemia; check hepatic and renal function periodically.

Diagnoses:

  • Risk for hypoglycemia
  • Impaired tissue perfusion related to hypoglycemia

Implementation: Administer with breakfast or first meal of the day; educate patient on recognition and management of hypoglycemia.

Evaluation: Assess blood glucose levels and clinical response to therapy; adjust dose accordingly.

Patient/Family Teaching

  • Take medication with food to reduce gastrointestinal upset.
  • Report symptoms of hypoglycemia (sweating, trembling, confusion).
  • Maintain consistent diet and monitor blood glucose as instructed.
  • Carry quick-acting carbohydrate source in case of hypoglycemia.

Special Considerations

Black Box Warnings:

  • Potential for hypoglycemia; not for use in type 1 diabetes or diabetic ketoacidosis.

Genetic Factors: CYP2C9 genetic polymorphisms can affect drug metabolism and response.

Lab Test Interference: None significant.

Overdose Management

Signs/Symptoms: Severe hypoglycemia—confusion, seizures, unconsciousness.

Treatment: Administer glucose orally or intravenously; use of glucagon may be necessary if the patient is unconscious.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F), away from moisture and light.

Stability: Stable for the duration of the labeled expiration date when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.