What dose of Gliclazide (sulfonylurea) is equivalent to 2mg of Glimepiride (sulfonylurea)?

Glimepiride 2 mg is Equivalent to Gliclazide 60-80 mg

Glimepiride 2 mg is approximately equivalent to gliclazide 60-80 mg in terms of glucose-lowering efficacy. 1

Sulfonylurea Comparison and Equivalence

• Glimepiride and gliclazide are both second-generation sulfonylureas that stimulate insulin secretion from pancreatic β-cells and have high glucose-lowering efficacy 2
• The GUIDE study, a large-scale head-to-head comparison of these two medications, demonstrated that both drugs provide similar glycemic control with HbA1c reductions from approximately 8.2-8.4% to 7.2% 1
• In the GUIDE study, gliclazide MR (modified release) 30-120 mg was compared to glimepiride 1-6 mg, with the distribution of doses being similar between groups for equivalent glycemic control 1

Dosing Considerations

• For glimepiride, the effective dosage range is 0.5 to 8 mg/day, with little difference in efficacy between 4 and 8 mg/day 3
• For gliclazide, the dosing range is typically 30-120 mg for the modified-release formulation 1
• When converting between sulfonylureas, it's important to consider that glimepiride 2 mg falls in the low-to-mid range of its dosing spectrum, corresponding to approximately 60-80 mg of gliclazide 1, 4

Safety Profile Differences

• Gliclazide may have a lower risk of hypoglycemia compared to glimepiride. In the GUIDE study, confirmed hypoglycemic episodes (blood glucose <3 mmol/L) occurred in 3.7% of patients on gliclazide MR versus 8.9% of patients on glimepiride 1
• Both medications are considered newer-generation sulfonylureas that confer a lower risk of hypoglycemia compared to older agents like glibenclamide 2
• For patients with renal impairment, dosing adjustments may be needed for both medications, but gliclazide may be preferred in patients with GFR <30 ml/min/1.73 m² 2

Clinical Implications

• When switching between these medications, careful monitoring for hypoglycemia is essential, especially during the transition period 4
• Fasting serum glucose levels and HbA1c should be monitored to determine the optimal dose for each patient after switching 4
• Both medications can be used as monotherapy or in combination with other antidiabetic agents such as metformin 5
• The choice between glimepiride and gliclazide should consider individual patient factors including hypoglycemia risk, renal function, and cost 2

Cost Considerations

• Both medications are available as generics and are relatively inexpensive compared to newer classes of antidiabetic medications 2
• According to recent pricing data, glimepiride 4 mg has a median AWP of $73 and NADAC of $3 for a 30-day supply 2
• Gliclazide is not listed in the US pricing tables as it is not FDA-approved in the United States, though it is widely used internationally 2

Practical Conversion Approach

• When converting from glimepiride 2 mg to gliclazide:
  • Start with gliclazide 60 mg daily and monitor blood glucose response 1, 4
  • Adjust dose as needed based on glycemic control and hypoglycemia risk 4
• When converting from gliclazide to glimepiride 2 mg:
  • If on gliclazide 60-80 mg, a direct switch to glimepiride 2 mg is appropriate 1, 4
  • If on higher doses of gliclazide (>80 mg), consider starting with glimepiride 3-4 mg 4