OralType 2 diabetes mellitusAdult: Each tab contains pioglitazone 15 mg or 30 mg and glimepiride 2 mg or 4 mg: Initially, 1 tab once daily then titrate gradually as needed. Elderly: Should start w/ glimepiride 1 mg/day prior to initiating pioglitazone + glimepiride combination.
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CrCl <22 mL/min: Should start w/ glimepiride 1 mg/day prior to initiating pioglitazone + glimepiride combination.
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Should start w/ glimepiride 1 mg/day prior to initiating pioglitazone + glimepiride combination.
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Should be taken with food. Take w/ 1st main meal of the day.
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History of allergic reaction to sulfonamide derivative. Patient w/ established CHF (NYHA class III or IV). Not intended for treatment of type 1 DM or diabetic ketoacidosis.
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Patients w/ prior history of active bladder cancer; anaemia, G6PD deficiency, symptomatic heart failure. Premenopausal/anovulatory females. May exacerbate CHF. Do not initiate in patient w/ active liver disease of ALT >2.5 times the upper limit of normal at baseline. Hepatic and renal impairment. Pregnancy and lactation.
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Fracture, macular oedema, hypoglycaemia, wt gain, peripheral oedema, upper resp tract infection, headache, nausea, anaemia, diarrhoea, UTI, limb pain.
Potentially Fatal: CHF, severe hypoglycaemia, oedema, haemolytic anaemia, hepatic failure.
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Monitor for signs and symptoms of heart failure (e.g. excessive, rapid wt gain, oedema, dyspnoea) after initiation.
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Glimepiride: Symptoms: Severe hypoglycaemia w/ coma, seizure, or neurological impairment. Management: Admin glucagon or IV glucose. Additional carbohydrate intake may be necessary as hypoglycaemia may recur after apparent clinical recovery.
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Increased plasma levels w/ CYP2C8 inhibitors (e.g. gemfibrozil) and CYP2C9 inhibitors (e.g. fluconazole). Decreased plasma levels w/ CYP2C8 inducers (e.g. rifampicin). Colesevelam may reduce the max plasma concentration and total exposure of glimepiride. Concominant use w/ oral miconazole may lead to severe hypoglycaemia.
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Alcohol may increase hypoglycaemic effect.
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Description: Pioglitazone, a thiazolidinedione, reduces blood glucose by improving target cell response to insulin w/o increasing pancreatic insulin secretion and is dependent on the presence of insulin for activity. Glimepiride, a sulfonylurea, stimulates insulin release from the pancreatic β-cells. It also reduces glucose output from the liver and increases insulin sensitivity at peripheral target sites. Pharmacokinetics: Absorption: Pioglitazone: Rapidly absorbed from the GI tract. Time to peak plasma concentrations: W/in 2 hr. Bioavailability: >80%. Glimepiride: Completely absorbed from the GI tract. Time to peak plasma concentrations: 2-3 hr. Distribution: Pioglitazone: Plasma protein binding: >99%. Glimepiride: Highly protein bound. Metabolism: Pioglitazone: Extensively metabolised mainly by CYP2C8 isoenzyme to both active and inactive metabolites. Glimepiride: Extensively metabolised to hydroxy derivative by CYP2C9 isoenzyme and to carboxy derivative by cytosolic enzymes. Excretion: Pioglitazone: Via urine and faeces. Plasma half-life: Up to 7 hr. Half-life: Up to 24 hr (active metabolites). Glimepiride: Via urine (approx 60%) and faeces (40%). Half-life: Approx 9 hr (after multiple doses).
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Anon. Pioglitazone and Glimepiride. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 30/06/2014. Buckingham R (ed). Glimepiride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 01/07/2014. Buckingham R (ed). Pioglitazone. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 01/07/2014. Duetact Tablet (Takeda Pharmaceuticals America, Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 01/07/2014. Wickersham RM. Pioglitazone/Glimepiride. Facts and Comparisons [online]. St. Louis, MO. Wolters Kluwer Clinical Drug Information, Inc. https://www.wolterskluwercdi.com/facts-comparisons-online/. Accessed 01/07/2014.
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