Amaril (glimepiride) tablets 3 mg. №30

active ingredient: glimepiride;

1 tablet contains glimepiride 3 mg;

excipients: lactose, sodium starch (type A), povidone, microcrystalline cellulose, magnesium stearate, iron oxide yellow (E 172).

Hypoglycemic agents, with the exception of insulins. Sulfonamides, urea derivatives. ATX code A10B B12.

Glimepiride is an orally active hypoglycemic agent that belongs to the sulfonylurea group. It can be used for non-insulin-dependent diabetes mellitus.

Glimepiride acts predominantly by stimulating the release of insulin from pancreatic beta cells.

As with other sulfonylurea drugs, this effect is based on an increase in the sensitivity of pancreatic cells to physiological stimulation with glucose. In addition, glimepiride has a pronounced post-pancreatic effect, which is also characteristic of other sulfonylurea drugs.

Release of insulin. Sulfonylureas regulate insulin secretion by closing the ATP-dependent potassium channel located in the pancreatic beta cell membrane. Closing the potassium channel causes depolarization of the beta cell and, by opening calcium channels, leads to an increase in calcium influx into the cell, which in turn leads to the release of insulin by exocytosis.

Glimepiride binds at a high rate of substitution to the beta-cell membrane protein associated with the ATP-dependent potassium channel, but the location of its binding site differs from the usual binding site for sulfonylurea drugs.

Postpancreatic activity. Post-pancreatic effects include, for example, improved sensitivity of peripheral tissues to insulin and reduced utilization of insulin by the liver.

Utilization of blood glucose by peripheral tissues (muscle and fat) occurs with the help of special transport proteins located in the cell membrane. The transport of glucose into these tissues is limited by the rate of the glucose utilization step. Glimepiride very quickly increases the number of active glucose transport molecules on the plasma membranes of muscle and adipose tissue cells, which leads to stimulation of glucose uptake.

Glimepiride increases the activity of glycosylphosphatidylinositol-specific phospholipase C, with which drug-induced lipogenesis and glycogenesis can be correlated in isolated muscle and fat cells.

Glimepiride inhibits hepatic glucose production by increasing intracellular concentrations of fructose-2,6-bisphosphate, which in turn inhibits gluconeogenesis.

General characteristics. In healthy volunteers, the minimum effective oral dose was approximately 0.6 mg. The effect of glimepiride is dose-dependent and reproducible. The physiological response to acute physical exertion, that is, a decrease in insulin secretion, remains under the action of glimepiride.

There was no significant difference in the effect of glimepiride when taking the drug 30 minutes before a meal or immediately before a meal. In patients with diabetes mellitus, proper metabolic control within 24 hours can be achieved by taking the drug once a day.

Although the hydroxylated metabolite causes a slight but significant decrease in blood glucose levels in healthy individuals, this is only a minor component of the overall effect of the drug.

Use in combination with metformin. One study demonstrated improvement in metabolic control with concomitant therapy with glimepiride compared with metformin alone in patients whose diabetes is not adequately controlled by the highest doses of metformin.

Use in combination with insulin. Data on the use of the drug in combination with insulin are limited. In patients whose diabetes is not adequately controlled with maximum doses of glimepiride, concomitant insulin treatment may be initiated. In two studies, this combination achieved the same improvement in metabolic control as with insulin alone; however, combination therapy requires a lower average dose of insulin.

Special categories of patients. Children, including teenagers. In a 24-week clinical study with active control (glimepiride up to 8 mg per day or metformin at a dose up to 2000 mg per day), 285 children (aged 8-17 years) with type II diabetes participated.

Both glimepiride and metformin resulted in a significant reduction in HbA1c from baseline (glimepiride 0.95 (SD 0.41) metformin 1.39 (SD 0.40)). However, glimepiride has not been shown to be more effective than metformin in terms of mean change in HbA1c from baseline. The difference between the two treatments was 0.44% in favor of metformin. The upper limit (1.05) of the 95% confidence interval for this difference was no less than the 0.3% limit of non-inferiority.

No new safety concerns have been identified in pediatric patients compared with adult patients with type II diabetes mellitus in glimepiride treatment. There are no data on long-term efficacy and safety in children.

Type II diabetes mellitus in adults when blood sugar cannot be maintained by diet, exercise, and weight loss alone.

Amaryl is not intended for the treatment of insulin-dependent diabetes mellitus, diabetic ketoacidosis, diabetic coma. The use of the drug is contraindicated in patients with severely impaired renal or hepatic function. In case of severe impairment of kidney or liver function, the patient must be transferred to insulin.

Amaryl should not be taken by patients with hypersensitivity to glimepiride or to any auxiliary ingredient that is part of the drug, to other sulfonylurea derivatives or sulfanilamide drugs (risk of hypersensitivity reactions).

The drug is intended for oral administration.

Successful treatment of diabetes depends on patients following an appropriate diet, regular physical activity, and constant monitoring of blood and urine glucose levels. Non-compliance with the patient’s diet cannot be compensated by taking pills or using insulin.

The dosage depends on the results of blood and urine glucose tests.

The initial dose is 1 mg (1/2 tablet of 2 mg) of glimepiride per day. If such a dose allows control of the disease, it should be used for maintenance therapy.

If glycemic control is not optimal, the dose should be increased to 2, 3 or 4 mg of glimepiride per day in stages (at intervals of 1-2 weeks). For various treatment regimens, the drug is available in various dosages.

A dose of more than 4 mg per day gives better results only in selected cases. The maximum recommended dose is 6 mg Amaryl per day.

If the maximum daily dose of metformin does not provide sufficient glycemic control, concomitant therapy with glimepiride can be initiated.

Following metformin pre-dosing, glimepiride should be started at a low dose, which can then be gradually increased to the maximum daily dose, focusing on the desired level of metabolic control. Combination therapy should be carried out under medical supervision.

If the maximum daily dose of Amaryl does not provide sufficient glycemic control, if necessary, concomitant insulin therapy can be started. Following pre-dosing of glimepiride, insulin treatment should be started at a low dose, which can then be increased based on the desired level of metabolic control.

Combination therapy should be carried out under medical supervision.

Usually one dose of glimepiride per day is sufficient. It is recommended to take it shortly before or during a hearty breakfast or, if there is no breakfast, shortly before or during the first main meal. Errors in the use of the drug, such as skipping the next dose, can never be corrected by the subsequent intake of a higher dose. The tablet should be swallowed without chewing with liquid.

If a patient has a hypoglycemic reaction to the use of glimepiride at a dose of 1 mg per day, this means that diabetes mellitus can only be controlled by diet.

Improved control of diabetes is accompanied by an increase in insulin sensitivity, so the need for glimepiride may decrease during the course of treatment. To avoid hypoglycemia, gradually reduce the dose or interrupt therapy altogether. The need to revise the dosage may also arise if the patient has a change in body weight or lifestyle, or other factors that increase the risk of hypo- or hyperglycemia.

Switching from oral antidiabetic agents to Amaryl.

It is usually possible to switch from other oral hypoglycemic agents to Amaryl. During such a transition, the strength and half-life of the previous agent should be taken into account. In some cases, especially if the antidiabetic drug has a long half-life (for example, chlorpropamide), it is recommended to wait a few days before starting Amaryl. This reduces the risk of hypoglycemic reactions due to the additive action of the two agents.

The recommended starting dose is 1 mg glimepiride per day. As noted above, the dose can be gradually increased taking into account the reactions to the drug.

Switching from insulin to Amaryl.

In exceptional cases, patients with type II diabetes mellitus taking insulin may be shown to replace it with Amaryl. Such a transition should be carried out under the supervision of a physician.