Drugs for diabetes mellitus Amaryl analogue. Amaryl: how to take, what to replace, contraindications

Amaryl is a hypoglycemic drug used in the treatment non-insulin dependent diabetes .

The main active ingredient is glimepiride, which increases the production of insulin in the pancreas and thereby affects the amount of glucose.

Effectively reduces sugar, protects the body from the development complications , such as diabetic nephropathy . On the basis of glimepiride, synonyms are released under other names. Amaryl analogues have a different composition, but a similar hypoglycemic effect.

Amaryl is prescribed to patients with type 2 diabetes when diabetic diet and exercise do not stabilize sugar. Used alone or in combination with metformin or insulin.

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Subject: Grandma's blood sugar returned to normal!

From: Christina [email protected])

To: site administration

Christina
Moscow

My grandmother has been suffering from diabetes for a long time (type 2), but recently there have been complications in her legs and internal organs.

Russian counterparts

In the Russian Federation, several medicines are being manufactured that can replace Amaryl.

The drug is produced on the basis of glimepiride. Dosage - 1, 2, 3, 4 and 6 mg. The package contains 30, 60 or 100 tablets.

It is prescribed for patients with non-insulin-dependent type 2 diabetes with poor effectiveness of diabetic nutrition and physical activity. May be combined with metformin or insulin.

The initial dose consists of 1 mg taken before or during the morning meal. The maximum dose is 6 mg. A good analogue of Amaryl.

The drug is based on the active ingredient glimepiride. Dosage - 1, 2, 3 and 4 mg. The package contains 30 or 60 tablets.

It is prescribed for type 2 diabetes, when sugar is not stabilized with diabetic nutrition and physical activity. May be combined with metformin or insulin.

The starting dose consists of 1 mg taken before or during a heavy breakfast. The maximum dose is 8 mg. It is also prescribed as an analogue of Amaryl in Russia.

The drug is based on glimepiride. Dosage - 1, 2, 3 and 4 mg. The package contains 30 or 60 tablets.

It is prescribed for non-insulin-dependent type 2 diabetes, when the effect of diabetic nutrition and physical education is not enough. It can be used together with other hypoglycemic drugs.

Treatment begins with a dose of 1 mg taken before or during a heavy morning meal. The maximum dose is 6 mg. It is prescribed as an analogue of Amaryl.

The drug is produced on the basis of metformin. Dosage - 0.25, 0.5, 0.85 and 1 g. The package contains 30, 60 or 100 tablets.

It is prescribed for non-insulin-dependent diabetes, when diabetic nutrition and physical activity are not enough to stabilize sugar. It inhibits the absorption of glucose in the intestine, increases tissue susceptibility to insulin.

The initial dose consists of 0.5 or 1 g, which is used during or after meals. The maximum dose is 3 g per day, which is divided into several doses when side effects occur.

It is based on metformin 500 mg and gliclazide 40 mg. The package contains 30 or 60 tablets.

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The drug improves the production of insulin in the pancreas, increases cellular susceptibility to insulin, inhibits the absorption of sugar in the intestine, and helps the tissues to utilize it.

It is prescribed for type 2 diabetes when diabetic nutrition and physical activity do not help stabilize sugar, also for replacement therapy after treatment with two drugs (metformin and gliclazide) in patients with well-stabilized sugar.

The initial dose consists of 1-3 tablets, which are taken one or more times a day (morning and evening).

Foreign analogues

Foreign pharmaceutical companies also manufacture drugs that can be used as substitutes for Amaryl.

Avandaglim

The drug is produced on the basis of glimepiride 4 mg and rosiglitazone 4 or 8 mg. The package contains 28 tablets.

The drug improves cellular susceptibility to insulin and its production in the pancreas. It is prescribed for non-insulin dependent patients who received combination therapy with thiazolidinedione and sulfonylurea derivatives, as well as for ineffective treatment with these drugs separately. May be given concomitantly with metformin.

The drug is taken once a day during a meal.

Produced on the basis of glimepiride. The dosage of tablets is 2, 3 or 4 mg. The package contains 30 tablets.

It is prescribed for the ineffectiveness of diabetic nutrition and exercise to stabilize sugar in patients with type 2 diabetes. Increases the production of insulin in the pancreas.

The active substance in tablets is glimepiride 4 mg. The package contains 15, 30 or 60 tablets.

The action of the drug is aimed at increasing the production of insulin. Used in type 2 diabetes with unstabilized sugar in diabetic nutrition and exercise.

The initial dose for treatment is 1 mg, the maximum is 6 mg. Take before or during a hearty breakfast.

The drug contains glimepiride 1 or 2 mg and metformin 250 or 500 mg. The package contains 30 tablets.

The action is aimed at increasing insulin production and reducing tissue resistance to it.

Assign to patients with non-insulin-dependent diabetes with insufficient diabetic diet and physical activity to stabilize sugar. Also, when treatment with glimepiride and metformin alone did not give an effect or to combine both drugs in one.

The medication is taken one or more times a day with meals. The maximum allowable dose of metformin is 200 mg and glimepiride is 8 mg.

Available on the basis of metformin 500 or 1000 mg and rosiglitazone 1, 2 or 4 mg. The package contains 14, 28, 56, 112 tablets.

The drug increases cellular susceptibility to insulin and its secretion in the pancreas, inhibits the absorption of glucose in the intestine.

It is prescribed for non-insulin-dependent type 2 diabetes with insufficient diabetic nutrition and physical education for glycemic control. Also to replace monotherapy with metformin or thiazolidinedione, combotherapy with these drugs.

Treatment begins with 4 mg/1000 mg, the maximum dose is 8 mg/1000 mg. Accepted regardless of food. Used as an analogue of Amaryl M.

The drug is produced on the basis of glibenclamide 2.5 or 5 mg and metformin 500 mg. The package contains 30 tablets.

The action is aimed at increasing the production of insulin in the pancreas and increasing the susceptibility of tissues to it.

It is indicated for failure of diabetic nutrition and exercise to stabilize blood sugar in patients with type 2 diabetes and previous treatment with glibenclamide or metformin. Also to replace monotherapy with these drugs in patients with stabilized sugar.

The initial dose is 500 mg / 2.5 or 5 mg with meals, the maximum is 2 g / 20 mg.

Doctors' opinion

Shishkina E. I. Endocrinologist

I often prescribe Amaryl M to patients. It is convenient to take it, just once a day. Side effects are rare.

Alexander Igorevich, endocrinologist.

I prescribe Amaryl to patients with diabetes mellitus. Reduces sugar well. The disadvantage is the price. If you're on a budget, glimepiride is the way to go.

Due to the high cost of Amaryl, analogues are used much more often to normalize blood glucose levels in diabetics with an insulin-independent type of disease. This drug is ideal for maintaining glycemic levels during special diets and sports.

However, not everyone can afford this hypoglycemic agent. Therefore, this article will reveal the pharmacological action of Amaryl and name its main analogues produced in Russia.

Pharmacological action of the drug

Amaryl is an oral hypoglycemic drug that helps reduce blood sugar levels by stimulating the release and activation of insulin synthesis by specific beta cells located in the tissues of the pancreas.

The main mechanism for stimulating synthesis processes is that Amaryl increases the responsiveness of beta cells to an increase in the concentration of glucose in the human bloodstream.

In small doses, this drug contributes to a slight increase in insulin release. Amaryl has the ability to increase the sensitivity of cell membranes of cells of insulin-dependent tissues to insulin.

Being a derivative of a sulfonylurea, Amaryl is able to influence the process of insulin production. This is ensured by the fact that the active compound of the drug interacts with the ATP channels of beta cells. Amaryl selectively binds to proteins on the surface of the cell membrane. This property of the drug allows you to increase the sensitivity of tissue cells to insulin.

The absorption of excess glucose is carried out mainly by the cells of the muscle tissues of the body.

In addition, the use of the drug inhibits the release of glucose by cells of the liver tissue. This process occurs due to an increase in the content of fructose-2,6-biophosphate, which contributes to the inhibition of gluconeogenesis.

Activation of insulin synthesis occurs due to the fact that the active substance of the drug enhances the influx of potassium ions into the beta cells, and an excess of potassium in the cell leads to an increase in the production of the hormone.

When using combination therapy in combination with metformin, patients experience an improvement in the metabolic control of sugar levels in the body.

Combination therapy in combination with insulin injections. This method of control is used in cases where the optimal level of metabolic control is not achieved when taking a single drug. When carrying out this type of drug therapy for diabetes, a mandatory adjustment of the dose of insulin administered is required.

The amount of insulin used with this type of therapy is significantly reduced.

Pharmacokinetics of drug use

Sugar level

With a single dose of the drug at a daily dose of 4 mg, its maximum concentration is observed after 2.5 hours and is 309 ng / ml. The bioavailability of the drug is 100%. Eating does not have a special effect on the absorption process, with the exception of some insignificant slowdown in the rate of the process.

The active substance of the drug is characterized by the ability to penetrate into the composition of breast milk and through the placental barrier. This limits the possibility of using the drug during pregnancy and breastfeeding.

Metabolization of the active substance is carried out in the liver tissues. The main isoenzyme involved in metabolism is CYP2C9. During the metabolism of the main active compound, two metabolites are formed, which are subsequently excreted in the feces and urine.

The excretion of the drug is carried out by the kidneys in the amount of 58% and about 35% with the help of the intestines. The active substance of the drug in the urine is not found unchanged.

Based on the results of the studies, it was found that pharmacokinetics does not depend on the patient's gender and age group.

If patients have disorders in the functioning of the kidneys and the excretory system, the patient has an increase in the clearance of glimepiride and a decrease in its average concentrations in the blood serum, which is caused by a more accelerated elimination of the drug due to lower binding of the active compound to proteins

General characteristics of the drug

Amaryl is considered a third generation sulfonylurea derivative. The manufacturing countries of the drug are Germany and Italy. The drug is produced in tablet form of 1, 2, 3 or 4 mg. 1 tablet of Amaryl contains the main component - glimepiride and other excipients.

The effect of glimepiride is mainly aimed at lowering the amount of glucose in the blood by stimulating the production of insulin by beta cells. In addition, the active substance has an insulin mimetic effect and increases the sensitivity of cell receptors to the sugar-lowering hormone.

When a patient takes Amaryl orally, the highest concentration of glimepiride is reached after 2.5 hours. The medicine can be taken regardless of the time of eating. However, food intake has a small effect on the activity of glimepiride. Basically, this component is excreted from the body through the intestines and kidneys.

The attending specialist prescribes Amaryl tablets to a patient with type 2 diabetes as monotherapy or when combined with hypoglycemic agents.

However, taking the medicine does not preclude the continuation of a proper diet, excluding fats and easily digestible carbohydrates, and an active lifestyle.

Instructions for using the medicine

You cannot buy the drug without a doctor's prescription. Before using the drug, you must visit the doctor and ask him all the questions of interest. It is he who can determine the dosage of the drug and prescribe a therapy regimen based on the patient's glucose level.

Amaryl tablets are taken orally, without chewing, and washed down with a sufficient amount of water. If the patient forgot to take the medicine, doubling the dose is prohibited. During treatment, you need to regularly check the level of sugar, as well as the concentration of glycosylated hemoglobin.

Initially, the patient takes a single dose of 1 mg per day. Gradually, at intervals of one to two weeks, the dosage of the drug can be increased by 1 mg. For example, 1 mg, then 2 mg, 3 mg, and so on up to 8 mg per day.

Diabetics who have good glycemic control take a daily dose of up to 4 mg.

Often the drug is taken once before the morning meal or, in case of skipping the use of tablets, before the main meal. In this case, the specialist must take into account the lifestyle of a diabetic, the time of eating and his physical activity. Adjustment of the dosage of the drug may be necessary when:

1. weight reduction;
2. changing habitual lifestyle (nutrition, exercise, meal times);
3. other factors.

It is imperative to consult a doctor and start with the minimum dose (1 mg) of Amaryl if the patient needs:

• replacement of another sugar-lowering drug with Amaryl;
• combination - glimepiride and metformin;
• a combination of glimepiride and insulin.

It is not advisable to take the drug in patients with kidney dysfunction, as well as renal and / or liver failure.

Contraindications and negative reactions

The glimepiride contained in the drug Amaryl, as well as additional components, do not always have a positive effect on the body of a diabetic.

Just like other drugs, the drug contains contraindications.

Patients should not take pills in the following situations:

• insulin-dependent type of diabetes;
• the period of bearing a child and breastfeeding;
• (violation of carbohydrate metabolism), the state of diabetic precoma and coma;
• patients under the age of 18;
• galactose intolerance, lactase deficiency;
• development of glucose-galactose malabsorption;
• violations of the liver and kidneys, in particular patients undergoing hemodialysis;
• individual intolerance to the contents of the drug, sulfonylurea derivatives, sulfanilamide drugs.

The attached instructions say that in the first weeks of therapy, Amaryl should be taken with caution in order to avoid the development of a hypoglycemic state. In addition, in violation of the absorption of food and drugs from the digestive tract, deficiency of glucose-6-phosphate dehydrogenase, intercurrent diseases and if there is a risk of developing a hypoglycemic state, the drug Amaryl is used with caution.

With the wrong use of tablets (for example, skipping a dose), serious reactions may develop:

1. Hypoglycemic condition, the signs of which are headaches and dizziness, impaired attention, aggression, confusion, drowsiness, fainting, tremors, convulsions and blurred vision.
2. Adrenergic counterregulation as a response to a rapid decrease in glucose, manifested by anxiety, palpitations, tachycardia, cardiac arrhythmia and the appearance of cold sweat.
3. Indigestion - attacks of nausea, vomiting, flatulence, abdominal pain, diarrhea, hepatitis, increased liver enzymes, jaundice or cholestasis.
4. Violation of the hematopoietic system - leukopenia, thrombocytopenia, granulocytopenia and some other pathologies.
5. Allergy, manifested by skin rashes, itching, urticaria, sometimes anaphylactic shock and allergic vasculitis.

There may be other reactions - photosensitivity and hyponatremia.

Cost, reviews and analogues

The price of the drug Amaryl directly depends on the form of its release. Since the medicine is imported, accordingly, its cost is quite high. The price ranges of Amaryl tablets are as follows.

• 1 mg 30 tablets - 370 rubles;
• 2 mg 30 tablets - 775 rubles;
• 3 mg 30 tablets - 1098 rubles;
• 4 mg 30 tablets - 1540 rubles;

As for the opinions of diabetics about the effectiveness of the drug, they are positive. With prolonged use of the drug, the glucose level returns to normal. Although the list contains many possible side effects, the percentage of their occurrence is very small. However, there are also negative reviews from patients associated with the high cost of the drug. Many of them have to look for substitutes for Amaryl.

In fact, this drug has many synonyms and analogues produced in the Russian Federation, for example:

1. Glimepiride is a medicine containing the same active ingredient, contraindications and side effects. The difference is only in the additional substances. The average price of the drug (2 mg No. 30) is 189 rubles.
2. Diaglinide is a hypoglycemic agent, its composition is similar to the imported drug NovoNorm. The active substance is repaglinide. Novonorm (Diaglinide) has almost the same contraindications and negative reactions. To better understand the difference between these two analogues, it is necessary to compare the cost: the price of Diaglinide (1 mg No. 30) is 209 rubles, and NovoNorm (1 mg No. 30) is 158 rubles.
3. Glidiab is a Russian drug, which is also an analogue of a well-known remedy. The average cost of Glidiab tablets (80 mg No. 60) is 130 rubles, and the price of the drug Diabeton (30 mg No. 60) is 290 rubles.

Amaryl is a good hypoglycemic agent, but expensive. Therefore, it can be replaced by cheaper, both domestic (Diaglinide, Glidiab) and imported (NovoNorm, Diabeton) drugs. The composition contains either glimepiride, or other substances that help lower glucose levels. Knowing about the analogues, the doctor and the patient will be able to decide which drug is better to take. The video in this article will continue the topic of Amaryl in diabetes.

Amaryl is a tablet for the treatment of type 2 diabetes. So that they do not harm health, a person needs to carefully study the instructions for use before starting to take them, as well as familiarize themselves with possible side effects. This will allow you to correlate the harm and benefit of the drug. You also need to have information about how to take it so that an overdose does not happen.

Amaryl is an expensive drug, but very convenient in terms of administration. After all, you need to drink a pill only 1 time per day. Also on sale there are inexpensive analogues of Amaryl, which are produced in Russia. The drug is based on the active substance called glimepiride.

Amaryl: instructions for use

Taking Amaryl with food

Amaryl is taken before meals so that glimepiride will start working by the time the food is digested. Doctors recommend taking Amaryl before breakfast. If a person in the morning meal, for one reason or another, refuses himself, then he needs to take an Amaryl tablet before dinner.

It is imperative to eat after taking the drug, otherwise a person may develop hypoglycemia, in which the level drops to critical levels.

Depending on the severity of the course of hypoglycemia, it can be expressed in increased heart rate and even go into a coma.

Can I take Amaryl and drink alcohol?

During treatment with Amaryl, you must stop drinking alcohol. If this recommendation is not followed, then the person is more likely to develop hypoglycemia. The liver may also be affected. For many people, the complete rejection of alcoholic beverages is a serious problem, because the treatment of diabetes must continue throughout life.

Therefore, if the patient cannot eliminate alcohol, then he needs to switch to other drugs to lower blood sugar levels.

How long does it take Amaril to start working?

Blood sugar decreases as much as possible approximately 2-3 hours after taking the drug. Scientists believe that the drug begins to work half an hour - an hour before the maximum drop in blood glucose levels. Therefore, it is impossible to postpone eating until a later date, otherwise a person will experience hypoglycemia.

The drug is valid for 24 hours after ingestion.

Amaryl or Diabeton - what to choose?

The drug Diabeton is not available for sale, at the moment you can find only a drug called Diabeton MB in pharmacies. This is a new generation drug that is milder than its predecessor.

If a person is thinking about which drug to choose - Diabeton or Amaryl, then he needs to consult a doctor and resolve this issue.

Amaryl or Glucophage - what to choose?

Glucophage is a drug based on metformin. He should be given preference in terms of the treatment of diabetes, since Glucophage does not cause hypoglycemia, but reduces blood sugar. To achieve maximum results, you need to not only take medicines, but also follow a diet.

Is it possible to combine the reception of Amaryl and Janumet?

Janumet is a combined drug based on metformin. It has a high cost and has no cheap analogues. You can try to start treatment with drugs that contain only one active ingredient - metformin. The original remedy based on it is Glucophage. Sometimes doctors recommend that patients with diabetes combine Amaryl and Janumet in a complex scheme, but such combinations cannot be made on their own.

Amaril's analogs

An analogue of Amaryl of foreign production is the drug Glimepiride-Teva. It is produced by the Croatian company Pliva Hrvatska.

Russian analogues of the drug Amaryl are:

Glemaz, from the company Valiant.

Glimepiride from Atoll, Pharmproekt, Pharmstandard and Vertex.

Diameride from the company Akrikhin.

Glimepiride Canon from Canonpharma.

All manufacturers produce their drugs in dosages of 1, 2, 3, 4 mg. The cost of a particular drug must be specified at the pharmacy.

Amaryl M is a combination drug which, in addition to glimepiride, contains metformin. This allows you to more effectively reduce blood sugar levels and protect a person from the complications of diabetes, which can be very severe.

However, it is best to start treatment with a drug only based on metformin. If you cannot achieve the desired effect, then you need to get medical advice.

Analogues of the drug Amaryl M

There are no analogues of the drug Amaryl M. Therefore, if a person decides to replace this drug with something else, then drugs based on metformin should be preferred, without any additions, for example, Glucophage.

Instructions for use. Contraindications and release form.

tab. 4mg #90

Compound

active substance: glimepiride 4 mg.

Characteristic

Hypoglycemic agent for oral administration of the III generation sulfonylurea group.

pharmachologic effect

Hypoglycemic.

Indications for use

Type 2 diabetes mellitus (as monotherapy or as part of combination therapy with metformin or insulin).

Contraindications

• hypersensitivity to glimepiride or any excipient of the drug, other sulfonylurea derivatives or sulfanilamide drugs (risk of developing hypersensitivity reactions);
• diabetes mellitus type 1;
• diabetic ketoacidosis, diabetic precoma and coma;
• severe liver dysfunction (lack of clinical experience);
• severe renal dysfunction, incl. in patients on hemodialysis (lack of clinical experience);
• pregnancy;
• lactation;
• children's age (lack of clinical experience of use);
• rare hereditary diseases such as galactose intolerance, lactase deficiency or glucose-galactose malabsorption.

Carefully:

condition in the first weeks of treatment (increased risk of hypoglycemia). If there are risk factors for the development of hypoglycemia (see section "Special Instructions"), dose adjustment of glimepiride or all therapy may be required;

intercurrent diseases during treatment or when changing the lifestyle of patients (changes in diet and meal times, increase or decrease in physical activity);

insufficiency of glucose-6-phosphate dehydrogenase;

malabsorption of food and drugs in the gastrointestinal tract (intestinal obstruction, intestinal paresis).

Side effects

From the side of metabolism: as a result of the hypoglycemic effect of the drug Amaryl®, hypoglycemia may develop, which, as with other sulfonylurea derivatives, can be prolonged.

Symptoms of hypoglycemia are: headache, hunger, nausea, vomiting, fatigue, drowsiness, sleep disturbance, anxiety, aggressiveness, impaired concentration, vigilance and reaction speed, depression, confusion, speech disorders, aphasia, visual disorders, tremor, paresis, sensory disturbances, dizziness, loss of self-control, delirium, cerebral convulsions, somnolence or loss of consciousness, up to coma, shallow breathing, bradycardia.

In addition, there may be manifestations of adrenergic counterregulation in response to hypoglycemia, such as the appearance of cold clammy sweat, anxiety, tachycardia, increased blood pressure, angina pectoris, palpitations and heart rhythm disturbances.

The clinical picture of severe hypoglycemia may be similar to that of a stroke. Symptoms of hypoglycemia almost always disappear after it is eliminated.

On the part of the organ of vision: during treatment (especially at its beginning), transient visual impairment may occur due to changes in the concentration of glucose in the blood. Their cause is a temporary change in the swelling of the lenses, depending on the concentration of glucose in the blood, and due to this - a change in the refractive index of the lenses.

From the digestive tract: in rare cases - nausea, vomiting, feeling of heaviness or fullness in the epigastrium, abdominal pain, diarrhea; in some cases - hepatitis, increased activity of liver enzymes and / or cholestasis and jaundice, which can progress to life-threatening liver failure, but may regress when the drug is discontinued.

From the hematopoietic and lymphatic systems: rarely - thrombocytopenia; in some cases - leukopenia, hemolytic anemia, erythrocytopenia, granulocytopenia, agranulocytosis and pancytopenia. In post-marketing use of the drug, cases of severe thrombocytopenia with a platelet count of less than 10,000 / µl and thrombocytopenic purpura have been reported (frequency unknown).

General disorders: in rare cases, allergic and pseudo-allergic reactions are possible, such as itching, urticaria, skin rash. Such reactions can turn into severe reactions with shortness of breath, a sharp decrease in blood pressure, which can sometimes progress to anaphylactic shock. If symptoms of hives appear, you should immediately consult a doctor. In some cases, there may be a decrease in serum sodium concentrations, allergic vasculitis, photosensitivity.
Interaction

Glimepiride is metabolized by cytochrome P4502C9 (CYP2C9), which should be taken into account when co-administered with inducers (eg rifampicin) or inhibitors (eg fluconazole) of CYP2C9.

Potentiation of the hypoglycemic effect and in some cases the possible development of hypoglycemia associated with this can be observed when combined with one of the following drugs: insulin and other oral hypoglycemic agents, ACE inhibitors, anabolic steroids and male sex hormones, chloramphenicol, coumarin derivatives, cyclophosphamide, disopyramide , fenfluramine, feniramidol, fibrates, fluoxetine, guanethidine, ifosfamide, MAO inhibitors, fluconazole, para-aminosalicylic acid, pentoxifylline (high parenteral doses), phenylbutazone, azapropazone, oxyphenbutazone, probenecid, quinolones, salicylates, sulfinpyrazone, clarithromycin, tetracyclines, sulfonamides tritoqualin, trophosfamide.

Weakening of the hypoglycemic effect and the associated increase in blood glucose concentration can be observed when combined with one of the following drugs: acetazolamide, barbiturates, corticosteroids, diazoxide, diuretics, epinephrine and other sympathomimetic agents, glucagon, laxatives (with prolonged use), nicotinic acid (in high doses), estrogens and progestogens, phenothiazines, phenytoin, rifampicin, iodine-containing thyroid hormones.

Blockers of H2-histamine receptors, beta-blockers, clonidine and reserpine can both enhance and weaken the hypoglycemic effect of glimepiride. Under the influence of sympatholytic agents, such as beta-blockers, clonidine, guanethidine and reserpine, signs of adrenergic counterregulation in response to hypoglycemia may be reduced or absent.

Against the background of taking glimepiride, an increase or decrease in the action of coumarin derivatives may be observed.

Single or chronic alcohol consumption can both enhance and weaken the hypoglycemic effect of glimepiride.

Dosage and administration

Inside, whole, without chewing, drinking plenty of liquid (about 0.5 cup).

As a rule, the dose of the drug Amaryl® is determined by the target concentration of glucose in the blood. The lowest dose sufficient to achieve the desired metabolic control should be used.

During treatment with Amaryl®, it is necessary to regularly determine the concentration of glucose in the blood. In addition, regular monitoring of the level of glycated hemoglobin is recommended.

Incorrect use of the drug, for example, skipping the next dose, should never be made up for by taking a subsequent dose of a higher dose.

The patient's actions in case of errors when taking the drug (in particular, when skipping the next dose or skipping meals) or in situations where it is not possible to take the drug, should be discussed by the patient and the doctor in advance.

Starting dose and dose adjustment

The initial dose is 1 mg of glimepiride once a day.

If necessary, the daily dose can be gradually (at intervals of 1-2 weeks) increased. It is recommended that the dose increase be carried out under regular monitoring of blood glucose concentration and in accordance with the following dose increase step: 1 mg-2 mg-3 mg-4 mg-6 mg (-8 mg).

Dose range in patients with well-controlled diabetes mellitus

The usual daily dose in patients with well-controlled diabetes mellitus is 1-4 mg of glimepiride. A daily dose of more than 6 mg is more effective only in a small number of patients.

Dosing regimen

The time of taking the drug and the distribution of doses during the day is set by the doctor, depending on the patient's lifestyle at a given time (meal time, amount of physical activity).

Usually, a single dose of the drug during the day is sufficient. It is recommended that in this case the entire dose of the drug be taken immediately before a full breakfast or, if it was not taken at this time, immediately before the first main meal. It is very important not to skip meals after taking the tablets.

Since improved metabolic control is associated with increased insulin sensitivity, the need for glimepiride may decrease during treatment. In order to avoid the development of hypoglycemia, it is necessary to reduce doses in a timely manner or stop taking Amaryl®.

Conditions that may also require dose adjustment of glimepiride:

Decreased body weight in a patient;

Changes in the patient's lifestyle (change in diet, meal times, amount of physical activity);

The occurrence of other factors that lead to a predisposition to the development of hypoglycemia or hyperglycemia (see section "Special Instructions").

Duration of treatment

Treatment with glimepiride is usually long-term.

Transfer of a patient from another oral hypoglycemic agent to Amaryl®

There is no exact relationship between doses of Amaryl® and other oral hypoglycemic agents. When another oral hypoglycemic agent is changed to Amaryl®, it is recommended that the prescribing procedure be the same as for the original Amaryl® prescribing, i.e. treatment should begin with a low dose of 1 mg (even if the patient is transferred to Amaryl® from the maximum dose of another oral hypoglycemic drug). Any dose escalation should be done in stages based on the response to glimepiride, as recommended above.

It is necessary to take into account the strength and duration of the effect of the previous oral hypoglycemic agent. It may be necessary to interrupt treatment in order to avoid any accumulation of effects, which may increase the risk of hypoglycemia.

Use in combination with metformin

In patients with insufficiently controlled diabetes mellitus, when taking the maximum daily doses of either glimepiride or metformin, treatment with a combination of these two drugs can be initiated. In this case, previous treatment with either glimepiride or metformin is continued at the same dose level, and additional metformin or glimepiride is started at a low dose, which is then titrated depending on the target level of metabolic control up to the maximum daily dose. Combination therapy should be initiated under strict medical supervision.

Use in combination with insulin

In patients with insufficiently controlled diabetes mellitus, when taking the maximum daily doses of glimepiride, insulin may be administered concomitantly. In this case, the last dose of glimepiride prescribed to the patient remains unchanged. In this case, insulin treatment begins with low doses, which gradually increase under the control of blood glucose concentration. Combined treatment requires careful medical supervision.

Use in patients with renal insufficiency. There is limited information on the use of the drug in patients with renal insufficiency. Patients with impaired renal function may be more sensitive to the hypoglycemic effect of glimepiride.

Use in patients with hepatic impairment. There is a limited amount of information on the use of the drug in liver failure (see section "Contraindications").

Application in children. Data on the use of the drug in children is not enough.

Overdose

Symptoms: Acute overdose, as well as prolonged treatment with too high doses of glimepiride, can lead to the development of severe life-threatening hypoglycemia.

Treatment: as soon as an overdose is detected, it is necessary to inform the doctor immediately. Hypoglycemia can almost always be quickly controlled by immediate intake of carbohydrates (glucose or sugar cubes, sweet fruit juice, or tea). In this regard, the patient should always have at least 20 g of glucose (4 pieces of sugar) with him. Sweeteners are ineffective in the treatment of hypoglycemia.

Until the doctor decides that the patient is out of danger, the patient needs careful medical observation. It should be remembered that hypoglycemia may recur after the initial recovery of blood glucose levels.

If a diabetic patient is treated by different doctors (for example, during a hospital stay after an accident, when sick on weekends), he must necessarily inform them about his disease and previous treatment.

Sometimes it may be necessary to hospitalize the patient, even if only as a precautionary measure. Significant overdose and severe reaction with symptoms such as loss of consciousness or other serious neurological impairment are medical emergencies and require immediate treatment and hospitalization.

In the case of an unconscious patient, it is necessary to / in the introduction of a concentrated solution of dextrose (glucose) (for adults, starting with 40 ml of a 20% solution). As an alternative for adults, intravenous, s / c or IM administration of glucagon is possible, for example, at a dose of 0.5-1 mg.

In the treatment of hypoglycemia due to accidental ingestion of Amaryl® by infants or young children, the dose of dextrose administered should be carefully adjusted in terms of the possibility of dangerous hyperglycemia, and the administration of dextrose should be carried out under constant monitoring of blood glucose concentration.

In case of an overdose of Amaryl®, gastric lavage and activated charcoal may be required.

After a rapid recovery of blood glucose concentration, an IV infusion of a lower concentration of dextrose solution is necessary to prevent the recurrence of hypoglycemia. The concentration of glucose in the blood in such patients should be constantly monitored for 24 hours. In severe cases with a prolonged course of hypoglycemia, the risk of lowering blood glucose concentrations to hypoglycemic levels may persist for several days.

special instructions

In specific clinical stress situations such as trauma, surgery, febrile infections, metabolic control may be impaired in patients with diabetes mellitus, and they may need to be temporarily switched to insulin therapy to maintain adequate metabolic control.

In the first weeks of treatment, the risk of developing hypoglycemia may increase, and therefore, especially careful monitoring of blood glucose concentrations is required at this time.

Factors that contribute to the risk of developing hypoglycemia include:

Unwillingness or inability of the patient (more often observed in elderly patients) to cooperate with the doctor;

Malnutrition, irregular meals, or skipping meals;

Imbalance between exercise and carbohydrate intake;

Diet change;

Drinking alcohol, especially in combination with skipping meals;

Severe renal dysfunction;

Severe hepatic impairment (in patients with severe hepatic impairment, a switch to insulin therapy is indicated, at least until metabolic control is achieved);

Overdose of glimepiride;

Some decompensated endocrine disorders that disrupt carbohydrate metabolism or adrenergic counterregulation in response to hypoglycemia (eg, some thyroid and anterior pituitary disorders, adrenal insufficiency);

Simultaneous reception of certain drugs (see section "Interaction");

Reception of glimepiride in the absence of indications for its reception.

Treatment with sulfonylurea derivatives, which include glimepiride, can lead to the development of hemolytic anemia, therefore, in patients with glucose-6-phosphate dehydrogenase deficiency, special care should be taken when prescribing glimepiride and it is better to use hypoglycemic agents that are not sulfonylurea derivatives.

In the presence of the above risk factors for the development of hypoglycemia, dose adjustment of glimepiride or all therapy may be required. This also applies to the occurrence of intercurrent diseases during treatment or changes in the lifestyle of patients.

Those symptoms of hypoglycemia that reflect the body's adrenergic counter-regulation in response to hypoglycemia (see the section "Side effects") may be mild or absent with the gradual development of hypoglycemia, in elderly patients, patients with neuropathy of the autonomic nervous system or patients receiving beta -blockers, clonidine, reserpine, guanethidine and other sympatholytic agents.

Hypoglycemia can be quickly corrected by the immediate intake of fast-absorbing carbohydrates (glucose or sucrose).

As with other sulfonylurea derivatives, despite initial successful management of hypoglycemia, hypoglycemia may recur. Therefore, patients should remain under constant supervision.

In severe hypoglycemia, immediate treatment and medical supervision are additionally required, and in some cases, hospitalization of the patient.

During treatment with glimepiride, regular monitoring of liver function and peripheral blood picture (especially the number of leukocytes and platelets) is required.

Since certain side effects, such as severe hypoglycemia, serious changes in the blood picture, severe allergic reactions, liver failure, can under certain circumstances be life-threatening, if adverse or severe reactions develop, the patient should immediately inform the attending physician about them and not in any case, do not continue taking the drug without his recommendation.

Influence on the ability to drive vehicles and other mechanisms. In the event of hypoglycemia or hyperglycemia, especially at the beginning of treatment or after a change in treatment, or when the drug is not taken regularly, a decrease in attention and speed of psychomotor reactions is possible. This may impair the patient's ability to drive vehicles or other mechanisms.

Terms of dispensing from pharmacies

On prescription.

Storage conditions

At a temperature not higher than 30 °C.

Keep out of the reach of children.

Shelf life

Amaryl is considered popular among diabetics. Its reception allows patients to control their condition, to minimize the likelihood of developing hyperglycemia. This medication is prescribed only for people with type II diabetes.

Compound

The active ingredient in Amaryl is glimepiride. The composition of the tablets also includes auxiliary components. Their list will depend on the dosage of glimepiride. A different combination of additional substances in tablets is due to a different color.

INN (international name): glimepiride (Latin name Glimepiride).

Pharmacies also sell Amaryl M1, M2. The composition of the tablets, in addition to glimepiride, includes metformin in an amount of 250 or 500 mg, respectively. This combined drug can only be prescribed by an endocrinologist.

Release form

Amaryl goes on sale in the form of tablets. The color depends on the dosage of the active substance:

• 1 mg glimepiride - pink;
• 2 - green;
• 3 - light yellow;
• 4 - blue.

They differ in the labeling on the tablets.

pharmachologic effect

Glimepiride has a hypoglycemic effect on the body. It is a third generation sulfonylurea derivative.

Amaryl has a primary prolonged effect. When using tablets, the pancreas is stimulated, the work of beta cells is activated. As a result, insulin begins to be released from them, the hormone enters the bloodstream. This helps to lower the concentration of sugar after eating.

At the same time, glimepiride has an extrapancreatic effect. It increases the sensitivity of muscle, adipose tissue to insulin. When using the drug, a general antioxidant, antiatherogenic, antiplatelet effect is observed.

Amaryl differs from other sulfonylurea derivatives in that when it is used, the content of released insulin is less than when using other hypoglycemic drugs. Due to this, the risk of hypoglycemia is minimal.

Strengthening the process of glucose utilization in muscle, fatty tissues becomes possible due to the presence of special transport proteins in cell membranes. Amaryl increases their activity.

The drug practically does not block ATP-sensitive potassium channels of cardiac myocytes. They retain the ability to adapt to ischemic conditions.

When treated with Amaryl, the production of glucose by liver cells is blocked. This effect is due to the increasing content of fructose-2,6-biophosphate in hepatocytes. This substance stops gluconeogenesis.

The drug contributes to blocking the secretion of cyclooxygenase, reducing the process of transformation of thromboxane A2 from arachidonic acid. This reduces the intensity of platelet aggregation. Under the influence of Amaryl, the severity of oxidative reactions that are observed in non-insulin-dependent diabetes decreases.

Indications

Prescribe drugs based on glimepiride to patients with type II disease, if physical activity, diet do not allow control of sugar levels.

The instructions for use indicate that it is allowed to combine Amaryl with metformin, insulin injections.

Dr. Bernstein insists that the prescription of hypoglycemic agents is not justified, even if there are indications for use. He argues that the drugs are harmful, increasing the metabolic disorders that have arisen. To normalize the condition, you can use not sulfonylurea derivatives, but a diet in combination with a special treatment regimen.

Contraindications

Amaryl should not be prescribed to patients who:

• insulin dependence;
• ketoacidosis, diabetic coma;
• impaired kidney function (including in cases where hemodialysis is necessary);
• malfunctions in the functioning of the liver;
• individual intolerance or hypersensitivity to glimepiride, excipients, other drugs of the sulfonylurea group;
• childhood.

Physicians should not prescribe the drug to patients who are malnourished, eat irregularly, limit the caloric content of the diet, consuming less than 1000 kcal. A contraindication is a violation of the process of absorption of food from the gastrointestinal tract.

Side effects

Before you start taking Amaryl, you should read the annotation to the drug. Patients should be aware of what complications may occur.

The most well-known side effect is metabolic disorders. The patient may begin to develop hypoglycemia shortly after taking the pill. At home, this condition is difficult to normalize, you will need the help of doctors. But a sudden drop in blood glucose is rare, occurring in less than 1 in 1,000 patients.

When taking Amaryl, there are also such complications from:

• Gastrointestinal tract: diarrhea, feeling of hunger, epigastric pain, jaundice, nausea, hepatitis, development of liver failure;
• hematopoietic organs: thrombocytopenia, agranulocytosis, erythrocytopenia, leukopenia;
• nervous system: increased drowsiness, fatigue, headaches, increased anxiety, aggressiveness, speech disorders, confusion, paresis, cerebral convulsions, the appearance of sticky cold sweat;
• organs of vision: transient disorders due to changes in blood sugar levels.

Some develop hypersensitivity reactions. Patients complain of itching, skin rash, urticaria, allergic vasculitis. Usually, such side effects are mild, in individual cases, the possibility of anaphylactic shock cannot be ruled out.

Instructions for use

It is allowed to take Amaryl according to the prescription of the attending physician. The specialist will select the initial dosage for each patient personally. It depends on the concentration of glucose in the blood, the intensity of the excretion of sugar in the urine.

At the beginning of therapy, it is recommended to drink tablets containing 1 mg of glimepiride. It is necessary to increase the dose gradually. They switch to 2 mg tablets no earlier than 1-2 weeks after the start of therapy. At the initial stages, the doctor monitors the patient's condition, adjusts the treatment depending on the reaction to the drug. The maximum allowable daily dose is 6-8 mg of glimepiride.

If the desired therapeutic effect cannot be achieved even when taking the maximum allowable amount of Amaryl, then insulin is additionally prescribed.

It is necessary to take tablets before the main meal 1 time per day. Doctors recommend drinking the drug before breakfast. If necessary, it is allowed to shift the reception time for lunch.

It is strictly forbidden to refuse food after drinking Amaryl. After all, this will provoke a sharp drop in the concentration of glucose. Hypoglycemia can lead to neurological disorders, cause diabetic coma, and death.

Tablets are swallowed whole without chewing.

Overdose

It is necessary to use Amaryl in the quantities prescribed by the doctor. An overdose causes the development of hypoglycemia. A sharp drop in sugar sometimes provokes a diabetic coma.

If the allowable rate of use is exceeded, nausea, vomiting, epigastric pain appear. Various side effects may occur:

• visual impairment;
• drowsiness;
• tremor;
• convulsions;
• coma;
• problems with coordination.

In case of overdose, it is necessary to wash the stomach. After cleaning give enterosorbents. At the same time, a glucose solution is administered intravenously. Further tactics of action are developed depending on the patient's condition. In severe cases, the patient is hospitalized in the intensive care unit.

Interaction

Before prescribing Amaryl, the doctor must find out what drugs the patient is taking. Some drugs enhance, others reduce the hypoglycemic effect of glimepiride.

When conducting research, it was found that a sharp decrease in blood sugar is observed when using:

• oral antidiabetic agents;
• Phenylbutazone;
• oxyphenbutazone;
• Azapropazon;
• Sulfinpyrazone;
• Metformin;
• Tetracycline;
• miconazole;
• salicylates;
• MAO inhibitors;
• sex male hormones;
• anabolic steroids;
• quinol antibiotics;
• Clarithromycin;
• Fluconazole;
• sympatholytics;
• fibrates.

Therefore, it is not recommended to start drinking Amaryl on your own without obtaining an appropriate prescription from a doctor.

Weaken the effectiveness of glimepiride such means:

• progestogens;
• estrogens;
• thiazide diuretics;
• saluretics;
• glucocorticoids;
• nicotinic acid (when used in high doses);
• laxative medicines (subject to long-term use);
• barbiturates;
• Rifampicin;
• Glucagon.

This effect must be taken into account when choosing a dosage.

Sympatholytics (beta-blockers, Reserpine, Clonidine, Guanethidine) have an unpredictable effect on the hypoglycemic effect of Amaryl.

When using coumarin derivatives, please note: glimepiride enhances or weakens the effect of these drugs on the body.

The doctor selects drugs for the patient for hypertension, non-steroidal anti-inflammatory drugs, and other popular drugs.

Combine Amaryl with insulin, metformin. This combination is required when glimepiride fails to achieve the desired metabolic control. The dosage of each drug is set by the doctor individually.

• metformin;
• sitagliptin;
• glimepiride.

This combination of active ingredients improves the effectiveness of therapy, helps to better control the condition of diabetics.

Terms of sale

In pharmacies, you can buy Amaryl if you have a prescription from your doctor.

Storage features

Tablets based on glimepiride should be stored in a dark place, protected from direct sunlight, out of the reach of children. Storage temperature - up to +30 ° C.

Shelf life

Use of the drug is allowed for 36 months from the date of issue.

Analogues

The attending endocrinologist should select a suitable substitute for Amaryl. He can prescribe an analogue made on the basis of the same active substance, or pick up a medicine made from other components.

Patients can be prescribed the Russian substitute Diameride, which is relatively cheap. For 30 tablets of a preparation made on the basis of glimepiride, with a dosage of 1 mg in a pharmacy, patients will pay 179 rubles. As the concentration of the active substance increases, the cost increases. For Diameride at a dosage of 4 mg, it will be necessary to pay 383 rubles.

If necessary, replace Amaryl with Glimepiride, which is produced by the Russian company Vertex. These tablets are inexpensive. For a pack of 30 pcs. 2 mg each will have to pay 191 rubles.

The cost of Glimepiride Canon, which is produced by Canonpharma, is even lower. The price of a package of 30 tablets of 2 mg is considered cheap, it is 154 rubles.

In case of intolerance to glimepiride, patients are prescribed other analogues produced on the basis of metformin (Avandamet, Glimecomb, Metglib) or vildagliptin (Galvus). They are selected taking into account the individual characteristics of the patient's body.

Alcohol and Amaril

It is impossible to predict in advance how alcohol-containing drinks will affect a person who takes drugs based on glimepiride. Alcohol is able to weaken or enhance the hypoglycemic effect of Amaryl. Therefore, they cannot be used at the same time.

Hypoglycemic medication has to be taken over a long period. Because of this, a categorical ban on the use of alcoholic beverages becomes a problem for many.

Pregnancy, lactation

During the period of intrauterine bearing of a baby, breast-feeding a newborn, it is impossible to use sulfonylurea derivatives. In the blood of a pregnant woman, the concentration of glucose should be within the normal range. After all, hyperglycemia leads to an increase in the risk of congenital malformations, increases infant mortality rates.

Pregnant women are transferred to insulin. It will be possible to exclude the possibility of a toxic effect of the drug on the child in utero if you refuse sulfonylureas at the planning stage of conception.

During lactation, Amaryl therapy is prohibited. The active substance passes into breast milk, the body of the newborn. When breastfeeding, it is necessary that the woman completely switches to insulin therapy.