Maximum Dose of Glimepiride
The maximum recommended dose of glimepiride is 8 mg once daily, administered with breakfast or the first main meal of the day. 1
Standard Dosing Parameters
- The FDA-approved maximum daily dose is definitively 8 mg once daily 1
- This maximum is confirmed by the American Diabetes Association in their 2023 Standards of Care 2, 3
- Doses should be taken with breakfast or the first main meal to optimize glucose-lowering effects and minimize hypoglycemia risk 1
Important Clinical Caveat About Maximum Dosing
If glycemic targets are not achieved at the maximum 8 mg dose, switching to insulin therapy is recommended rather than continuing at maximum dose indefinitely. 3 Further dose escalation beyond 8 mg provides no meaningful benefit and only increases hypoglycemia risk without additional glucose-lowering efficacy 3
Dose-Response Considerations
- There is minimal difference in efficacy between 4 mg and 8 mg daily doses 4, 5
- The greatest blood glucose-lowering effects occur within the first 4 hours after dosing 4
- The dose-response curve may be bell-shaped due to receptor down-regulation at higher chronic exposures 6
Special Population Adjustments
Renal Impairment
- Patients with eGFR 30-50 mL/min/1.73 m² should start at 1 mg daily with conservative titration 3
- Assess kidney function before any dose increase; eGFR <30 mL/min/1.73 m² warrants switching to alternative agents entirely 3
- Glimepiride can be used cautiously in renal impairment, unlike glyburide which should be avoided when eGFR <50 mL/min/1.73 m² 3
Elderly Patients
- Start at 1 mg daily in elderly patients due to increased hypoglycemia risk 1
- Use conservative titration with longer intervals between dose adjustments 1