What are the contraindications of Glimepiride (Glibenclamide, a Sulfonylurea)

From the Guidelines

Glimepiride is contraindicated in patients with severe renal impairment (eGFR <15 mL/min/1.73 m²) and should be used with caution in those with moderate renal impairment (eGFR 15-30 mL/min/1.73 m²) due to the increased risk of hypoglycemia 1. When considering the use of glimepiride, several important factors must be taken into account to minimize the risk of adverse effects.

• Patients with type 1 diabetes should not use glimepiride as it works by stimulating insulin release from pancreatic beta cells, which are non-functional in type 1 diabetes.
• Those with diabetic ketoacidosis should avoid glimepiride and instead receive insulin therapy and fluid resuscitation.
• Patients with known hypersensitivity to glimepiride or other sulfonylureas should not take this medication due to risk of allergic reactions.
• Severe hepatic impairment is a contraindication as the drug is metabolized in the liver, potentially leading to drug accumulation and hypoglycemia.
• Pregnant and breastfeeding women should generally avoid glimepiride as safer alternatives exist.
• Patients with G6PD deficiency should not use sulfonylureas like glimepiride due to risk of hemolytic anemia.
• Additionally, glimepiride should be used cautiously in elderly patients and those with adrenal or pituitary insufficiency due to increased hypoglycemia risk. According to the most recent guidelines, initiating glimepiride at a lower dose (e.g., 1 mg daily) and titrating slowly is recommended to avoid hypoglycemia in patients with moderate renal impairment 1. It is essential to carefully evaluate the benefits and risks of glimepiride in each patient, considering their individual clinical scenario and comorbidities, to ensure the best possible outcome in terms of morbidity, mortality, and quality of life. The use of glimepiride should always be guided by the most recent and highest-quality evidence, taking into account the patient's specific needs and circumstances 1.

From the FDA Drug Label

Glimepiride tablets are contraindicated in patients with a history of a hypersensitivity reaction to: • Glimepiride or any of the product's ingredients [see WARNINGS AND PRECAUTIONS (5.2)]. • Sulfonamide derivatives: Patients who have developed an allergic reaction to sulfonamide derivatives may develop an allergic reaction to glimepiride tablets. Do not use glimepiride tablets in patients who have a history of an allergic reaction to sulfonamide derivatives.

The main contraindications for Glimepiride are:

• A history of hypersensitivity reaction to Glimepiride or any of the product's ingredients
• A history of an allergic reaction to sulfonamide derivatives 2

From the Research

Glimepiride Contraindications

• The provided studies do not explicitly list contraindications for glimepiride 3, 4, 5, 6, 7.
• However, it is mentioned that glimepiride should be used with caution in the elderly and in patients with renal or hepatic disease 3.
• There is no significant difference between 4 and 8 mg/day of glimepiride, but it should be used with caution in certain patient populations 3.
• Glimepiride can be used in combination with other oral antidiabetic agents or insulin to optimize glycemic control, but the safety and efficacy of such combinations should be carefully evaluated 4.
• The studies suggest that glimepiride is generally well-tolerated, but it may be associated with a higher risk of hypoglycemia and other adverse events in certain patient populations 5, 6.

Special Considerations

• Glimepiride may be safer in patients with cardiovascular disease because of its lack of detrimental effects on ischemic preconditioning 3, 4.
• The drug can be used in older patients and those with renal compromise, but careful monitoring is recommended 4.
• Glimepiride preserves myocardial preconditioning, a protective mechanism that limits damage in the event of an ischemic event 4.

Patient Populations

• Glimepiride can be used in patients with type 2 diabetes mellitus who are not adequately controlled by dietary and lifestyle modifications 3, 4.
• The drug may be associated with a lower risk of hypoglycemia and less weight gain compared to other sulfonylureas 3, 4.
• Glimepiride is effective in reducing fasting plasma glucose, post-prandial glucose, and glycosylated hemoglobin levels 3.