Amaryl M 2 mg+500 mg (Tablet (Prolonged Release))

Unit Price: ৳ 18.00 (3 x 10: ৳ 540.00)
Strip Price: ৳ 180.00

Medicine Details

Category Details
Generic Glimepiride metformin
Company Synovia pharma plc
Also available as
Amaryl m 1 mg tablet

Therapeutic Class

  • Combination Oral hypoglycemic preparations

Indications

  • Adjunct to diet and exercise in type 2 diabetes mellitus patients
  • Monotherapy with glimepiride or metformin not resulting in adequate glycemic control
  • Replacement of combination therapy of glimepiride and metformin

Pharmacology

  • Glimepiride: Sulfonylurea antidiabetic agent
  • Stimulates release of insulin from pancreatic beta cells
  • Improves sensitivity of beta cells to glucose stimulus
  • Reduces basal hepatic glucose production
  • Increases peripheral tissue sensitivity to insulin and glucose uptake
  • Metformin Hydrochloride: Biguanide type oral antihyperglycemic drug
  • Lowers both basal and postprandial plasma glucose
  • Improves insulin sensitivity
  • Decreases hepatic glucose production
  • Decreases intestinal absorption of glucose

Dosage

  • Governing factor is desired blood glucose level
  • Must be the lowest sufficient to achieve desired metabolic control
  • Glucose levels in blood and urine must be measured regularly
  • Timely dose reduction or cessation of therapy must be considered to avoid hypoglycemia
  • Highest recommended dose per day: 8 mg of glimepiride and 2000 mg of metformin

Administration

  • Tablet must be swallowed whole and not crushed or chewed

Interaction

  • Glimepiride: Metabolized by cytochrome P450 2C9 (CYP2C9)
  • Potentiation of blood-glucose-lowering effect and hypoglycemia with certain drugs
  • Weakening of blood-glucose-lowering effect and raised blood glucose levels with certain drugs
  • Acute and chronic alcohol intake may potentiate or weaken the blood-glucose-lowering action in an unpredictable fashion
  • Metformin: Concomitant use not recommended with alcohol, iodinated contrast agents, and combinations requiring precautions for use

Contraindications

  • Hypersensitivity to glimepiride, metformin, sulfonylureas, sulfonamides, or any excipients
  • Pregnancy, breastfeeding
  • Severe impairment of liver function, dialysis, acute metabolic acidosis, severe renal failure, renal dysfunction, acute conditions altering renal function, tissue hypoxia, hepatic insufficiency, acute alcohol intoxication, alcoholism

Side Effects

  • Hypoglycemia, prolonged hypoglycemia, temporary visual impairment, gastrointestinal symptoms, hepatitis, elevation of liver enzyme levels, cholestasis, jaundice, blood disorders, alopecia, allergic or pseudo allergic reactions, decrease in serum sodium concentration, weight gain
  • Gastrointestinal symptoms, metallic taste, decrease of vitamin B12 absorption, lactic acidosis, hemolytic anemia, reduction of thyrotropin level, hypomagnesemia, encephalopathy, photosensitivity, hepatobiliary disorders

Pregnancy & Lactation

  • Glimepiride: Must not be taken during pregnancy, change over to insulin recommended
  • Metformin: Diabetes should not be treated with metformin during pregnancy, insulin should be used to maintain blood glucose levels as close to normal as possible
  • Glimepiride: Must not be taken by breastfeeding women, change over to insulin recommended
  • Metformin: Excreted into milk in lactating rats, decision should be made whether to discontinue nursing or metformin

Precautions & Warnings

  • Initial weeks of treatment, risk of hypoglycemia may be increased
  • Severe hypoglycemia requires immediate treatment and follow-up by a physician
  • Caution in patients with G6PD-deficiency, non-sulfonylurea alternative should be considered
  • Regular monitoring of TSH levels in patients with hypothyroidism
  • Long-term treatment associated with decrease in vitamin B12 serum levels, monitoring recommended

Use in Special Populations

  • Insufficient data to recommend pediatric use
  • Renal impairment: Assessment of GFR before initiation of treatment, GFR should be assessed annually, maximum daily dose of metformin should be divided into 2-3 daily doses, metformin contraindicated in GFR <30 mL/min

Overdose Effects

  • Acute overdosage or treatment with too high a dose of glimepiride may lead to severe hypoglycemia
  • Hypoglycemia not seen with metformin doses up to 85 g, lactic acidosis occurred in such circumstances, treatment in hospital necessary
  • Pancreatitis may occur in the context of a metformin overdose

Storage Conditions

  • Store in a cool and dry place, protected from light

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