From the Guidelines
Glimepiride is typically started at a low dose of 1-2 mg once daily with breakfast or the first main meal, with dose adjustments based on blood glucose response, up to a maximum daily dose of 8 mg, as recommended by recent guidelines 1. The dose can be adjusted based on blood glucose response, usually in increments of 1-2 mg every 1-2 weeks.
- For elderly patients or those with renal or hepatic impairment, a lower starting dose of 1 mg daily is recommended to minimize the risk of hypoglycemia.
- Glimepiride works by stimulating insulin release from pancreatic beta cells and improving insulin sensitivity in peripheral tissues, making it effective for lowering blood glucose in type 2 diabetes.
- It has a long duration of action, allowing for once-daily dosing.
- Patients should be monitored for hypoglycemia, especially when starting therapy or increasing doses.
- Glimepiride should be taken consistently at the same time each day, and patients should be advised that skipping meals after taking the medication increases the risk of hypoglycemia.
- Regular blood glucose monitoring is essential to assess efficacy and adjust dosing as needed, as emphasized in recent standards of care in diabetes 1. Key considerations in the management of type 2 diabetes include a patient-centered approach, taking into account comorbidities, hypoglycemia risk, impact on weight, cost, and patient preferences 1. The choice of pharmacologic agents should be guided by these factors, with the goal of achieving individualized glycemic targets while minimizing adverse effects and improving quality of life 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION There is no fixed dosage regimen for the management of diabetes mellitus with glimepiride or any other hypoglycemic agent. The usual starting dose of glimepiride as initial therapy is 1-2 mg once daily, administered with breakfast or the first main meal. The usual maintenance dose is 1 to 4 mg once daily. The maximum recommended dose is 8 mg once daily.
The recommended dosing for glimepiride in patients with type 2 diabetes is:
- Usual Starting Dose: 1-2 mg once daily, administered with breakfast or the first main meal.
- Usual Maintenance Dose: 1 to 4 mg once daily, with a maximum recommended dose of 8 mg once daily.
- Dose increments should be made in increments of no more than 2 mg at 1-2 week intervals based upon the patient’s blood glucose response 2.
From the Research
Glimperide Dosing
- The recommended dosing for glimperide (glimepiride) in patients with type 2 diabetes is typically started at 1 mg/day, titrated to glycaemic control at 1- to 2-week intervals to a usual dosage range of 1 to 4 mg/day (maximum 6 mg/day in the UK or 8 mg/day in the US) 3.
- The effective dosage range of glimepiride is 0.5 to 8 mg/day, although there is little difference in efficacy between dosages of 4 and 8 mg/day 3.
- A study found that low-dose glimepiride (0.5-2 mg/day) in combination with sitagliptin improves glycemic control without dose-dependency in patients with type 2 diabetes inadequately controlled on high-dose glimepiride 4.
Combination Therapy
- Glimepiride can be used in combination with other oral antidiabetic drugs, such as metformin, to improve glycemic control in patients with type 2 diabetes 5, 6.
- The addition of glimepiride to metformin monotherapy has been shown to result in superior glycaemic control compared with glimepiride or metformin monotherapy 5.
- Combination therapy with glimepiride and metformin has also been shown to reduce the daily insulin dose, weight gain, and hypoglycemic episodes in patients with type 2 diabetes mellitus 6.
Safety and Efficacy
- Glimepiride has been shown to be safe and effective in patients with type 2 diabetes, with a lower incidence of hypoglycaemia compared to other sulphonylureas 3, 7.
- The incidence of symptomatic hypoglycaemia was higher in patients treated with glimepiride in combination with insulin, but the combination therapy was still effective in improving glycemic control 7, 6.