Gliclazide Dosing for Adults with Type 2 Diabetes
The recommended starting dose of gliclazide modified release (MR) for adults with type 2 diabetes is 30 mg once daily, with titration up to a maximum of 120 mg once daily based on glycemic response.
Dosing Guidelines
Initial Dosing and Titration
- Starting dose: 30 mg once daily, taken with breakfast
- Titration: Dose can be increased based on glycemic response
- Maximum dose: 120 mg once daily
- Dosing frequency: Once daily administration (for MR formulation)
Dose Adjustment Based on Response
- Assess glycemic control after 4-6 weeks of treatment
- If glycemic targets are not met, increase dose in increments of 30 mg
- Follow stepwise titration: 30 mg → 60 mg → 90 mg → 120 mg
Special Populations
Renal Impairment
- eGFR >30 mL/min/1.73m²: No dose adjustment required
- eGFR <30 mL/min/1.73m²: Use with caution; consider starting at lower dose (30 mg)
- Dialysis: Generally not recommended
Elderly Patients
- Start at 30 mg once daily
- Titrate more cautiously to minimize risk of hypoglycemia
- Monitor more frequently for hypoglycemic events
Hepatic Impairment
- Mild to moderate impairment: Start at 30 mg once daily
- Severe impairment: Not recommended
Monitoring and Safety
Hypoglycemia Risk
- Gliclazide MR has a lower risk of hypoglycemia compared to other sulfonylureas 1
- Only 3.7% of patients experience confirmed hypoglycemia with blood glucose <3 mmol/L
- No severe hypoglycemic events requiring external assistance were reported in clinical trials
Efficacy Monitoring
- Monitor fasting and postprandial glucose levels
- Assess HbA1c after 3 months of stable dosing
- Expected HbA1c reduction: approximately 0.5-1.0% 2
Clinical Pearls
- Gliclazide MR provides 24-hour glycemic control with once-daily dosing 3
- Maximum efficacy appears to be achieved at 80 mg daily, with limited additional benefit from increasing to 160 mg daily 4
- Consider combination therapy with other agents (metformin, SGLT2 inhibitors, GLP-1 RAs) if glycemic targets are not achieved with maximum gliclazide dose
- When adding gliclazide to SGLT2 inhibitor therapy, monitor closely for hypoglycemia and consider lower initial dose
Mechanism of Action
- Gliclazide increases insulin secretion by:
- Increasing insulin secretory burst mass
- Increasing basal insulin secretion
- Does not significantly alter insulin pulse frequency or regularity 5
Advantages Over Other Sulfonylureas
- Once-daily dosing improves adherence
- Lower risk of hypoglycemia compared to glimepiride (3.7% vs 8.9% of patients) 1
- Good safety profile in elderly patients and those with impaired renal function 2
Remember that gliclazide is part of a comprehensive diabetes management plan that should include lifestyle modifications and may require combination with other antidiabetic medications based on individual patient factors and comorbidities.