Diomeride pills 4mg №30

Pills

Composition

1 pill contains Glimepiride in terms of 100% substance - 4 mg

Packing

30 pieces

Mechanism of action

Diomeride acts mainly by stimulating the secretion and release of insulin from the beta cells of the pancreas (pancreatic action). Like other sulfonylurea derivatives, this effect is based on an increase in the response of beta cells of the pancreas to physiological stimulation by glucose, while the amount of secreted insulin is much less than with the action of traditional sulfonylurea derivatives. The least stimulating effect of glimepiride on insulin secretion provides a lower risk of hypoglycemia. In addition to this, glimepiride has an extra pancreatic action — the ability to improve the sensitivity of peripheral tissues (muscle, fat) to the action of its own insulin, and to reduce the absorption of insulin by the liver; inhibits glucose production in the liver. Glimepiride selectively inhibits cyclooxygenase and reduces the conversion of arachidonic acid to thromboxane A2, which promotes platelet aggregation, thus providing an antiplatelet effect.Glimepirid contributes to the normalization of lipids, reduces the concentration of malondialdehyde in the blood, which leads to a significant decrease in lipid peroxidation, it contributes to the anti-atherogenic effect of the drug. Glimepiride increases the level of endogenous α-tocopherol, the activity of catalase, glutathione peroxidase and superoxide dismutase, which helps reduce the severity of oxidative stress in the body of a patient who is constantly present in type 2 diabetes.

Indications and usage

Type 2 diabetes mellitus with the ineffectiveness of a previously prescribed diet and exercise. With the ineffectiveness of monotherapy with glimepiride, it may be used in combination therapy with Metformin or insulin.

Contraindications

• type 1 diabetes;
• diabetic ketoacidosis, diabetic precoma and coma;
• conditions involving a violation of food intake and the development of hypoglycemia (including infectious diseases);
• leukopenia;
• severe abnormal liver function;
• severe renal dysfunction (including patients on hemodialysis);
• hypersensitivity to glimepiride or to any inactive component of the drug, to other sulfonylurea derivatives or to sulfanilamide drugs (risk of developing hypersensitivity reactions);
• pregnancy and lactation;
• lactose intolerance, lactase deficiency, glucose-galactose malabsorption;
• > children's age up to 18 years.

Carefully 
Conditions requiring the transfer of the patient to insulin therapy (extensive burns, severe multiple injuries, large surgical interventions, as well as violations of the absorption of food and drugs in the gastrointestinal tract - intestinal obstruction, paresis of the stomach, etc.).

Pregnancy and Breastfeeding

Glimepiride is contraindicated for use in pregnant women. In the case of a planned pregnancy or pregnancy, a woman should be transferred to insulin therapy. Since glimepiride penetrates into breast milk, it should not be given to women during lactation. In this case, it is necessary to switch to insulin therapy or stop breastfeeding.

Dosage and administration

The preparation Diomeride is applied inside. The initial and maintenance doses of glimepiride are determined individually on the basis of the results of regular monitoring of the concentration of glucose in the blood.Initial dose and dose selection 
At the beginning of treatment, 1 mg of glimepiride is prescribed once a day. When an optimal therapeutic effect is achieved, it is recommended to take this dose as a maintenance dose.
In the absence of glycemic control, the daily dose should be gradually increased under regular control of the concentration of glucose in the blood (at intervals of 1-2 weeks) to 2 mg, 3 mg or 4 mg per day. Doses in excess of 4 mg per day are effective only in exceptional cases.The maximum recommended daily dose is 6 mg.
Time and frequency of admission The daily dose is determined by the doctor taking into account the lifestyle of the patient. The daily dose is administered at one time immediately before or during a hearty breakfast, or the first main meal. Glimepiride pills are taken whole without chewing, with a sufficient amount of liquid (about 0.5 cups). It is not recommended to skip meals after taking glimepiride.
Duration of treatment 
Glimepiride treatment is long-term, under the control of blood glucose.
Use in combination with metmorphine 
In the absence of glycemic control in patients taking metmorphine, concomitant glimepiride therapy may be initiated. While maintaining the dose of metformin at the same level, treatment with glimepiride begins with a minimum dose, and then the dose gradually increases depending on the desired level of glycemic control, up to the maximum daily dose. Combination therapy should be carried out under close medical supervision.
Use in combination with insulin 
In cases where the glycemic control cannot be achieved by taking the maximum dose of glimepiride in monotherapy or in combination with the maximum dose of metformin, a combination of glimepiride with insulin is possible. In this case, the last dose of glimepiride assigned to the patient remains unchanged.In this case, insulin treatment begins with a minimum dose, with the possible subsequent gradual increase in its dose under the control of glucose concentration in the blood. Combined treatment requires mandatory medical supervision.
Transfer of a patient from another oral hypoglycemic drug to glimepiride 
When transferring a patient from another oral hypoglycemic drug to glimepiride, the initial daily dose of the latter should be 1 mg (even if the patient is transferred to glimepiride from the maximum dose of another oral hypoglycemic drug). Any increase in the dose of glimepiride should be carried out in stages in accordance with the above recommendations. The efficacy, dose and duration of action of the hypoglycemic agent used must be taken into account. In some cases, especially when taking hypoglycemic drugs with a long half-life, it may be necessary to temporarily (within a few days) discontinue treatment in order to avoid an additive effect that increases the risk of hypoglycemia.
Transfer of the patient from insulin to glimepiride 
In exceptional cases, when insulin therapy is performed in patients with type 2 diabetes mellitus, when compensating for the disease and when the secretory function of b-cells of the pancreas is preserved, insulin can be replaced with glimepiride. Translation must be carried out under the close supervision of a physician.In this case, the transfer of the patient to glimepiride begins with a minimum dose of 1 mg.

Adverse reactions

Metabolism: may develop hypoglycemic reactions. These reactions mainly occur shortly after taking the drug, can have a severe form and over and they are not always easy to stop. The onset of these symptoms depends on individual factors, such as dietary patterns and dosing.
On the part of the organ of vision: during treatment (especially at its onset) transient visual disturbances due to changes in glucose concentration in the blood may occur.
On the part of the digestive system: nausea, vomiting, feeling of heaviness or discomfort in the epigastrium, abdominal pain, diarrhea, very rarely leading to discontinuation of treatment; increased activity of “liver” enzymes, cholestasis, jaundice, hepatitis (up to the development of liver failure).
From the hemopoietic system: thrombocytopenia (moderate to severe), leukopenia, hemolytic or aplastic anemia, erythrocytopenia, granulocytopenia, agranulocytosis and pancytopenia.Allergic reactions: urticaria may appear (itching, skin rash). Such reactions are, as a rule, moderately pronounced, but can progress, accompanied by a drop in blood pressure, shortness of breath, up to the development of anaphylactic shock. If urticaria appears, consult a doctor immediately.Possible cross-allergy with other sulfonylurea derivatives, sulfonamides or other sulfonamides, it is also possible the development of allergic vasculitis.
Other side effects: in exceptional cases, headache, asthenia, hyponatremia, photosensitivity, and late skin porphyria may develop.

Diomeride should be taken in recommended doses and at the scheduled time. Errors in the use of the drug, for example, skipping a dose, can never be eliminated by the subsequent intake of a higher dose. The doctor and the patient should discuss in advance the measures to be taken in case of such errors (for example, skipping the drug or eating) or in situations where it is impossible to take the next dose of the drug at the scheduled time. The patient should immediately inform the doctor in case of receiving too high a dose of the drug. The development of hypoglycemia in a patient after taking 1 mg of glimepiride per day means that glycemia can be controlled solely by diet. When compensation for type 2 diabetes is achieved, insulin sensitivity is increased. In this regard, the need for glimepiride may decrease during the treatment process. In order to avoid the development of hypoglycemia, it is necessary to temporarily reduce the dose or cancel glimepiride. Dose adjustment should also be carried out with a change in the patient’s body weight, lifestyle, or other factors that increase the risk of developing hypo- or hyperglycemia.Adequate diet, regular and sufficient exercise and, if necessary, weight loss are just as important for achieving optimal control of blood glucose levels as regular glimepiride intake. Clinical symptomshyperglycemia are: an increase in the frequency of urination, severe thirst, dry mouth and dry skin. This must also be done in the case of an intercurrent disease or a change in the lifestyle of the patient. Symptoms of hypoglycemia may be smoothed out or absent altogether in the elderly, in patients with autonomic neuropathy, or b-blockers, clonidine, reserpine, guanetidine, receiving simultaneous treatment. Hypoglycemia can almost always be quickly stopped by taking carbohydrates immediately (glucose or sugar, for example, in the form of a piece of sugar, sweet fruit juice or tea). In this regard, the patient should always carry at least 20 g of glucose (4 pieces of sugar). Sweeteners are ineffective in the treatment of hypoglycemia. From the experience of using other sulfonylurea drugs, it is known that, despite the initial success in stopping hypoglycemia, it is possible to relapse. In this regard, continuous and careful observation of the patient is necessary. Severe hypoglycemia requires immediate treatment under the supervision of a physician, and under certain circumstances, hospitalization of the patient. If a patient with diabetes is treated by various doctors (for example,during his stay in hospital after an accident, during illness on weekends), he must inform them of his illness and prior treatment. During treatment with glimepiride, regular monitoring of liver function and a picture of peripheral blood (especially the number of leukocytes and platelets) is required. In stressful situations (for example, in case of injury, surgery, infectious diseases involving fever), it may be necessary to temporarily transfer the patient to insulin therapy. There is no experience with glimepiride in patients with severe impaired liver and kidney function or patients on hemodialysis. Patients with severe impaired renal function and liver are shown to be transferred to insulin therapy. During treatment with glimepiride, regular monitoring of the glucose concentration in the blood, as well as the concentration of glycated hemoglobin is necessary. Individual side effects (severe hypoglycemia, serious changes in the blood picture, severe allergic reactions, liver failure) may, under certain circumstances, pose a threat to the patient's life. In the event of the development of undesirable or severe reactions, the patient should immediately inform the attending physician about them and in no case should continue taking the drug without his recommendation.

The simultaneous use of glimepiride with some drugs can cause both strengthening and weakening of the hypoglycemic effect of the drug. Therefore, other drugs can be taken only after consultation with the doctor.
Strengthening hypoglycemic action and, in connection with this, the possible development of hypoglycemia can be observed with the simultaneous use of Glimepiride with insulin, aphorium, aphorium, aphrophyne, aphrophyne, antifungal enzyme inhibitors, aloloprinol, anabolic steroids and male sex hormones, chloramphenicol, anlolopinol, anabolic steroids and male sex hormone isophosphamide, fenfluramine, fibrates, Fluoxetine, sympatholytic (guanetidine), monoamine oxidase inhibitors (MAO), miconazole, entoksifillinom (when administered parenterally in high doses), phenylbutazone, azapropazone, oxyphenbutazone, probenecid, quinolone antibiotics, salicylates and aminosalicylic acid, sulfinpyrazone, some sulfonamides prolonged action, tetracyclines, tritokvalinom, Fluconazole .
The weakening of hypoglycemic actionand associated with this, an increase in the concentration of glucose in the blood can be observed with the simultaneous use of glimepiride with acetazolamide, barbiturates, glucocorticosteroids, diazoxide, saluretics, thiazide diuretics,epinephrine and other sympathomimetic agents, glucagon, laxatives (with prolonged use), nicotinic acid (at high doses) and nicotinic acid derivatives, estrogens and progestogens, phenothiazine derivatives, including chlorpromazine, phenytoin, rifampin, thyroid hormones, lithium salts . Blockers H₂-histamine receptors, clonidine and reserpine are able to both potentiate and weaken the hypoglycemic effect of glimepiride. Under the action of b-adrenergic blockers, clonidine, guanethidine and reserpine, the weakening or absence of clinical signs of hypoglycemia is possible. Against the background of glimepiride intake, the effect of coumarin derivatives may be enhanced or weakened. With simultaneous use with drugs that inhibit bone marrow hematopoiesis, the risk of myelosuppression increases. Single or chronic drinking can both strengthen and weaken the hypoglycemic effect of glimepiride.

After ingestion of a large dose of glimepiride, hypoglycemia may develop, lasting from 12 to 72 hours, which may recur after the initial recovery of glucose concentration in the blood. In most cases, it is recommended observation in the hospital.
Symptoms of hypoglycemia: increased sweating, anxiety, tachycardia, increased blood pressure, palpitations,pain in the heart, arrhythmia, headache, dizziness, a sharp increase in appetite, nausea, vomiting, apathy, drowsiness, anxiety, aggressiveness, impaired concentration, depression, confusion, tremor, paresis, impaired sensitivity, convulsions of central genesis. Sometimes the clinical picture of hypoglycemia may resemble a stroke. Perhaps the development of coma.
Treatment includes induction of vomiting, plentiful drink with Activated carbon (adsorbent) and sodium picosulphate (laxative). When a large amount of the drug is taken, gastric lavage is indicated, followed by sodium picosulphate and activated carbon. Dextrose administration is started as soon as possible, if necessary in the form of an intravenous stream of 50 ml of 40% solution, followed by an infusion of 10% solution, with careful monitoring of the concentration of glucose in the blood. Further treatment should be symptomatic.

In a dry, dark place, at a temperature not higher than 25 ° C. Keep out of the reach of children.